inputSchema:
  type: object
  properties:
    title: COVID 19 Vaccination Screening Questionnaire
    pages:
    - id: 1
      name: respondent_name
      label: Full Name
      hint: null
      type: text
      options: []
      required: true
    - id: 2
      name: respondent_dob
      label: Date of Birth
      hint: null
      type: date
      options: []
      required: true
    - id: 3
      name: email
      label: Email Address
      hint: null
      type: email
      options: []
      required: true
    - id: 4
      name: phone
      label: Phone Number
      hint: null
      type: text
      options: []
      required: true
    - id: 5
      name: screening_section
      label: -- Pre-Vaccination Screening --
      hint: null
      type: note
      options: []
      required: false
    - id: 6
      name: symptoms_last_2_weeks
      label: Have you had symptoms of COVID-19 in the last 2 weeks
      hint: Fever, cough, loss of taste or smell, etc.
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 7
      name: positive_test
      label: Have you tested positive for COVID-19 in past 90 days
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      required: true
    - id: 8
      name: close_contact
      label: Close contact with confirmed COVID-19 case
      hint: In the past 14 days
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unknown
      required: true
    - id: 9
      name: health_conditions_section
      label: -- Health Conditions --
      hint: null
      type: note
      options: []
      required: false
    - id: 10
      name: heart_disease
      label: Have you been diagnosed with heart disease
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 11
      name: lung_disease
      label: Have you been diagnosed with lung disease or asthma
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 12
      name: diabetes
      label: Do you have diabetes
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 13
      name: kidney_disease
      label: Do you have chronic kidney disease
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 14
      name: immunocompromised
      label: Are you immunocompromised or have HIV
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 15
      name: cancer_treatment
      label: Currently undergoing cancer treatment
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 16
      name: organ_transplant
      label: Have you had an organ or stem cell transplant
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 17
      name: other_conditions
      label: Other significant health conditions
      hint: null
      type: text
      options: []
      required: false
    - id: 18
      name: medications_section
      label: -- Medications and Allergies --
      hint: null
      type: note
      options: []
      required: false
    - id: 19
      name: medication_list
      label: Are you taking any medications
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 20
      name: specific_medications
      label: If yes, list medications
      hint: null
      type: text
      options: []
      required: false
    - id: 21
      name: vaccine_allergies
      label: Are you allergic to any vaccine components
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      required: true
    - id: 22
      name: severe_allergies
      label: History of severe allergic reactions or anaphylaxis
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 23
      name: allergy_description
      label: If yes, describe allergy or reaction
      hint: null
      type: text
      options: []
      required: false
    - id: 24
      name: pregnancy_section
      label: -- Pregnancy Status --
      hint: null
      type: note
      options: []
      required: false
    - id: 25
      name: pregnant
      label: Are you pregnant
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      - Unsure
      - Prefer not to answer
      required: true
    - id: 26
      name: breastfeeding
      label: Are you breastfeeding
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 27
      name: vaccination_section
      label: -- Vaccination History --
      hint: null
      type: note
      options: []
      required: false
    - id: 28
      name: prior_covid_vaccine
      label: Have you received a COVID-19 vaccine before
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true
    - id: 29
      name: prior_vaccine_type
      label: If yes, which vaccine
      hint: null
      type: select_one
      options:
      - Pfizer
      - Moderna
      - Johnson and Johnson
      - Other
      required: false
    - id: 30
      name: prior_vaccine_date
      label: Date of last dose
      hint: null
      type: date
      options: []
      required: false
    - id: 31
      name: adverse_reaction_prior
      label: Any adverse reactions to prior COVID vaccines
      hint: null
      type: select_one
      options:
      - 'True'
      - 'False'
      required: true