other_text
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If you selected "Other", please specify the building type below., type: esriFieldTypeString
)
reschedule
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is there a date that would be better for you or another person in the home to answer a few questions? The survey should only take around 5 minutes., type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you or anyone in your household being bitten by mosquitoes?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [prefer_not: Prefer not to say]
)
question_1a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What time(s) of the day is biting occurring?, type: esriFieldTypeString
)
question_1b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: How recently has biting occurred?, type: esriFieldTypeString
)
question_2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you aware of any standing water (a teaspoon or greater) in objects/containers/area drains on your property or in the area?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: Don't Know/Unsure]
, ...1 more...
)
question_3
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Would you allow a Vector Control Technician to check your property for mosquito breeding sources?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_4
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If mosquito breeding is found or adult mosquitoes are present, would you allow control measures to be taken, such as dumping out containers or applying pesticides?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [more_info: Need more information]
)
question_5
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Have your been bitten by mosquitoes at any other locations in the neighborhood?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_6
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you aware of the Invasive Aedes mosquito, Aedes aegypti?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_7
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Would you be open to a mosquito trap being placed on your property?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_8
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Have you or anyone in the household experienced flu-like illness in the last 2 months?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: Don't Know/Unsure]
, ...1 more...
)
if_no
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Thank you for your time!, type: esriFieldTypeString
)
agency_completing
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What agency are you completing this form on behalf of?, type: esriFieldTypeString
, Coded Values:
[Environmental Health: Environmental Health]
, [Public Health: Public Health]
)
age_consent
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you over the age of 18?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
if_under_18
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please ask to speak with a parent or guardian to complete the survey., type: esriFieldTypeString
, Coded Values:
[available: Available]
, [unavailable: Unavailable]
)
question_3_ph
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Would you allow a Vector Control Technician to check your property for mosquito breeding sources?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_8_eh
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Would you allow someone from our Public Health team to come ask a few follow up questions?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
question_9
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Have you or any household members travelled outside of the state or internationally over the past month?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [prefer_not: Prefer not to say]
)
question_9_a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Where did you travel?, type: esriFieldTypeString
)
question_9_b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What were the dates of travel?, type: esriFieldTypeString
)
question_10
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: To your knowledge, did anyone visit your household who had recently traveled out of state or internationally?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [prefer_not: Prefer not to say]
)
question_10_a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Where did they travel?, type: esriFieldTypeString
)
question_10_b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What were the dates of travel?, type: esriFieldTypeString
)
question_13_a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the provider's First and Last Name (if known)?, type: esriFieldTypeString
)
question_13_b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the institution name?, type: esriFieldTypeString
)
question_13_c
(
nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: What date did you seek medical care?, type: esriFieldTypeDate
)
question_14
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did you experience any of the following signs/symptoms?, type: esriFieldTypeString
)
question_14_a
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If Fever, what was your highest temp?, type: esriFieldTypeString
)
question_14_b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If joint pain, what joints?, type: esriFieldTypeString
)
question_17_a
(
nullable: true, editable: true, defaultValue: null, alias: How many total nights were spent in the hospital?, type: esriFieldTypeInteger
)
question_17_b
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: During any part of the hospitalization, did the patient stay in an intensive care unit (ICU) or a critical care unit (CCU)?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unknown: Unknown]
)