{ "template": { "code": "universal_intake", "name": "Universal Intake", "category": "universal", "version": 1, "is_current": true, "is_active": true, "scoring_strategy": null, "description": "Disease-agnostic structured intake: presenting complaint, social history, and functional status. Demographics, allergies, vitals, and labs remain on typed Care forms.", "meta": { "capture_roles": ["doctor", "nurse"], "specialty": "general", "estimated_minutes": 8, "attribution": "Ladill Care universal clinical intake (platform-authored). Not a licensed third-party instrument." } }, "questions": [ { "code": "chief_complaint", "section": "Presenting complaint", "label": "Chief complaint", "help_text": "Primary reason for this visit in the patient's own words when possible.", "answer_type": "textarea", "is_required": true, "sort_order": 10, "options": null, "validation": { "max": 2000 } }, { "code": "hpi", "section": "Presenting complaint", "label": "History of presenting illness", "help_text": "Onset, course, associated features. Free-text symptoms on the consultation remain the narrative source of truth (not auto-synced).", "answer_type": "textarea", "is_required": false, "sort_order": 20, "options": null, "validation": { "max": 10000 } }, { "code": "duration_value", "section": "Presenting complaint", "label": "Duration (value)", "help_text": "Numeric duration; pair with duration unit.", "answer_type": "number", "is_required": false, "sort_order": 30, "options": { "min": 0, "max": 9999 }, "validation": { "min": 0, "max": 9999 } }, { "code": "duration_unit", "section": "Presenting complaint", "label": "Duration unit", "answer_type": "single_choice", "is_required": false, "sort_order": 40, "options": { "choices": [ { "code": "minutes", "label": "Minutes" }, { "code": "hours", "label": "Hours" }, { "code": "days", "label": "Days" }, { "code": "weeks", "label": "Weeks" }, { "code": "months", "label": "Months" }, { "code": "years", "label": "Years" } ] } }, { "code": "pain_score", "section": "Presenting complaint", "label": "Pain score (0–10)", "help_text": "0 = no pain, 10 = worst imaginable pain.", "answer_type": "scale", "is_required": false, "sort_order": 50, "options": { "min": 0, "max": 10 }, "validation": { "min": 0, "max": 10 } }, { "code": "current_symptoms", "section": "Presenting complaint", "label": "Current symptoms", "help_text": "Structured symptom list or free description. Does not replace consultation free-text symptoms.", "answer_type": "textarea", "is_required": false, "sort_order": 60, "options": null, "validation": { "max": 5000 } }, { "code": "smoking_status", "section": "Social history", "label": "Smoking status", "answer_type": "single_choice", "is_required": false, "sort_order": 100, "options": { "choices": [ { "code": "never", "label": "Never smoked" }, { "code": "former", "label": "Former smoker" }, { "code": "current", "label": "Current smoker" }, { "code": "unknown", "label": "Unknown / not asked" } ] } }, { "code": "smoking_pack_years", "section": "Social history", "label": "Smoking pack-years", "help_text": "If former or current smoker. Packs/day × years.", "answer_type": "number", "is_required": false, "sort_order": 110, "options": { "min": 0, "max": 500, "unit": "pack-years" }, "validation": { "min": 0, "max": 500 } }, { "code": "alcohol_use", "section": "Social history", "label": "Alcohol use", "answer_type": "single_choice", "is_required": false, "sort_order": 120, "options": { "choices": [ { "code": "none", "label": "None" }, { "code": "occasional", "label": "Occasional" }, { "code": "moderate", "label": "Moderate" }, { "code": "heavy", "label": "Heavy" }, { "code": "unknown", "label": "Unknown / not asked" } ] } }, { "code": "occupation", "section": "Social history", "label": "Occupation", "answer_type": "text", "is_required": false, "sort_order": 130, "options": null, "validation": { "max": 255 } }, { "code": "mobility", "section": "Functional status", "label": "Mobility", "answer_type": "single_choice", "is_required": false, "sort_order": 200, "options": { "choices": [ { "code": "independent", "label": "Independent" }, { "code": "with_aid", "label": "With aid (stick/frame)" }, { "code": "wheelchair", "label": "Wheelchair" }, { "code": "bedbound", "label": "Bedbound" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "communication", "section": "Functional status", "label": "Communication", "answer_type": "single_choice", "is_required": false, "sort_order": 210, "options": { "choices": [ { "code": "normal", "label": "Normal" }, { "code": "impaired", "label": "Impaired" }, { "code": "non_verbal", "label": "Non-verbal" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "vision", "section": "Functional status", "label": "Vision", "answer_type": "single_choice", "is_required": false, "sort_order": 220, "options": { "choices": [ { "code": "normal", "label": "Normal / corrected" }, { "code": "impaired", "label": "Impaired" }, { "code": "blind", "label": "Blind" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "hearing", "section": "Functional status", "label": "Hearing", "answer_type": "single_choice", "is_required": false, "sort_order": 230, "options": { "choices": [ { "code": "normal", "label": "Normal" }, { "code": "impaired", "label": "Impaired" }, { "code": "deaf", "label": "Deaf" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "feeding", "section": "Functional status", "label": "Feeding", "answer_type": "single_choice", "is_required": false, "sort_order": 240, "options": { "choices": [ { "code": "independent", "label": "Independent" }, { "code": "needs_help", "label": "Needs help" }, { "code": "dependent", "label": "Dependent / tube" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "continence", "section": "Functional status", "label": "Continence", "answer_type": "single_choice", "is_required": false, "sort_order": 250, "options": { "choices": [ { "code": "continent", "label": "Continent" }, { "code": "occasional", "label": "Occasional incontinence" }, { "code": "incontinent", "label": "Incontinent" }, { "code": "catheter", "label": "Catheter / diversion" }, { "code": "unknown", "label": "Unknown" } ] } }, { "code": "baseline_labs_summary", "section": "Baseline laboratories", "label": "Baseline labs summary (optional)", "help_text": "Free-text summary only. Prefer ordered investigation results in Lab for structured values (CBC, glucose, creatinine, electrolytes).", "answer_type": "textarea", "is_required": false, "sort_order": 300, "options": null, "validation": { "max": 5000 } } ] }