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form.json
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{
"questions": [
{
"name": "tbrq",
"type": "datetime",
"title": "填报日期(Date)",
"readonly": true,
"defaultval": "now",
"required": true
},
{
"name": "zddy",
"type": "lbs",
"title": "自动定位(Automatic location)",
"readonly": true,
"required": true
},
{
"name": "sfjcs110",
"type": "radio",
"title": "近14天是否有与疫情中、高风险地区人员的接触史？(Did you contact any person(s) from medium or high risk area of the epidemic in the past 14 days?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "sfjcs2",
"type": "radio",
"title": "近14天是否有与疑似、确诊人员的接触史?(In the past 14 days, did you contact any COVID-19 suspected or confirmed person(s)?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "sfdgyq0",
"type": "radio",
"title": "近21天是否有中高风险地区旅居史，近14天是否有中高风险地区所在区旅居史？( In the past 21 days, have you been to medium or high-risk area? In the past 14 days, have you been to any places close to medium or high risk area?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "sfcyyxgc",
"type": "radio",
"title": "现是否处于医学观察状态？(Are you under medical observation currently ?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "yxgcxx",
"type": "textarea",
"title": "若处于医学观察状态，请填写隔离地点和隔离起始时间？(If yes, please indicate the place and the starting date.)",
"required": false
},
{
"name": "sfcyjjgl",
"type": "radio",
"title": "现是否处于居家隔离状态？(Are you in home quarantine now?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "jjglxx",
"type": "textarea",
"title": "若处于居家隔离状态，请填写隔离地点和隔离起始时间？(If yes, please indicate the place and the starting date.)",
"required": false
},
{
"name": "xstzk",
"type": "radio",
"title": "现身体状况，是否存在发热体温、寒战、咳嗽、胸闷以及呼吸困难等症状？( Do you have any symptoms such as fever, chills, cough, chest tightness, and difficulty breathing?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "jssfjcs10",
"type": "radio",
"title": "同住家属近14天是否有与疫情中、高风险地区人员或疑似、确诊人员的接触史？(Did your family member (s) living together contact any person(s) from medium or high risk area in the past 14 days?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "jssfdgyq",
"type": "radio",
"title": "同住家属近14天是否到过疫情中、高风险地区？(Have any family members living together been to medium or high risk area in the past 14 days?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "jssfcyyxgc",
"type": "radio",
"title": "同住家属现是否处于医学观察状态?(Are the family members living together under medical observation?)",
"required": true,
"options": [{ "title": "是(Yes)" }, { "title": "否(NO)" }]
},
{
"name": "ymjzqk",
"type": "radio",
"title": "疫苗接种情况?(Vaccination status?)",
"options": [
{ "title": "已接种两针剂疫苗（科兴、生物等）第一针" },
{ "title": "已接种两针剂疫苗（科兴、生物等）第二针" },
{ "title": "已接种两针剂疫苗（科兴、生物等）加强针" },
{ "title": "已接种三针剂疫苗（安徽智飞）第一针" },
{ "title": "已接种三针剂疫苗（安徽智飞）第二针" },
{ "title": "已接种三针剂疫苗（安徽智飞）第三针" },
{ "title": "未接种疫苗" }
]
},
{
"name": "hzjkm",
"type": "radio",
"title": "今日申领学校所在地健康码的颜色? What's the color of today's health code?",
"required": true,
"options": [
{ "title": "绿码(Green code)" },
{ "title": "黄码(Yellow code)" },
{ "title": "红码(Red code)" },
{ "title": "橙色(Orange code)" }
]
},
{
"name": "sfcrj",
"type": "radio",
"title": "本人或家庭成员(包括其他亲密接触人员)是否有近28日入境或未来7日拟入境的情况?Have you or your family members(including other close contact persons) entered China over the past 28 days or plan to enter China in 7 days?",
"required": true,
"options": [
{
"title": "是 Yes(请及时向所在单位报告实际情况,Please contact your college/school immediately.)"
},
{ "title": "否 No" }
]
}
],
"answer": {
"填报日期(Date)": "",
"自动定位(Automatic location)": "",
"近14天是否有与疫情中、高风险地区人员的接触史？(Did you contact any person(s) from medium or high risk area of the epidemic in the past 14 days?)": "否(NO)",
"近14天是否有与疑似、确诊人员的接触史?(In the past 14 days, did you contact any COVID-19 suspected or confirmed person(s)?)": "否(NO)",
"近21天是否有中高风险地区旅居史，近14天是否有中高风险地区所在区旅居史？( In the past 21 days, have you been to medium or high-risk area? In the past 14 days, have you been to any places close to medium or high risk area?)": "否(NO)",
"现是否处于医学观察状态？(Are you under medical observation currently ?)": "否(NO)",
"若处于医学观察状态，请填写隔离地点和隔离起始时间？(If yes, please indicate the place and the starting date.)": "",
"现是否处于居家隔离状态？(Are you in home quarantine now?)": "否(NO)",
"若处于居家隔离状态，请填写隔离地点和隔离起始时间？(If yes, please indicate the place and the starting date.)": "",
"现身体状况，是否存在发热体温、寒战、咳嗽、胸闷以及呼吸困难等症状？( Do you have any symptoms such as fever, chills, cough, chest tightness, and difficulty breathing?)": "否(NO)",
"同住家属近14天是否有与疫情中、高风险地区人员或疑似、确诊人员的接触史？(Did your family member (s) living together contact any person(s) from medium or high risk area in the past 14 days?)": "否(NO)",
"同住家属近14天是否到过疫情中、高风险地区？(Have any family members living together been to medium or high risk area in the past 14 days?)": "否(NO)",
"同住家属现是否处于医学观察状态?(Are the family members living together under medical observation?)": "否(NO)",
"疫苗接种情况?(Vaccination status?)": "",
"今日申领学校所在地健康码的颜色? What's the color of today's health code?": "绿码(Green code)",
"本人或家庭成员(包括其他亲密接触人员)是否有近28日入境或未来7日拟入境的情况?Have you or your family members(including other close contact persons) entered China over the past 28 days or plan to enter China in 7 days?": "否 No"
}
}