inputSchema:
  type: object
  properties:
    title: COVID 19 Vaccine Screening
    pages:
    - id: 1
      name: patient_name
      label: Patient Full Name
      hint: null
      type: text
      options: []
      required: true
    - id: 2
      name: patient_dob
      label: Date of Birth
      hint: null
      type: date
      options: []
      required: true
    - id: 3
      name: patient_phone
      label: Phone Number
      hint: null
      type: text
      options: []
      required: true
    - id: 4
      name: patient_email
      label: Email Address
      hint: null
      type: email
      options: []
      required: false
    - id: 5
      name: screening_section
      label: -- Health Screening Questions --
      hint: null
      type: note
      options: []
      required: false
    - id: 6
      name: feeling_well
      label: Are you feeling well today
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 7
      name: fever
      label: Do you have a fever
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 8
      name: temperature
      label: Current Temperature
      hint: Fahrenheit
      type: number
      options: []
      required: false
    - id: 9
      name: cough
      label: Do you have a cough
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 10
      name: shortness_breath
      label: Difficulty breathing or shortness of breath
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 11
      name: sore_throat
      label: Do you have a sore throat
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 12
      name: loss_taste_smell
      label: Loss of taste or smell
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 13
      name: fatigue
      label: Unusual fatigue or weakness
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: false
    - id: 14
      name: allergies_section
      label: -- Allergies --
      hint: null
      type: note
      options: []
      required: false
    - id: 15
      name: vaccine_allergies
      label: Allergies to any vaccine components
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      required: true
    - id: 16
      name: allergy_description
      label: If yes, which components
      hint: null
      type: text
      options: []
      required: false
    - id: 17
      name: severe_reactions
      label: History of severe allergic reactions
      hint: Anaphylaxis to medications
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 18
      name: medications_section
      label: -- Current Medications --
      hint: null
      type: note
      options: []
      required: false
    - id: 19
      name: current_medications
      label: Currently taking any medications
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 20
      name: medication_list
      label: List medications
      hint: null
      type: text
      options: []
      required: false
    - id: 21
      name: blood_thinners
      label: Taking blood thinners or anticoagulants
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 22
      name: health_conditions_section
      label: -- Health Conditions --
      hint: null
      type: note
      options: []
      required: false
    - id: 23
      name: chronic_conditions
      label: Chronic health conditions
      hint: Heart disease, diabetes, lung disease
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 24
      name: condition_list
      label: If yes, which conditions
      hint: null
      type: text
      options: []
      required: false
    - id: 25
      name: immunocompromised
      label: Immunocompromised or immunosuppressed
      hint: HIV, cancer treatment, etc.
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      required: true
    - id: 26
      name: blood_clotting_disorder
      label: History of blood clotting disorders
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 27
      name: pregnancy_section
      label: -- Pregnancy Status --
      hint: null
      type: note
      options: []
      required: false
    - id: 28
      name: pregnant
      label: Are you pregnant
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      - Not applicable
      required: true
    - id: 29
      name: breastfeeding
      label: Are you breastfeeding
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Not applicable
      required: true
    - id: 30
      name: covid_section
      label: -- COVID-19 History --
      hint: null
      type: note
      options: []
      required: false
    - id: 31
      name: covid_positive
      label: Ever tested positive for COVID-19
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      required: true
    - id: 32
      name: covid_positive_date
      label: If yes, when
      hint: null
      type: date
      options: []
      required: false
    - id: 33
      name: fully_recovered
      label: Have you fully recovered
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Not applicable
      required: true
    - id: 34
      name: vaccination_section
      label: -- COVID-19 Vaccination History --
      hint: null
      type: note
      options: []
      required: false
    - id: 35
      name: prior_vaccine
      label: Prior COVID-19 vaccination
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 36
      name: vaccine_doses
      label: Number of doses received
      hint: null
      type: number
      options: []
      required: false
    - id: 37
      name: approval_section
      label: -- Screening Approval --
      hint: null
      type: note
      options: []
      required: false
    - id: 38
      name: screening_approved
      label: Approved for vaccination today
      hint: Pharmacist to complete
      type: select_one
      options:
      - Approved
      - Defer to physician
      - Not approved
      required: false
    - id: 39
      name: pharmacist_name
      label: Pharmacist Name
      hint: null
      type: text
      options: []
      required: false