{
  "template": {
    "code": "barthel",
    "name": "Barthel Index",
    "category": "disease",
    "version": 1,
    "is_current": true,
    "is_active": true,
    "scoring_strategy": "sum_items",
    "description": "Barthel Index of Activities of Daily Living (0–100). Optional on stroke pathway activation.",
    "meta": {
      "capture_roles": ["doctor", "nurse"],
      "specialty": "neurology",
      "estimated_minutes": 5,
      "pathway_codes": ["stroke"],
      "max_total": 100,
      "attribution": "Barthel Index — standard ADL scale for clinical use. Verify licensing for commercial redistribution."
    }
  },
  "questions": [
    {
      "code": "feeding",
      "section": "ADL",
      "label": "Feeding",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 10,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Unable", "score": 0 },
          { "code": "5", "label": "Needs help cutting, spreading butter, etc., or requires modified diet", "score": 5 },
          { "code": "10", "label": "Independent", "score": 10 }
        ]
      }
    },
    {
      "code": "bathing",
      "section": "ADL",
      "label": "Bathing",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 20,
      "score_key": "adl",
      "options": {
        "max": 5,
        "choices": [
          { "code": "0", "label": "Dependent", "score": 0 },
          { "code": "5", "label": "Independent (or in shower)", "score": 5 }
        ]
      }
    },
    {
      "code": "grooming",
      "section": "ADL",
      "label": "Grooming",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 30,
      "score_key": "adl",
      "options": {
        "max": 5,
        "choices": [
          { "code": "0", "label": "Needs help with personal care", "score": 0 },
          { "code": "5", "label": "Independent face/hair/teeth/shaving", "score": 5 }
        ]
      }
    },
    {
      "code": "dressing",
      "section": "ADL",
      "label": "Dressing",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 40,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Dependent", "score": 0 },
          { "code": "5", "label": "Needs help but can do about half unaided", "score": 5 },
          { "code": "10", "label": "Independent (including buttons, zips, laces, etc.)", "score": 10 }
        ]
      }
    },
    {
      "code": "bowels",
      "section": "ADL",
      "label": "Bowels",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 50,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Incontinent (or needs to be given enemas)", "score": 0 },
          { "code": "5", "label": "Occasional accident", "score": 5 },
          { "code": "10", "label": "Continent", "score": 10 }
        ]
      }
    },
    {
      "code": "bladder",
      "section": "ADL",
      "label": "Bladder",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 60,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Incontinent, or catheterized and unable to manage alone", "score": 0 },
          { "code": "5", "label": "Occasional accident", "score": 5 },
          { "code": "10", "label": "Continent", "score": 10 }
        ]
      }
    },
    {
      "code": "toilet",
      "section": "ADL",
      "label": "Toilet use",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 70,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Dependent", "score": 0 },
          { "code": "5", "label": "Needs some help, but can do something alone", "score": 5 },
          { "code": "10", "label": "Independent (on and off, dressing, wiping)", "score": 10 }
        ]
      }
    },
    {
      "code": "transfers",
      "section": "ADL",
      "label": "Transfers (bed to chair and back)",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 80,
      "score_key": "adl",
      "options": {
        "max": 15,
        "choices": [
          { "code": "0", "label": "Unable, no sitting balance", "score": 0 },
          { "code": "5", "label": "Major help (one or two people, physical), can sit", "score": 5 },
          { "code": "10", "label": "Minor help (verbal or physical)", "score": 10 },
          { "code": "15", "label": "Independent", "score": 15 }
        ]
      }
    },
    {
      "code": "mobility",
      "section": "ADL",
      "label": "Mobility (on level surfaces)",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 90,
      "score_key": "adl",
      "options": {
        "max": 15,
        "choices": [
          { "code": "0", "label": "Immobile or <50 yards", "score": 0 },
          { "code": "5", "label": "Wheelchair independent, including corners, >50 yards", "score": 5 },
          { "code": "10", "label": "Walks with help of one person (verbal or physical) >50 yards", "score": 10 },
          { "code": "15", "label": "Independent (but may use any aid; for example, stick) >50 yards", "score": 15 }
        ]
      }
    },
    {
      "code": "stairs",
      "section": "ADL",
      "label": "Stairs",
      "answer_type": "score_item",
      "is_required": true,
      "sort_order": 100,
      "score_key": "adl",
      "options": {
        "max": 10,
        "choices": [
          { "code": "0", "label": "Unable", "score": 0 },
          { "code": "5", "label": "Needs help (verbal, physical, carrying aid)", "score": 5 },
          { "code": "10", "label": "Independent", "score": 10 }
        ]
      }
    }
  ]
}
