| ENTRY SPECIFICATION |
{"name": "PHI",
"intro": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great.",
]},
{"id": "q8562", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6B. Recharge: Where I Want to Be",
"intro": "<strong>Recharge:</strong> Our bodies and minds need rest in order to optimize our health. Recharging also involves activities
that replenish your mental and physical energy.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
"columns": 11,
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2443", "type": "IntroText",
"text": "<strong>Food and Drink:</strong> What we eat and drink can have a huge effect on how we experience life, both physically and mentally."
},
{"id": "q8563", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7A. Food and Drink: Where I am Now",
"intro": "<strong>Food and Drink:</strong> What we eat and drink can have a huge effect on how we experience life, both physically and mentally.",
"columns": 11,
"choices":[
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8564", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7B. Food and Drink: Where I Want to Be",
"intro": "<strong>Food and Drink:</strong> What we eat and drink can have a huge effect on how we experience life, both physically and mentally.",
{"id": "c5150", "text": " 1 (Not so good)", "quickKey": 1},
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2444", "type": "IntroText",
"text": "<strong>Personal Development:</strong> Our health is impacted by how we spend our time. We feel best when we can do things that
{"id": "c5151", "text": " 2", "quickKey": 2},
really matter to us or bring us joy."
},
{"id": "q8565", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "8A. Personal Development: Where I am Now",
"intro": "<strong>Personal Development:</strong> Our health is impacted by how we spend our time. We feel best when we can do things that
really matter to us or bring us joy.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5152", "text": " 3", "quickKey": 3},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8566", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "8B. Personal Development: Where I Want to Be",
"intro": "<strong>Personal Development:</strong> Our health is impacted by how we spend our time. We feel best when we can do things that
really matter to us or bring us joy.",
"columns": 11,
"choices":[
{"id": "c5153", "text": " 4", "quickKey": 4},
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2445", "type": "IntroText",
"text": "<strong>Family, Friends, and Co-Workers:</strong> Our relationships, including those with pets, have as significant an effect
on our physical and emotional health as any other factor associated with well-being."
},
{"id": "c5154", "text": " 5 (Great)", "quickKey": 5}
{"id": "q8567", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "9A. Family, Friends, and Co-Workers: Where I am Now",
"intro": "<strong>Family, Friends, and Co-Workers:</strong> Our relationships, including those with pets, have as significant an effect
on our physical and emotional health as any other factor associated with well-being.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
]},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8568", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "9B. Family, Friends, and Co-Workers: Where I Want to Be",
"intro": "<strong>Family, Friends, and Co-Workers:</strong> Our relationships, including those with pets, have as significant an effect
on our physical and emotional health as any other factor associated with well-being.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "i2440", "type": "IntroText",
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2446", "type": "IntroText",
"text": "<strong>Spirit and Soul:</strong> Connecting with something greater than ourselves may provide a sense of meaning and purpose,
peace, or comfort. Spiritual connection can take many forms."
},
{"id": "q8569", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "10A. Spirit and Soul: Where I am Now",
"restartDays": 2,
"text": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great."
"intro": "<strong>Spirit and Soul:</strong> Connecting with something greater than ourselves may provide a sense of meaning and purpose,
peace, or comfort. Spiritual connection can take many forms.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
},
{"id": "q8570", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "10B. Spirit and Soul: Where I Want to Be",
"intro": "<strong>Spirit and Soul:</strong> Connecting with something greater than ourselves may provide a sense of meaning and purpose,
peace, or comfort. Spiritual connection can take many forms.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "q8556", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2447", "type": "IntroText",
"text": "<strong>Surroundings:</strong> Surroundings include where we live, work, learn, play, and worship--both indoors and out.
<br />Safe, stable, and comfortable surroundings have a positive effect on our health."
},
{"id": "q8571", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "11A. Surroundings: Where I am Now",
"intro": "<strong>Surroundings:</strong> Surroundings include where we live, work, learn, play, and worship--both indoors and out.
<br />Safe, stable, and comfortable surroundings have a positive effect on our health.",
"text": "2. Mental/Emotional Well-Being",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8572", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "11B. Surroundings: Where I Want to Be",
"intro": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great.",
"intro": "<strong>Surroundings:</strong> Surroundings include where we live, work, learn, play, and worship--both indoors and out.
<br />Safe, stable, and comfortable surroundings have a positive effect on our health.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
"columns": 11,
{"id": "i2448", "type": "IntroText",
"text": "<strong>Power of the Mind:</strong> Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing
our mindset can aid in healing and coping."
},
{"id": "q8573", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "12A. Power of the Mind: Where I am Now",
"intro": "<strong>Power of the Mind:</strong> Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing
our mindset can aid in healing and coping.",
"columns": 11,
"choices":[
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8574", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "12B. Power of the Mind: Where I Want to Be",
"intro": "<strong>Power of the Mind:</strong> Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing
our mindset can aid in healing and coping.",
{"id": "c5150", "text": " 1 (Not so good)", "quickKey": 1},
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2449", "type": "IntroText",
"text": "<strong>Professional Care:</strong> Partnering with your healthcare team to address your health concerns, understand care
{"id": "c5151", "text": " 2", "quickKey": 2},
options, and define actions you may take to promote your health and goals."
},
{"id": "q8575", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "13A. Professional Care: Where I am Now",
"intro": "<strong>Professional Care:</strong> Partnering with your healthcare team to address your health concerns, understand care
options, and define actions you may take to promote your health and goals.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5152", "text": " 3", "quickKey": 3},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8576", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "13B. Professional Care: Where I Want to Be",
"intro": "<strong>Professional Care:</strong> Partnering with your healthcare team to address your health concerns, understand care
options, and define actions you may take to promote your health and goals.",
"columns": 11,
"choices":[
"printTitle": "Personal Health Inventory (Short)",
{"id": "c5153", "text": " 4", "quickKey": 4},
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2450", "type": "IntroText",
"text": "<strong>Reflections</strong>"
},
{"id": "q8577", "type": "MemoQuestion", "required": false,
{"id": "c5154", "text": " 5 (Great)", "quickKey": 5}
"text": "14. Now that you have thought about what matters to you in all of these areas, what would your life look like if you had the health you want? What kind of activities would you be doing? Or how might you feel different?",
"intro": "<strong>Reflections</strong>",
"controlWidth": 658},
{"id": "i2450", "type": "IntroText",
"text": "<strong>Reflections</strong>"
},
{"id": "q8578", "type": "MemoQuestion", "required": false,
"text": "15. What area might you focus on? What might get in the way? How might you start?",
"intro": "<strong>Reflections</strong>",
"controlWidth": 658},
]},
{"id": "i2452", "type": "IntroText",
"text": "After completing the Personal Health Inventory, talk to a friend, a family member, your health coach, a peer, or someone on your healthcare team about areas you would like to explore further."
},
{"id": "q8579", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": " ",
"intro": "After completing the Personal Health Inventory, talk to a friend, a family member, your health coach, a peer, or someone on your healthcare team about areas you would like to explore further.",
"columns": 1,
"choices":[
{"id": "c5144", "text": "1. Click here to acknowledge you've read this statement.", "quickKey": 1}
]}]
{"id": "i2440", "type": "IntroText",
}
"text": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great."
},
{"id": "q8557", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3. Life: How is it to live your day-to-day life?",
"intro": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great.",
"columns": 11,
"content":[
"choices":[
{"id": "c5150", "text": " 1 (Not so good)", "quickKey": 1},
{"id": "c5151", "text": " 2", "quickKey": 2},
{"id": "c5152", "text": " 3", "quickKey": 3},
{"id": "c5153", "text": " 4", "quickKey": 4},
{"id": "c5154", "text": " 5 (Great)", "quickKey": 5}
]},
{"id": "i2451", "type": "IntroText",
"text": "What matters most to you in your life right now?"
},
{"id": "i2440", "type": "IntroText",
{"id": "q8558", "type": "MemoQuestion", "required": false,
"text": "4. Write a few words to capture your thoughts:",
"intro": "What matters most to you in your life right now?",
"controlWidth": 658},
{"id": "i2441", "type": "IntroText",
"text": "<strong>Where You Are and Where You Would Like to Be</strong><br /><br />
For each area below, consider “Where you are” and “Where you want to be”.
<br />Select a number between 1 (low) and 5 (high)
that best represents where you are and where you want to be. You do not need to be a 5 in any of the areas now,
nor even wish to be a 5 in the future.
"text": "Rate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great."
<br /><br />
<strong>Moving the Body:</strong> Our physical, mental, and emotional health are impacted by the amount and kind of movement we do."
},
{"id": "q8559", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5A. Moving the Body: Where I am Now",
"intro": "<strong>Moving the Body:</strong> Our physical, mental, and emotional health are impacted by the amount and kind of movement we do.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "q8560", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5B. Moving the Body: Where I Want to Be",
"intro": "<strong>Moving the Body:</strong> Our physical, mental, and emotional health are impacted by the amount and kind of movement we do.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "q8555", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
]},
{"id": "i2442", "type": "IntroText",
"text": "<strong>Recharge:</strong> Our bodies and minds need rest in order to optimize our health. Recharging also involves activities
that replenish your mental and physical energy."
},
{"id": "q8561", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1. Physical Well-Being",
"text": "6A. Recharge: Where I am Now",
"intro": "<strong>Recharge:</strong> Our bodies and minds need rest in order to optimize our health. Recharging also involves activities
that replenish your mental and physical energy.",
"columns": 11,
"choices":[
{"id": "c5145", "text": " 1 (Low)", "quickKey": 1},
{"id": "c5146", "text": " 2", "quickKey": 2},
{"id": "c5147", "text": " 3", "quickKey": 3},
{"id": "c5148", "text": " 4", "quickKey": 4},
{"id": "c5149", "text": " 5 (High)", "quickKey": 5}
|
