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SEP enrollment fields #489

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mariekers opened this issue Jan 19, 2021 · 0 comments
Open

SEP enrollment fields #489

mariekers opened this issue Jan 19, 2021 · 0 comments
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@mariekers
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mariekers commented Jan 19, 2021

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

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