sesForm.json

{
  "name": "Calcutta Kids Demographic/SES Form",
  "uuid": "6ae07f4d-c639-4cfa-a78b-9f39e0b24c60",
  "formType": "Encounter",
  "formElementGroups": [
    {
      "uuid": "433ec1f8-3c50-46cb-b661-0a319085b8ff",
      "name": "Household Population",
      "display": "Household Population",
      "displayOrder": 1,
      "formElements": [
        {
          "uuid": "8d1067b1-d9d8-40e0-a771-15f7c68abe34",
          "name": "Marital Status",
          "type": "SingleSelect",
          "concept": {
            "uuid": "aa6687c9-ba4d-49a3-9b3e-bba266eb6f32"
          },
          "displayOrder": 1,
          "mandatory": false
        },
        {
          "name": "What other marital status?",
          "uuid": "51286936-8bb1-421a-a826-93b1561a47ce",
          "keyValues": [],
          "concept": {
            "uuid": "04f0888b-d0b5-43ac-905d-ae3b5a9b1015"
          },
          "displayOrder": 2,
          "mandatory": false
        },
        {
          "uuid": "2031999b-2358-4da8-9136-db8565af26fe",
          "name": "Age at first marriage",
          "concept": {
            "uuid": "f1919fdc-5003-4ebc-82c7-059e6a4e8a21"
          },
          "displayOrder": 3,
          "mandatory": false
        },
        {
          "uuid": "dadf7760-560e-4a58-9e31-fc3c1d9e1ae6",
          "name": "Religion",
          "type": "SingleSelect",
          "keyValues": [
            {
              "key": "ExcludedAnswers",
              "value": [
                "Jain"
              ]
            }
          ],
          "concept": {
            "uuid": "c922c13c-1fa2-42dd-a7e8-d234b0324870"
          },
          "displayOrder": 4,
          "mandatory": false
        },
        {
          "uuid": "e8a46555-511c-4c77-8802-ef1ecbaa7a01",
          "name": "If other religion, please specify",
          "concept": {
            "uuid": "02461cb2-7d21-4225-a6ce-42357804a7e4"
          },
          "displayOrder": 5,
          "mandatory": false
        },
        {
          "uuid": "c28cb444-5163-4760-94b8-8f73d4a3d46a",
          "name": "Do you have a BPL card?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "6f33e933-a9f9-4ad9-8bd8-286c9223c934"
          },
          "displayOrder": 6,
          "mandatory": false
        },
        {
          "uuid": "83c2c6f5-2a5a-41c1-9375-0d972e78f99d",
          "name": "Do you have RSBY?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "c3598a99-357d-4b1e-a607-3e6ed077507a"
          },
          "displayOrder": 7,
          "mandatory": false
        },
        {
          "uuid": "fd219d3a-4918-401e-aeb7-07b8865bfb95",
          "name": "Number of Household members (eating together)",
          "concept": {
            "uuid": "25b73ca1-e268-452f-ba05-2595af28ac04"
          },
          "displayOrder": 8,
          "mandatory": false
        },
        {
          "uuid": "08b84c62-6b47-4040-9930-4069269495db",
          "name": "Number of people aged 0-17 years in the household",
          "type": "SingleSelect",
          "concept": {
            "uuid": "da79427f-f935-4b17-b6d8-44806323f03d"
          },
          "displayOrder": 9,
          "mandatory": true
        },
        {
          "uuid": "cf1e1060-2086-4a06-8b90-c95a8a1aa100",
          "name": "Have you migrated to Kolkata from another place?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "e955a293-df11-4d9f-b0b5-c8f57cfe71df"
          },
          "displayOrder": 10,
          "mandatory": false
        },
        {
          "uuid": "f92745cb-30d6-423b-9457-a46858dbf4f3",
          "name": "Where did you migrate from?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "ceaef306-a4bd-4e8e-b9d2-6baec7dc8d66"
          },
          "displayOrder": 11,
          "mandatory": false
        },
        {
          "uuid": "61dffca9-8260-4ba4-aec9-817eebd33e9a",
          "name": "If from other place, name of place",
          "concept": {
            "uuid": "a3e4ab44-9f95-4aaa-8dd7-c0d93e391a14"
          },
          "displayOrder": 12,
          "mandatory": false
        },
        {
          "uuid": "fc89b576-0364-4355-950c-c4ff0d970307",
          "name": "Please give the woman the laminated reading card and ask her to read the passage in the language of her choice",
          "type": "SingleSelect",
          "concept": {
            "uuid": "b4e5a662-97bf-4846-b9b7-9baeab4d89c4"
          },
          "displayOrder": 13,
          "mandatory": false
        },
        {
          "uuid": "8b2c870f-e15f-4fee-a7c3-2077c6147850",
          "name": "Could the woman read the passage?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "08c1c5bc-5e6c-4811-8aea-d980379ae450"
          },
          "displayOrder": 14,
          "mandatory": false
        },
        {
          "uuid": "6440bee7-efc4-476f-8c6c-c264376fc9c9",
          "name": "Woman’s last class completed",
          "concept": {
            "uuid": "f6f1610b-30c2-4e7b-af70-8cd456a3e6ee"
          },
          "displayOrder": 15,
          "mandatory": false
        },
        {
          "uuid": "efad8184-c3d0-452d-b071-c65c6295d6b6",
          "name": "Can your husband read?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "d4829479-b0b4-48ab-9263-61d85c0dd769"
          },
          "displayOrder": 16,
          "mandatory": false
        },
        {
          "uuid": "067e8a57-04d9-4cab-8258-3f3a01e33022",
          "name": "What is your occupation?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "cd83afec-d147-42b2-bd50-0ca460dbd55f"
          },
          "displayOrder": 17,
          "mandatory": false
        },
        {
          "name": "Which other occupation?",
          "uuid": "fc7d1b97-3ceb-40c4-b5a4-4297b0f821c6",
          "keyValues": [],
          "concept": {
            "uuid": "9d16f047-3108-468a-a9cb-10b392f8b012"
          },
          "displayOrder": 18,
          "mandatory": false
        },
        {
          "uuid": "24ce0e76-319a-4b7c-bb2c-79b392a94780",
          "name": "What is the additional work you do?",
          "concept": {
            "uuid": "c202bc3a-8e15-45af-9bc2-50f070997cd6"
          },
          "displayOrder": 19,
          "mandatory": false
        },
        {
          "uuid": "14608467-3be1-494f-a95e-982e25fe0529",
          "name": "Is this work done at home or outside of the home?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "9c7f710f-b05f-44dc-9000-a550f31c12c4"
          },
          "displayOrder": 20,
          "mandatory": false
        },
        {
          "uuid": "c9be2369-57b1-4d73-893d-11993503a1d3",
          "name": "Husband’s occupation",
          "concept": {
            "uuid": "bec93815-01a3-46de-afc3-4bdb9bb63e2e"
          },
          "displayOrder": 21,
          "mandatory": false
        },
        {
          "uuid": "8cfb6411-9d6b-4f4b-86d9-30bbdd23e26f",
          "name": "Is there are any other income earner in the household?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "2cc56b84-460c-4e5e-8ee2-74db082e9759"
          },
          "displayOrder": 22,
          "mandatory": false
        },
        {
          "uuid": "7cc8e01b-0578-4bfb-8e81-1352c68fb63b",
          "name": "What is his/her occupation?",
          "concept": {
            "uuid": "5a5cb414-483d-4c4f-bc7f-7b96c505d9b5"
          },
          "displayOrder": 23,
          "mandatory": false
        },
        {
          "uuid": "db1a71de-cc43-4702-9f85-49111befb959",
          "name": "Principal occupation of the household",
          "type": "SingleSelect",
          "concept": {
            "uuid": "219069ed-b150-4779-81f2-5c4c53b50239"
          },
          "displayOrder": 24,
          "mandatory": true
        },
        {
          "uuid": "f0102f76-12a5-482c-8288-460544bf0792",
          "name": "What is the household's income?",
          "concept": {
            "uuid": "76c1a980-9a20-462f-aa77-3f815a319727"
          },
          "displayOrder": 25,
          "mandatory": false
        },
        {
          "name": "Rupees received (per day, week or month)",
          "uuid": "3e187440-e90d-4bb4-9159-b994d56befff",
          "keyValues": [],
          "type": "SingleSelect",
          "concept": {
            "uuid": "2534f7cb-b4ae-4aa5-938c-9855c99b0a2b"
          },
          "displayOrder": 26,
          "mandatory": false
        }
      ]
    },
    {
      "uuid": "6fa0bafd-344d-4829-b444-3e7a7a0c78fc",
      "name": "Housing Characteristics/Consumer Durables",
      "display": "Housing Characteristics/Consumer Durables",
      "displayOrder": 2,
      "formElements": [
        {
          "uuid": "3ea98847-0118-497d-9f15-f5c98f37f4ab",
          "name": "Location of house",
          "type": "SingleSelect",
          "concept": {
            "uuid": "7570b4df-e0e0-4ec4-b98b-445d6f27203b"
          },
          "displayOrder": 1,
          "mandatory": false
        },
        {
          "uuid": "9a0f2bdb-4ebd-4304-b517-565d1feae033",
          "name": "Accommodation",
          "type": "SingleSelect",
          "concept": {
            "uuid": "07147a87-f0a6-4cf5-8ece-b11b4703d3d0"
          },
          "displayOrder": 2,
          "mandatory": false
        },
        {
          "uuid": "62e27300-b161-4cfd-bd8c-37e693fd7678",
          "name": "Which accommodation if other?",
          "concept": {
            "uuid": "c2f29f03-38eb-48d7-8d90-32b25dbf3e9a"
          },
          "displayOrder": 3,
          "mandatory": false
        },
        {
          "name": "Is the residence all pucca (burnt bricks, stone, cement, concrete, cement-plastered reeds, timber, tiles, galvanized tin or asbestos cement sheets)?",
          "uuid": "1072cf45-8219-46b5-9943-807eb86f5f8a",
          "concept": {
            "uuid": "0fbf8c35-2cf0-4591-8e83-914d3b8e8242"
          },
          "displayOrder": 3.5,
          "mandatory": true
        },
        {
          "uuid": "82847ce1-468a-40f7-9978-1576fc39b061",
          "name": "Does the household own a television?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "960a2d02-352a-48b3-9704-48bc6709ea85"
          },
          "displayOrder": 4,
          "mandatory": true
        },
        {
          "uuid": "be5adc75-2585-447d-81d1-6d42be7770b2",
          "name": "Does the household own a bicycle, scooter, or motor cycle?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "6ece3471-2e32-44e6-9f1b-999e549cf0c1"
          },
          "displayOrder": 5,
          "mandatory": true
        },
        {
          "uuid": "874b69dd-ebaf-4cda-bd2f-d4c9493c37e9",
          "name": "Does the household own an almirah/dressing table?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "8d144679-9089-4af6-9f5d-b55ffe5600df"
          },
          "displayOrder": 6,
          "mandatory": true
        },
        {
          "uuid": "4208d640-e30b-437e-922f-df303adf1a2b",
          "name": "Does the household own a sewing machine?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "b59b3a8f-8b40-4dd1-b79a-ee3eb2c1f32a"
          },
          "displayOrder": 7,
          "mandatory": true
        },
        {
          "uuid": "babd7c05-3f0d-43e5-a0c3-c536e848ea60",
          "name": "How many pressure cookers or pressure pans does the household own?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "c8fa6f94-956f-4988-b12b-93f4367a050d"
          },
          "displayOrder": 8,
          "mandatory": true
        },
        {
          "uuid": "6b4c86a0-31e2-42b9-ba56-4a3dbd5cf331",
          "name": "How many electric fans does the household own?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "bef73755-c9f6-45d1-8a95-c048feb4d4de"
          },
          "displayOrder": 9,
          "mandatory": true
        },
        {
          "uuid": "0086ac2c-5540-4c15-8cd3-b04f92f0bdf4",
          "name": "What is household’s primary source of energy for cooking?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "bf982fb0-a128-4e99-9172-484861f2bcd7"
          },
          "displayOrder": 10,
          "mandatory": true
        },
        {
          "uuid": "43087078-94ca-40a0-9d4a-a3e30a11833d",
          "name": "What type of toilet facility do you usually use for defecation?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "2d146780-4b72-46f0-bab0-b81b87baf797"
          },
          "displayOrder": 11,
          "mandatory": false
        }
      ]
    },
    {
      "uuid": "ac1af315-8e61-4433-9171-4baf8810f0d5",
      "name": "Health Seeking Behaviours",
      "display": "Health Seeking Behaviours",
      "displayOrder": 3,
      "formElements": [
        {
          "uuid": "98e80afb-c04a-400c-8ea9-d1c48a68f514",
          "name": "When you were pregnant, did you receive pregnancy care?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "591b140e-cce0-4433-bcf3-6c0b17aefb9f"
          },
          "displayOrder": 1,
          "mandatory": false
        },
        {
          "uuid": "f1423730-18d7-4425-8203-e12cb55abde9",
          "name": "Pregnancy care received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "2b0ba6d4-05b9-441c-9d89-fdc70394f852"
          },
          "displayOrder": 2,
          "mandatory": false
        },
        {
          "uuid": "9dd58646-044d-4c0d-94e7-9f0524a028b1",
          "name": "Which other facility was pregnancy care received from?",
          "concept": {
            "uuid": "a02b5d7b-f883-47f7-b4c2-8a945986c00c"
          },
          "displayOrder": 3,
          "mandatory": false
        },
        {
          "uuid": "aff32105-5add-42e7-bd1c-44a73c7ce2cc",
          "name": "Does your child get weighed each month?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "e65b2360-c965-44b9-91f1-9a0467bc34a2"
          },
          "displayOrder": 4,
          "mandatory": false
        },
        {
          "uuid": "81c29a21-f8ea-4069-a433-b8b221696040",
          "name": "Weighing service availed from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "0ac89224-baff-416d-959b-2854369d8530"
          },
          "displayOrder": 5,
          "mandatory": false
        },
        {
          "uuid": "40f7cd4c-51d6-4739-8c0a-93f9cbf5b9c9",
          "name": "Which other facility was weighing service availed from?",
          "concept": {
            "uuid": "125fae1f-d0c7-465b-8546-f021a66a1141"
          },
          "displayOrder": 6,
          "mandatory": false
        },
        {
          "uuid": "7a903d43-9ba1-432b-b380-30540e5415ae",
          "name": "Do you get food rations for your child?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "5141a616-56d0-48ab-a7bb-ad1e94f3035d"
          },
          "displayOrder": 7,
          "mandatory": false
        },
        {
          "uuid": "8225cff9-cc25-4318-97ab-3965e5bea899",
          "name": "Food rations received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "cdcafa55-25da-4158-b2ae-163d92528a28"
          },
          "displayOrder": 8,
          "mandatory": false
        },
        {
          "uuid": "d11b380b-a867-45ba-941d-f5b127b64e11",
          "name": "Which other facility was food ration received from?",
          "concept": {
            "uuid": "ec266fb3-9221-412b-a7a8-048488ebcea8"
          },
          "displayOrder": 9,
          "mandatory": false
        },
        {
          "uuid": "34d71792-bc14-414d-aaec-4cd179d9f1d7",
          "name": "Do you seek medical attention when you or your child are ill or hurt?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "3873335f-d20d-498b-b174-61b14c0b40f2"
          },
          "displayOrder": 10,
          "mandatory": false
        },
        {
          "uuid": "b4de5284-d5a9-4f14-94a4-7ac371d310b1",
          "name": "Health services received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "4806adf8-1120-4550-8703-faab343fdd9b"
          },
          "displayOrder": 11,
          "mandatory": false
        },
        {
          "uuid": "63870dfc-cd35-4a0e-bd8f-5ae158af7f8d",
          "name": "Which other facility was health services received from?",
          "concept": {
            "uuid": "becfa0ba-1bc9-426d-a25d-b88f2591bf11"
          },
          "displayOrder": 12,
          "mandatory": false
        },
        {
          "uuid": "38029e61-7648-476c-870b-59a7bbd4b573",
          "name": "Has your child received immunizations?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "b5301e37-9c86-4ba0-b7d3-1a563335ef26"
          },
          "displayOrder": 13,
          "mandatory": false
        },
        {
          "uuid": "9acf3542-7959-4041-8537-ade887975895",
          "name": "Immunization service received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "3be0f140-2c04-4b40-9af2-46ee2e133e64"
          },
          "displayOrder": 14,
          "mandatory": false
        },
        {
          "uuid": "1b4d2a9d-51e3-447a-9e2b-6d4a70ad2541",
          "name": "Which other facility was immunization received from?",
          "concept": {
            "uuid": "fea01561-6275-43d2-907e-c0530306686d"
          },
          "displayOrder": 15,
          "mandatory": false
        },
        {
          "uuid": "e6fae7c6-d40e-4d35-9e0b-daf035dd7df5",
          "name": "Have you needed to use emergency services for yourself or your child?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "cd4a9f19-f914-4939-a144-a63732e8d534"
          },
          "displayOrder": 16,
          "mandatory": false
        },
        {
          "uuid": "a1f35eab-8c94-4a9e-b61e-8fef3e8db03b",
          "name": "Emergency service received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "5339fc25-ef4f-42fe-9b4f-307efb9a8173"
          },
          "displayOrder": 17,
          "mandatory": false
        },
        {
          "uuid": "f3ce8306-4230-4d56-9acd-0aef7972c1fc",
          "name": "Which other facility was emergency service received from?",
          "concept": {
            "uuid": "fb7d1279-74c3-4d77-b8cc-d38691a4ea35"
          },
          "displayOrder": 18,
          "mandatory": false
        },
        {
          "uuid": "3f558960-c6c3-46c0-831c-cbead228dc13",
          "name": "Have you sought medical assistance for any other reasons?",
          "type": "SingleSelect",
          "concept": {
            "uuid": "ebe61471-b499-4b2c-9aa5-7a3c3b43767c"
          },
          "displayOrder": 19,
          "mandatory": false
        },
        {
          "uuid": "3b1088be-320e-407d-ae22-ccbe28a4a288",
          "name": "Medical assistance received from?",
          "type": "MultiSelect",
          "concept": {
            "uuid": "b47198e4-8bda-4b46-9020-4dd693135ab3"
          },
          "displayOrder": 20,
          "mandatory": false
        },
        {
          "uuid": "4cd0187f-91d0-4fb0-b1a5-e91bb2ff1129",
          "name": "Which other facility was medical assistance received from?",
          "concept": {
            "uuid": "91f43230-a79c-41f7-88bc-9c8c8c0f0917"
          },
          "displayOrder": 21,
          "mandatory": false
        }
      ]
    },
    {
      "uuid": "16d1de69-4e06-4df6-b457-c932b97fde11",
      "name": "Living Children",
      "display": "Living Children",
      "displayOrder": 4,
      "formElements": [
        {
          "uuid": "c60fbf9d-1be5-48ee-9265-314225df0971",
          "name": "Number of children currently enrolled in Calcutta Kids",
          "concept": {
            "uuid": "0bee8ffd-8189-4871-978e-d9ae934a4775"
          },
          "displayOrder": 1,
          "mandatory": false
        },
        {
          "uuid": "cc0d51d3-e959-4edd-a7ea-a2aaf00768c2",
          "name": "ID of child #1",
          "concept": {
            "uuid": "7250b61c-990e-463f-9f5f-0126055bf46b"
          },
          "displayOrder": 2,
          "mandatory": false
        },
        {
          "uuid": "5dc84a09-012e-459b-8abf-bef90dd96f22",
          "name": "ID of child #2",
          "concept": {
            "uuid": "f2a77574-f1d0-4640-abd6-644e4c356e1b"
          },
          "displayOrder": 3,
          "mandatory": false
        },
        {
          "uuid": "491cf831-90de-42ff-9d43-180a512232b0",
          "name": "ID of child #3",
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}