Skip to content

SEP enrollment fields #489

Description

@mariekers

Add non-participant fields from the SEP registration form to the participant form on the front end:

  • What zip code do you live in or spend the most time in (5 digit varchar)
  • Housing: □ Permanently Housed □ Temporarily Housed □ Shelter □ Street □ At Risk for Homelessness
  • What drug do you inject most often? □Heroin only □Heroin and cocaine □Cocaine only □Fentanyl □Crack □Amphetamines, Speed, Crystal Meth, Ice □Hormones □Steroids □Silicone □ Botox □Other:____________ □Do not Inject
  • Are you in drug treatment? □Yes □No
  • If yes, is it: □Methadone □Suboxone □Vivitrol □IOP □Recovery House (can this be a multi select similar to the site object?)
  • Do you have health insurance? □Medicare □Medicaid □No □Other:___________
  • Have you ever been tested for Hepatitis C? ___________
    • If so, when? ___________________
  • Have you ever been tested for HIV? ___________
    • If so, when? ___________________
  • Do you have Narcan today? □Yes □No

FOR STAFF ONLY:
□ Participant Received Harm Reduction Counseling □ Participant left with Narcan
□ Participant Received Overdose Prevention Counseling □ Participant left with mobile site schedule
□ Participant was referred to HIV/HCV testing

Dependent on #488

Activity

Sign up for free to join this conversation on GitHub. Already have an account? Sign in to comment

Metadata

Metadata

Assignees

No one assigned

    Labels

    Type

    No type

    Projects

    No projects

      Milestone

      No milestone

      Relationships

      None yet

      Development

      No branches or pull requests

      Issue actions