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["The findings and conclusions in this document are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services. This document has not been revised or edited to conform to agency standards"]
["Variable / Field Name","Form Name","Section Header","Field Type","Field Label","Choices, Calculations, OR Slider Labels","Field Note","Text Validation Type OR Show Slider Number","Text Validation Min","Text Validation Max","Identifier?","Branching Logic (Show field only if...)","Required Field?","Custom Alignment","Question Number (surveys only)","Matrix Group Name","Matrix Ranking?","Field Annotation"]
["redcapid","foodborne_illness_complaint_form",null,"text","REDCap ID",null,null,null,null,null,"y"]
["datasource","foodborne_illness_complaint_form",null,"radio","Data source","1, ICS | 2, PF",null,null,null,null,null,null,null,null,null,null,null," @HIDDEN-SURVEY @DEFAULT='2'"]
["image","foodborne_illness_complaint_form",null,"descriptive"]
["intro","foodborne_illness_complaint_form",null,"descriptive"," <span style=\"font-size: 10.5pt; font-weight:lighter\"><font face=\"Open Sans\"><B>Instructions: </B>Please fill in the fields below with the information needed to submit a foodborne illness complaint. Required fields are marked with an <B><font color=\"red\">*asterisk</font color=\"red\"></B>. Any additional information collected could aid in investigation or follow-up activities. Thank you."]
["rec_date","foodborne_illness_complaint_form",null,"text","Today's Date",null,null,"date_mdy",null,null,null,null,"y"]
["source","foodborne_illness_complaint_form",null,"radio","Who is filling out this form?","1, Member of the public | 2, Public health official",null,null,null,null,null,null,"y"]
["script_intro","foodborne_illness_complaint_form",null,"descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"> <font face=\"Open Sans\">The Tennessee Department of Health uses information from foodborne illness complaints to better identify and investigate illness at food establishments. We would like to learn about:<ul style=\"list-style-type:disc; font-weight:lighter\"> \n<li>suspected establishments</li><li>illness symptoms</li><li> ill persons</li><li> other establishments and exposures before your illness</li></ul>This information will be used for public health purposes only and will be kept confidential to the extent allowed by law. \n\nPeople often associate their illness with the last food or meal that they consumed. While there are some germs (particularly toxins) that cause illness to develop quickly after consuming contaminated food items (as short as 30 minutes), there are many foodborne illnesses such as Campylobacter, E. Coli, and Salmonella that can take up to 72 hours (3 days) or longer to develop. When thinking about what might have caused you to become ill, it is helpful to review the food items that you have eaten over the last several days.\n\nThe information you provide could help to prevent future foodborne illnesses from occurring. \n\nThank you!\n"]
["script_contact","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\"> Contact Information","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">To begin, we'd like to know a little about you and the best way to reach you."]
["pt_first_name","foodborne_illness_complaint_form",null,"text","First Name",null,"Public health may not be able to fully investigate complaints if name and contact information are not provided.",null,null,null,"y",null,"y"]
["pt_last_name","foodborne_illness_complaint_form",null,"text","Last Name",null,"Public health may not be able to fully investigate complaints if name and contact information are not provided.",null,null,null,"y",null,"y"]
["pt_city","foodborne_illness_complaint_form",null,"text","What city do you live in?",null,null,null,null,null,"y"]
["complainant_zip","foodborne_illness_complaint_form",null,"text","What is the zip code of your residence?",null,null,"zipcode"]
["pt_county","foodborne_illness_complaint_form",null,"dropdown","What county do you live in?","Anderson, Anderson | Bedford, Bedford | Benton, Benton | Bledsoe, Bledsoe | Blount, Blount | Bradley, Bradley | Campbell, Campbell | Cannon, Cannon | Carroll, Carroll | Carter, Carter | Cheatham, Cheatham | Chester, Chester | Claiborne, Claiborne | Clay, Clay | Cocke, Cocke | Coffee, Coffee | Crockett, Crockett | Cumberland, Cumberland | Davidson, Davidson | Decatur, Decatur | Dekalb, Dekalb | Dickson, Dickson | Dyer, Dyer | Fayette, Fayette | Fentress, Fentress | Franklin, Franklin | Gibson, Gibson | Giles, Giles | Grainger, Grainger | Greene, Greene | Grundy, Grundy | Hamblen, Hamblen | Hamilton, Hamilton | Hancock, Hancock | Hardeman, Hardeman | Hardin, Hardin | Hawkins, Hawkins | Haywood, Haywood | Henderson, Henderson | Henry, Henry | Hickman, Hickman | Houston, Houston | Humphreys, Humphreys | Jackson, Jackson | Jefferson, Jefferson | Johnson, Johnson | Knox, Knox | Lake, Lake | Lauderdale, Lauderdale | Lawrence, Lawrence | Lewis, Lewis | Lincoln, Lincoln | Loudon, Loudon | McMinn, McMinn | McNairy, McNairy | Macon, Macon | Madison, Madison | Marion, Marion | Marshall, Marshall | Maury, Maury | Meigs, Meigs | Monroe, Monroe | Montgomery, Montgomery | Moore, Moore | Morgan, Morgan | Obion, Obion | Overton, Overton | Perry, Perry | Pickett, Pickett | Polk, Polk | Putnam, Putnam | Rhea, Rhea | Roane, Roane | Robertson, Robertson | Rutherford, Rutherford | Scott, Scott | Sequatchie, Sequatchie | Sevier, Sevier | Shelby, Shelby | Smith, Smith | Stewart, Stewart | Sullivan, Sullivan | Sumner, Sumner | Tipton, Tipton | Trousdale, Trousdale | Unicoi, Unicoi | Union, Union | VanBuren, VanBuren | Warren, Warren | Washington, Washington | Wayne, Wayne | Weakley, Weakley | White, White | Williamson, Williamson | Wilson, Wilson | OOS, Out of State",null,"autocomplete"]
["pt_age","foodborne_illness_complaint_form",null,"text","What is your age (in years)?",null,"Years","number",0,110]
["race","foodborne_illness_complaint_form",null,"checkbox","What is your race?","1, American Indian / Alaskan | 2, Asian | 3, Black / African American | 4, Hawaiian / Pacific Islander | 5, White | 6, Refused | 7, Unknown | 8, Other","select all that apply"]
["race_other","foodborne_illness_complaint_form",null,"text","Specify other race",null,null,null,null,null,null,"[race(8)] = '1'"]
["pt_ethnicity","foodborne_illness_complaint_form",null,"radio","What is your ethnicity?","1, Hispanic | 2, Not Hispanic | 3, Unknown"]
["pt_sex","foodborne_illness_complaint_form",null,"radio","What is your gender?","1, Female | 2, Male | 3, Other",null,null,null,null,null,null,null,"RH"]
["pt_phone","foodborne_illness_complaint_form",null,"text","What is your preferred telephone number?",null,"Include Area Code","phone",null,null,"y"]
["pt_email","foodborne_illness_complaint_form",null,"text","What is your preferred email address?",null,null,"email",null,null,"y"]
["script_estab","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\"> Suspected Establishment","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">Next we'd like to know about the food establishment or meal that you suspect made you sick."]
["suspectestab","foodborne_illness_complaint_form",null,"text","Establishment Name\n\n<div style=\"font-weight:lighter\">Food establishments could include restaurants, catering, markets, convenience stores, food stands, schools/institutions, etc.",null,null,null,null,null,null,null,"y"]
["estab_address","foodborne_illness_complaint_form",null,"text","Establishment Street Address (or cross-street)"]
["estab_city","foodborne_illness_complaint_form",null,"text","Establishment City"]
["estab_county","foodborne_illness_complaint_form",null,"dropdown","Establishment County","Anderson, Anderson | Bedford, Bedford | Benton, Benton | Bledsoe, Bledsoe | Blount, Blount | Bradley, Bradley | Campbell, Campbell | Cannon, Cannon | Carroll, Carroll | Carter, Carter | Cheatham, Cheatham | Chester, Chester | Claiborne, Claiborne | Clay, Clay | Cocke, Cocke | Coffee, Coffee | Crockett, Crockett | Cumberland, Cumberland | Davidson, Davidson | Decatur, Decatur | Dekalb, Dekalb | Dickson, Dickson | Dyer, Dyer | Fayette, Fayette | Fentress, Fentress | Franklin, Franklin | Gibson, Gibson | Giles, Giles | Grainger, Grainger | Greene, Greene | Grundy, Grundy | Hamblen, Hamblen | Hamilton, Hamilton | Hancock, Hancock | Hardeman, Hardeman | Hardin, Hardin | Hawkins, Hawkins | Haywood, Haywood | Henderson, Henderson | Henry, Henry | Hickman, Hickman | Houston, Houston | Humphreys, Humphreys | Jackson, Jackson | Jefferson, Jefferson | Johnson, Johnson | Knox, Knox | Lake, Lake | Lauderdale, Lauderdale | Lawrence, Lawrence | Lewis, Lewis | Lincoln, Lincoln | Loudon, Loudon | McMinn, McMinn | McNairy, McNairy | Macon, Macon | Madison, Madison | Marion, Marion | Marshall, Marshall | Maury, Maury | Meigs, Meigs | Monroe, Monroe | Montgomery, Montgomery | Moore, Moore | Morgan, Morgan | Obion, Obion | Overton, Overton | Perry, Perry | Pickett, Pickett | Polk, Polk | Putnam, Putnam | Rhea, Rhea | Roane, Roane | Robertson, Robertson | Rutherford, Rutherford | Scott, Scott | Sequatchie, Sequatchie | Sevier, Sevier | Shelby, Shelby | Smith, Smith | Stewart, Stewart | Sullivan, Sullivan | Sumner, Sumner | Tipton, Tipton | Trousdale, Trousdale | Unicoi, Unicoi | Union, Union | VanBuren, VanBuren | Warren, Warren | Washington, Washington | Wayne, Wayne | Weakley, Weakley | White, White | Williamson, Williamson | Wilson, Wilson",null,"autocomplete"]
["time_chart1","foodborne_illness_complaint_form",null,"descriptive",{"$cut":{"chars":21300,"head":"<div class=\"rich-text-field-label\"><table style=\"border-collapse: collapse; width: 100%; height: 320.667px;\" border=\"1\"><colgroup><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"></colgroup> <tbody> <tr style=\"height: 24.6667px;\"> <td style=\"width: 467.5pt; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"4\" valign=\"top\" width=\"623\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time Conversion Chart</strong></p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Normal Time</strong></p> </td> <td style=\"width: 116.85pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time</strong></p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Normal Time</strong></p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time</strong></p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00 AM</p> </td> <td style=\"width: 116.85pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">00:00</p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00 PM</p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00</p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign"}},null,null,null,null,null,null,null,null,null,null,null,null,"time_chart"]
["mealdate","foodborne_illness_complaint_form",null,"text","<div class=\"rich-text-field-label\"><p>When did you eat at [suspectestab]? Our system uses military time. Please see chart above for conve<span style=\"background-color: var(--bs-body-bg);\">rsions:</span></p></div>",null,"Date and 24 hour military time","datetime_mdy",null,null,null,null,"y",null,null,null,null," @HIDEBUTTON"]
["suspectmeal","foodborne_illness_complaint_form",null,"notes","What foods did you eat or drink at [suspectestab]? ",null,null,null,null,null,null,null,"y"]
["script_illness","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\"> Illness Information","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">Next we'd like to know about your illness and medical care you may have received."]
["time_chart2","foodborne_illness_complaint_form",null,"descriptive",{"$cut":{"chars":21300,"head":"<div class=\"rich-text-field-label\"><table style=\"border-collapse: collapse; width: 100%; height: 320.667px;\" border=\"1\"><colgroup><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"><col style=\"width: 24.9758%;\"></colgroup> <tbody> <tr style=\"height: 24.6667px;\"> <td style=\"width: 467.5pt; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"4\" valign=\"top\" width=\"623\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time Conversion Chart</strong></p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Normal Time</strong></p> </td> <td style=\"width: 116.85pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time</strong></p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Normal Time</strong></p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\"><strong>Military Time</strong></p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00 AM</p> </td> <td style=\"width: 116.85pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">00:00</p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00 PM</p> </td> <td style=\"width: 116.9pt; border-top: none; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: solid windowtext 1.0pt; mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign=\"top\" width=\"156\"> <p style=\"margin-bottom: 0in; text-align: center; line-height: normal;\">12:00</p> </td> </tr> <tr style=\"height: 24.6667px;\"> <td style=\"width: 116.85pt; border: solid windowtext 1.0pt; border-top: none; mso-border-top-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;\" valign"}},null,null,null,null,null,null,null,null,null,null,null,null,"time_chart"]
["illnessonset","foodborne_illness_complaint_form",null,"text","<div class=\"rich-text-field-label\"><p>When did your illness start? Our system uses military time. Please see chart above for conversions:</p> <p> </p></div>",null,"Date and 24 hour military time","datetime_mdy","[mealdate]",null,null,null,"y",null,null,null,null," @HIDEBUTTON"]
["incubation_hrs","foodborne_illness_complaint_form",null,"calc","<div style=\"font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([mealdate], [illnessonset], \"h\", \"mdy\")),2)","Hours",null,null,null,null,"[illnessonset] <>''"]
["incubation_days","foodborne_illness_complaint_form",null,"calc","<div style=\"font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (days)","round ((datediff([mealdate], [illnessonset], \"d\", \"mdy\")), 2)","Days",null,null,null,null,"[illnessonset] <>''"]
["first_sympt","foodborne_illness_complaint_form",null,"text","What was the first symptom you experienced?"]
["symptoms","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did you experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,null,"y"]
["othersymptoms","foodborne_illness_complaint_form",null,"text","What other symptoms did you experience?",null,null,null,null,null,null,"[symptoms(7)] = '1'","y"]
["stillsick","foodborne_illness_complaint_form",null,"yesno","Are you still feeling ill?",null,null,null,null,null,null,null,null,"RH"]
["illnessend","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you feel better?",null,null,"date_mdy","[mealdate]",null,null,"[stillsick] = '0'",null,null,null,null,null," @HIDEBUTTON"]
["doctor","foodborne_illness_complaint_form",null,"yesno","During your illness, did you visit a doctor or other healthcare provider?",null,null,null,null,null,null,null,null,"RH"]
["dr_date","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did you visit a doctor or healthcare provider?",null,null,"date_mdy","[mealdate]",null,null,"[doctor] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["dr_facility","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did you visit?",null,null,null,null,null,null,"[doctor] = '1'"]
["dr_location","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where is [dr_facility] located?",null,null,null,null,null,null,"[doctor] = '1'"]
["dr_dx","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What was your diagnosis (if any)?",null,null,null,null,null,null,"[doctor] = '1'"]
["hospital","foodborne_illness_complaint_form",null,"yesno","Were you admitted to the hospital?",null,null,null,null,null,null,"[doctor] = '1'",null,"RH"]
["hosp_date","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date were you admitted?",null,null,"date_mdy","[mealdate]",null,null,"[hospital] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["hosp_name","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What hospital were you admitted to?",null,null,null,null,null,null,"[hospital] = '1'"]
["hosp_numdays","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">How many days were you in the hospital?",null,"days","number",null,null,null,"[hospital] = '1'"]
["stool_spec","foodborne_illness_complaint_form",null,"yesno","Did you give a stool sample?",null,null,null,null,null,null,"[doctor] = '1'",null,"RH"]
["stool_date","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you give a stool sample?",null,null,"date_mdy","[mealdate]",null,null,"[doctor] = '1' and [stool_spec] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["script_contactinfo","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Report Additional Illness","descriptive","<span style=\"font-size: 9.5pt\"><font color=\"#000080\"><font face=\"Open Sans\"> To investigate complaints and help prevent future illness, we would like to gather information from other ill people. \n\n<div style=\"font-weight:lighter\">If possible, we would like to talk with additional ill persons. \nHowever, you may also report illness information for other ill persons (children, family members, etc.) later in this report.\n\n</span>"]
["numdiners","foodborne_illness_complaint_form",null,"text","How many people were in your dining party? <span style=\"font-weight:lighter\"> \n(including yourself)",null,"Number","integer"]
["numill","foodborne_illness_complaint_form",null,"text","How many people in your dining party became ill? <span style=\"font-weight:lighter\">\n(including yourself)",null,"Number","integer"]
["household","foodborne_illness_complaint_form",null,"yesno","Do all ill persons live in the same household?",null,null,null,null,null,null,null,null,"RH"]
["otherill","foodborne_illness_complaint_form",null,"yesno","Do you know of any people outside of your dining party who became ill and ate at [suspectestab]?",null,null,null,null,null,null,null,null,"RH"]
["sharecontact","foodborne_illness_complaint_form",null,"radio","Would you be willing to share the name(s) and contact information for any ill persons you know?","1, Yes | 2, No | 3, Not Applicable",null,null,null,null,null,"[numill] > 1 or [otherill] = '1'",null,"RH"]
["addcontact_info","foodborne_illness_complaint_form",null,"notes","<div style=\"padding-left:3em; font-weight:lighter\">Name(s) and phones number(s) for ill persons",null,null,null,null,null,null,"[sharecontact] = '1'"]
["suspectestab_comm","foodborne_illness_complaint_form",null,"notes","Any observations or comments about this establishment?"]
["script_addillness","foodborne_illness_complaint_form",null,"descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">If you know of additional illnesses or medical care linked to this food establishment, we'd like to gather some additional details."]
["addreport","foodborne_illness_complaint_form",null,"yesno","Would you like to report another person's illness linked to the same establishment?\n\n<span style=\"font-weight:lighter\"> (i.e. child, dependent, family member) </span>",null,null,null,null,null,null,null,null,"RH"]
["reportnum","foodborne_illness_complaint_form",null,"text","How many people would you like to report?\n(1 - 10 people)",null,"Number 1-10","number",0,10,null,"[addreport] = '1'","y"]
["persontitle1","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #1",null,null,null,null,null,null,"[reportnum]>=1"]
["add_fname","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=1",null,"RH"]
["add_lname","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=1",null,"RH"]
["add_relat","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=1",null,"RH"]
["add_samemeal","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 1",null,"RH"]
["add_mealtime","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset","foodborne_illness_complaint_form",null,"text","When did this person's  illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=1",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Skin, mouth, or throat irritation (hives, swelling, flushing, burning) | 8, Blurred or double vision | 9, Other","select all that apply",null,null,null,null,"[reportnum]>=1"]
["add_othersymp","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms(7)] = '1'"]
["add_stillsick","foodborne_illness_complaint_form",null,"yesno","Are they still feeling ill?",null,null,null,null,null,null,"[reportnum]>=1",null,"RH"]
["add_feelbetter","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor","foodborne_illness_complaint_form",null,"yesno","During their illness, did they visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=1",null,"RH"]
["add_drdate","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor] = '1'"]
["addreport2","foodborne_illness_complaint_form",null,"yesno","Do you know of any other people with illness details that you would like to report?",null,null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["persontitle2","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #2",null,null,null,null,null,null,"[reportnum]>=2"]
["add_fname2","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=2",null,"RH"]
["add_lname2","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=2",null,"RH"]
["add_relat2","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=2",null,"RH"]
["add_samemeal2","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 2",null,"RH"]
["add_mealtime2","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal2] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset2","foodborne_illness_complaint_form",null,"text","When did this person's  illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=2",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms2","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=2"]
["add_othersymp2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms2(7)] = '1'"]
["add_stillsick2","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=2",null,"RH"]
["add_feelbetter2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick2] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor2","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=2",null,"RH"]
["add_drdate2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor2] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor2] = '1'"]
["persontitle3","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #3",null,null,null,null,null,null,"[reportnum]>=3"]
["add_fname3","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=3",null,"RH"]
["add_lname3","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=3",null,"RH"]
["add_relat3","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=3",null,"RH"]
["add_samemeal3","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 3",null,"RH"]
["add_mealtime3","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal3] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset3","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=3",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms3","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=3"]
["add_othersymp3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms3(7)] = '1'"]
["add_stillsick3","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=3",null,"RH"]
["add_feelbetter3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick3] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor3","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=3",null,"RH"]
["add_drdate3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor3] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor3] = '1'"]
["persontitle4","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #4",null,null,null,null,null,null,"[reportnum]>=4"]
["add_fname4","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=4",null,"RH"]
["add_lname4","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=4",null,"RH"]
["add_relat4","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=4",null,"RH"]
["add_samemeal4","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 4",null,"RH"]
["add_mealtime4","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal4] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset4","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=4",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms4","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=4"]
["add_othersymp4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms4(7)] = '1'"]
["add_stillsick4","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=4",null,"RH"]
["add_feelbetter4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick4] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor4","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=4",null,"RH"]
["add_drdate4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor4] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor4] = '1'"]
["persontitle5","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #5",null,null,null,null,null,null,"[reportnum]>=5"]
["add_fname5","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=5",null,"RH"]
["add_lname5","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=5",null,"RH"]
["add_relat5","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=5",null,"RH"]
["add_samemeal5","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 5",null,"RH"]
["add_mealtime5","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal5] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset5","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=5",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms5","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=5"]
["add_othersymp5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms5(7)] = '1'"]
["add_stillsick5","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=5",null,"RH"]
["add_feelbetter5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick5] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor5","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=5",null,"RH"]
["add_drdate5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor5] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor5] = '1'"]
["persontitle6","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #6",null,null,null,null,null,null,"[reportnum]>=6"]
["add_fname6","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=6",null,"RH"]
["add_lname6","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=6",null,"RH"]
["add_relat6","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=6",null,"RH"]
["add_samemeal6","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 6",null,"RH"]
["add_mealtime6","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal6] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset6","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=6",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms6","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=6"]
["add_othersymp6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms6(7)] = '1'"]
["add_stillsick6","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=6",null,"RH"]
["add_feelbetter6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick6] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor6","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=6",null,"RH"]
["add_drdate6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor6] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor6] = '1'"]
["persontitle7","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #7",null,null,null,null,null,null,"[reportnum]>=7"]
["add_fname7","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=7",null,"RH"]
["add_lname7","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=7",null,"RH"]
["add_relat7","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=7",null,"RH"]
["add_samemeal7","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 7",null,"RH"]
["add_mealtime7","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal7] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset7","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=7",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms7","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=7"]
["add_othersymp7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms7(7)] = '1'"]
["add_stillsick7","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=7",null,"RH"]
["add_feelbetter7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick7] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor7","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=7",null,"RH"]
["add_drdate7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor7] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor7] = '1'"]
["persontitle8","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #8",null,null,null,null,null,null,"[reportnum]>=8"]
["add_fname8","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=8",null,"RH"]
["add_lname8","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=8",null,"RH"]
["add_relat8","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=8",null,"RH"]
["add_samemeal8","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 8",null,"RH"]
["add_mealtime8","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal8] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset8","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=8",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms8","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=8"]
["add_othersymp8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms8(7)] = '1'"]
["add_stillsick8","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=8",null,"RH"]
["add_feelbetter8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick8] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor8","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=8",null,"RH"]
["add_drdate8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor8] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor8] = '1'"]
["persontitle9","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #9",null,null,null,null,null,null,"[reportnum]>=9"]
["add_fname9","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=9",null,"RH"]
["add_lname9","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=9",null,"RH"]
["add_relat9","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=9",null,"RH"]
["add_samemeal9","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 9",null,"RH"]
["add_mealtime9","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal9] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset9","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=9",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms9","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=9"]
["add_othersymp9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms9(7)] = '1'"]
["add_stillsick9","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=9",null,"RH"]
["add_feelbetter9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick9] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor9","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=9",null,"RH"]
["add_drdate9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor9] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor9] = '1'"]
["persontitle10","foodborne_illness_complaint_form",null,"descriptive","<p style=\"padding: 4px; color: white; background-color: #999999\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Additional Person #10",null,null,null,null,null,null,"[reportnum]>=10"]
["add_fname10","foodborne_illness_complaint_form",null,"text","First Name",null,null,null,null,null,null,"[reportnum]>=10",null,"RH"]
["add_lname10","foodborne_illness_complaint_form",null,"text","Last Name",null,null,null,null,null,null,"[reportnum]>=10",null,"RH"]
["add_relat10","foodborne_illness_complaint_form",null,"text","What is your relationship to this person?",null,null,null,null,null,null,"[reportnum]>=10",null,"RH"]
["add_samemeal10","foodborne_illness_complaint_form",null,"yesno"," <span style=\"font-size: 10pt; font-weight:lighter\"> <b>Did this person eat at the same meal?</b> ([mealdate])",null,null,null,null,null,null,"[reportnum] >= 10",null,"RH"]
["add_mealtime10","foodborne_illness_complaint_form",null,"text","When did this person eat at the suspected establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[add_samemeal10] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_illnessonset10","foodborne_illness_complaint_form",null,"text","When did this person's illness start?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[reportnum]>=10",null,"RH",null,null,null," @HIDEBUTTON"]
["add_symptoms10","foodborne_illness_complaint_form",null,"checkbox","Which of these symptoms did this person experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal cramps | 5, Fever | 6, Headache | 7, Other","select all that apply",null,null,null,null,"[reportnum]>=10"]
["add_othersymp10","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What other symptoms did this person experience?",null,null,null,null,null,null,"[add_symptoms10(7)] = '1'"]
["add_stillsick10","foodborne_illness_complaint_form",null,"yesno","Is this person still feeling ill?",null,null,null,null,null,null,"[reportnum]>=10",null,"RH"]
["add_feelbetter10","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did this person feel better?",null,null,"date_mdy",null,null,null,"[add_stillsick10] = '0'",null,"RH",null,null,null," @HIDEBUTTON"]
["add_visitdoctor10","foodborne_illness_complaint_form",null,"yesno","During their illness, did this person visit a doctor or other healthcare provider?",null,null,null,null,null,null,"[reportnum]>=10",null,"RH"]
["add_drdate10","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What date did this person visit a doctor or healthcare provider?",null,null,"date_mdy",null,null,null,"[add_visitdoctor10] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["add_drfacility10","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What healthcare facility did this person visit?",null,null,null,null,null,null,"[add_visitdoctor10] = '1'"]
["add_comments","foodborne_illness_complaint_form",null,"notes","Do you have any comments regarding additional illnesses?",null,null,null,null,null,null,"[addreport] = '1'",null,"RH"]
["script_foodhx","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Food History","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">Next, we'd like to collect the name(s) and date(s) of any other food establishments you may have visited in the <u>3 days</u> before you became ill."]
["script_foodhx2","foodborne_illness_complaint_form",null,"descriptive","</B>Many people may assume the last meal they ate is what caused them to become ill. However, foodborne illnesses can take up to 3 days or more after eating an item for symptoms to occur. Please provide information from <B><U>3 days</B></U> before illness onset<font color=\"red\"> (displayed below in red)</font color=\"red\">. \n\n<B>Food Recall Tips:\n<ul style=\"padding-left:2em; font-weight:lighter; list-style-type:disc\"><li>Use a calendar</li><li>Consider using bank statements or food diaries</li><li>"]
["prompt_onset","foodborne_illness_complaint_form",null,"descriptive","<div class=\"red\" >You stated that your illness began on : <b>[illnessonset] </b> <I>(24 hour military time)<I>"]
["otherestab_name1","foodborne_illness_complaint_form",null,"text","1. Establishment Name and Location"]
["otherestab_date1","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,null,null,null,null,null,null," @HIDEBUTTON"]
["incub_estab1","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date1], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date1] <> ''"]
["otherestab_obs1","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?"]
["otherestab_name2","foodborne_illness_complaint_form",null,"text","2. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name1] <> \"\""]
["otherestab_date2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name1] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab2","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date2], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date2] <> ''"]
["otherestab_obs2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name1] <> \"\""]
["otherestab_name3","foodborne_illness_complaint_form",null,"text","3. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name2] <> \"\""]
["otherestab_date3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name2] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab3","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date3], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date3] <> ''"]
["otherestab_obs3","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name2] <> \"\""]
["otherestab_name4","foodborne_illness_complaint_form",null,"text","4. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name3] <> \"\""]
["otherestab_date4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name3] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab4","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date4], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date4] <> ''"]
["otherestab_obs4","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name3] <> \"\""]
["otherestab_name5","foodborne_illness_complaint_form",null,"text","5. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name4] <> \"\""]
["otherestab_date5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name4] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab5","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date5], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date5] <> ''"]
["otherestab_obs5","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name4] <> \"\""]
["otherestab_name6","foodborne_illness_complaint_form",null,"text","6. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name5] <> \"\""]
["otherestab_date6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name5] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab6","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date6], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date6] <> ''"]
["otherestab_obs6","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name5] <> \"\""]
["otherestab_name7","foodborne_illness_complaint_form",null,"text","7. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name6] <> \"\""]
["otherestab_date7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name6] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab7","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date7], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date7] <> ''"]
["otherestab_obs7","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name6] <> \"\""]
["otherestab_name8","foodborne_illness_complaint_form",null,"text","8. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name7] <> \"\""]
["otherestab_date8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name7] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab8","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date8], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date8] <> ''"]
["otherestab_obs8","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name7] <> \"\""]
["otherestab_name9","foodborne_illness_complaint_form",null,"text","9. Establishment Name and Location",null,null,null,null,null,null,"[otherestab_name8] <> \"\""]
["otherestab_date9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">When did you eat at this establishment?",null,"Date and 24 hour military time","datetime_mdy",null,null,null,"[otherestab_name8] <> \"\"",null,null,null,null,null," @HIDEBUTTON"]
["incub_estab9","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and meal time (hours)","round ((datediff([otherestab_date9], [illnessonset], \"h\", \"mdy\")),2)",null,null,null,null,null,"[otherestab_date9] <> ''"]
["otherestab_obs9","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:4em; font-weight:lighter\">Any observations or comments about this establishment?",null,null,null,null,null,null,"[otherestab_name8] <> \"\""]
["observeill","foodborne_illness_complaint_form",null,"radio","Did you observe anyone who appeared to be ill at any of the establishments you visited?","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["observeill_where","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Which establishment?",null,null,null,null,null,null,"[observeill] = '1'"]
["observeill_describe","foodborne_illness_complaint_form",null,"notes","<div style=\"padding-left:3em; font-weight:lighter\">Please describe what you observed",null,null,null,null,null,null,"[observeill] = '1'"]
["other_rest","foodborne_illness_complaint_form",null,"notes","Any comments or additional information on establishments you visited?"]
["script_exphx","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\">  Exposure History","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">The next questions are about other exposures you may have had during the <U>3 days</U> before you became ill."]
["prompt_onset2","foodborne_illness_complaint_form",null,"descriptive","<div class=\"red\" >You stated that your illness began on : <b>[illnessonset] </b> <I>(24 hour military time)<I>"]
["script_exphx2","foodborne_illness_complaint_form",null,"descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">During the 3 days before your illness began..."]
["travel","foodborne_illness_complaint_form",null,"radio","Did you travel outside your normal routine?","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["travelinfo","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where did you travel?",null,null,null,null,null,null,"[travel] = '1'"]
["travel_depart","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did leave for your destination?",null,null,"date_mdy",null,null,null,"[travel] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["travel_return","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you return from your destination? (if applicable)",null,null,"date_mdy",null,null,null,"[travel] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["specialevents","foodborne_illness_complaint_form",null,"radio","Did you attend any special events or gatherings?\n<div style=\"font-weight:lighter\">(concerts, festivals, meeting, religious events, etc.)","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["speicalevent_what","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">What event did you attend?",null,null,null,null,null,null,"[specialevents] = '1'"]
["specialevent_when","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you attend the event?",null,null,"date_mdy",null,null,null,"[specialevents] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["specialevent_where","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where did you attend the event?",null,null,null,null,null,null,"[specialevents] = '1'"]
["animal","foodborne_illness_complaint_form",null,"radio","Did you come into contact with any animals?","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["animal_type","foodborne_illness_complaint_form",null,"checkbox","<div style=\"padding-left:3em; font-weight:lighter\">What type of animals did you come into contact with?","1, dog | 2, cat | 9, bird (chicken, turkey, duck, etc.) | 10, livestock/farm animal (cattle, goat, pig, etc.) | 11, reptile/amphibian (turtle, lizard, frog, etc.) | 12, other",null,null,null,null,null,"[animal] = '1'"]
["animal_other","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Please specify other animal",null,null,null,null,null,null,"[animal_type(12)] = '1'"]
["animal_home","foodborne_illness_complaint_form",null,"yesno","<div style=\"padding-left:3em; font-weight:lighter\">Did you come into contact with the animal(s) only at your home?",null,null,null,null,null,null,"[animal] = '1'",null,"RH"]
["animals_where","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where did you come into contact with animals?",null,null,null,null,null,null,"[animal] = '1' and [animal_home] = '0'"]
["animal_when","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you come into contact with animals?",null,null,"date_mdy",null,null,null,"[animal] = '1' and [animal_home] = '0'",null,null,null,null,null," @HIDEBUTTON"]
["swim","foodborne_illness_complaint_form",null,"radio","Did you swim or wade in any natural water?\n<div style=\"font-weight:lighter\">(lakes, river, etc.)","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["swim_location","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where did you swim or wade?",null,null,null,null,null,null,"[swim] = '1'"]
["swim_when","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you swim or wade?",null,null,"date_mdy",null,null,null,"[swim] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["drink_untreat","foodborne_illness_complaint_form",null,"radio","Did you drink any untreated water from a lake, untreated well, etc.? <div style=\"font-weight:lighter\">(including brushing teeth)","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["drink_location","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where did you drink or use untreated water?",null,null,null,null,null,null,"[drink_untreat] = '1'"]
["drink_when","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">When did you drink or use untreated water?",null,null,"date_mdy",null,null,null,"[drink_untreat] = '1'",null,null,null,null,null," @HIDEBUTTON"]
["outdoor_activity","foodborne_illness_complaint_form",null,"radio","Did you perform any outdoor or organized adventure activity?","1, Yes | 2, No | 3, Unknown","Examples: caving, camping, hiking, mountain biking, rafting, zip lining, off road ATV or vehicle, etc.",null,null,null,null,null,null,"RH"]
["activity","foodborne_illness_complaint_form",null,"checkbox","<div style=\"padding-left:3em; font-weight:lighter\">If \"Yes\" what activity?","1, Zip Lining | 2, Caving | 3, Camping | 4, Hiking | 5, Mountain Biking | 6, Rafting | 7, Canoeing | 8, Off Road ATV/Vehicle | 9, Other",null,null,null,null,null,"[outdoor_activity] = '1'"]
["activity_other","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">If \"Other,\" please specify.",null,null,null,null,null,null,"[activity(9)] = '1'",null,"RH"]
["activity_date","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Date/Time of activity",null,null,"datetime_mdy",null,null,null,"[outdoor_activity] = '1'",null,"RH"]
["act_incubation","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:4em; font-weight:lighter\"><font color=\"red\">Incubation time between illness onset and outdoor activity time (hours)","round ((datediff([activity_date], [illnessonset], \"h\", \"mdy\")),2)"]
["act_est_name","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Establishment name",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_est_address","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Establishment address",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_est_city","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Establishment city",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_est_county","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Establishment county",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_food","foodborne_illness_complaint_form",null,"yesno","<div style=\"padding-left:3em; font-weight:lighter\">Did you consume any food or beverages (including water) while visiting the facility?",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_food_consumed","foodborne_illness_complaint_form",null,"notes","<div style=\"padding-left:3em; font-weight:lighter\">If  \"Yes\" please list the food/beverage items consumed.",null,null,null,null,null,null,"[act_food] = '1'"]
["act_other_ill","foodborne_illness_complaint_form",null,"yesno","<div style=\"padding-left:3em; font-weight:lighter\">Do you know anyone else who became ill after the activity?",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_number_ill","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">How many became ill in your party? (including yourself)",null,null,"integer",1,1000,null,"[act_other_ill] = '1'"]
["act_other_ill_contact","foodborne_illness_complaint_form",null,"yesno","<div style=\"padding-left:3em; font-weight:lighter\">If \"Yes,\" are you willing to provide us with their name and contact information?",null,null,null,null,null,null,"[act_other_ill] = '1'"]
["act_name1","foodborne_illness_complaint_form",null,"notes","<div style=\"padding-left:3em; font-weight:lighter\">First and last name, phone number, and email",null,null,null,null,null,null,"[act_other_ill_contact] = '1'"]
["act_ill_staff","foodborne_illness_complaint_form",null,"yesno","<div style=\"padding-left:3em; font-weight:lighter\">Did you notice illness among other individuals at the facility? (visitors, staff members, etc.)",null,null,null,null,null,null,"[outdoor_activity] = '1'"]
["act_ill_other","foodborne_illness_complaint_form",null,"checkbox","<div style=\"padding-left:3em; font-weight:lighter\">If \"Yes\" please specify","1, Staff Members | 2, Visitors/customers | 3, Other",null,null,null,null,null,"[act_ill_staff] = '1'"]
["act_ill_other2","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">If \"Other\" please specify",null,null,null,null,null,null,"[act_ill_other(3)] = '1'"]
["act_other_sympt","foodborne_illness_complaint_form",null,"checkbox","<div style=\"padding-left:3em; font-weight:lighter\">If known, what symptoms did they experience?","1, Diarrhea | 2, Vomiting | 3, Nausea | 4, Abdominal Cramps | 5, Fever | 6, Headache | 7, Other",null,null,null,null,null,"[act_ill_staff] = '1'"]
["act_sypmt_other","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">If \"Other,\" please specify the symptoms ",null,null,null,null,null,null,"[act_other_sympt(7)] = '1'"]
["contactw_diarrhea","foodborne_illness_complaint_form",null,"radio","Were you in close contact with a person who had diarrhea or vomiting?","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["sensitivework","foodborne_illness_complaint_form",null,"yesno","Are you a food handler, healthcare worker or day care worker?",null,null,null,null,null,null,null,null,"RH"]
["workplace","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em; font-weight:lighter\">Where do you work?",null,null,null,null,null,null,"[sensitivework] = '1'"]
["exp_notes","foodborne_illness_complaint_form",null,"notes","Any other comments about general exposures in the 3 days before illness?"]
["script_report","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\"> Other Reports","descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\">Lastly, we have just a couple questions to wrap up this complaint report."]
["otherreport","foodborne_illness_complaint_form",null,"radio","Did you report your illness in any other way? \n\n<span style =\"font-weight:lighter\">(social media, another health agency, news media, contact restaurant directly, etc.)","1, Yes | 2, No | 3, Unknown",null,null,null,null,null,null,null,"RH"]
["otherreport_how","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em\">How else did you report this illness? \n\n<span style =\"font-weight:lighter\">(Ex: Facebook, Twitter, other social media, another health agency, news media, contact restaurant directly, etc.)</span>",null,null,null,null,null,null,"[otherreport] = '1'"]
["comments","foodborne_illness_complaint_form",null,"notes","Is there anything else you feel may be relevant that has not been asked? "]
["contact_followup","foodborne_illness_complaint_form","<p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\"> Interview Conclusion","yesno","May we contact you in the future with additional questions about your illness?"]
["sub_script","foodborne_illness_complaint_form",null,"descriptive","<span style=\"font-size: 10pt\"><font color=\"#000080\"><font face=\"Open Sans\"> Thank you for taking the time to make this complaint. The information you just provided could help to prevent future foodborne illnesses from occurring. \n\n"]
["intvw_notes","foodborne_illness_complaint_form",null,"notes","Additional interview note(s)",null,null,null,null,null,null,null,null,"LV"]
["incubation_hrs_repeat","foodborne_illness_complaint_form",null,"calc","Incubation time between illness onset and suspect meal (hours)","[incubation_hrs]","Hours",null,null,null,null,null,null,null,null,null,null," @HIDDEN-SURVEY"]
["invest_date","foodborne_illness_complaint_form",null,"text","Date of environmental health investigation",null,null,"date_mdy",null,null,null,null,null,null,null,null,null," @HIDEBUTTON @HIDDEN-SURVEY"]
["invest_report","foodborne_illness_complaint_form",null,"file","Please upload investigation report here (i.e. scanned field notes)",null,null,null,null,null,null,null,null,null,null,null,null," @HIDDEN-SURVEY"]
["add_files","foodborne_illness_complaint_form",null,"file","Additional Files"]
["obinvest","foodborne_illness_complaint_form",null,"yesno","Did this complaint result in an outbreak investigation?",null,null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN-SURVEY"]
["eh_notes","foodborne_illness_complaint_form",null,"notes","Additional notes or comments",null,null,null,null,null,null,null,null,"LV",null,null,null," @HIDDEN-SURVEY"]
["linked_reports","foodborne_illness_complaint_form"," <p style=\"padding: 4px; color: white; background-color: #000080; border: white 1px solid\"><font color=\"white\" font size=\"2\" font face=\"open sans\">Linked Complaints","yesno","<font color=\"red\">Is this complaint linked to any other complaints?",null,null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN-SURVEY"]
["link_num","foodborne_illness_complaint_form",null,"dropdown","How many complaints would you like to link?","1, 1 | 2, 2 | 3, 3 | 4, 4",null,null,null,null,null,"[linked_reports] = '1'"]
["link_id1","foodborne_illness_complaint_form",null,"sql","<div style=\"padding-left:3em; font-weight:lighter\">Select the ID of the linked complaint","SELECT a.record, CONCAT_WS(' | ', CONCAT('ID: ', max(if(a.field_name = 'redcapid', a.value, NULL))), CONCAT(max(if(a.field_name = 'rec_date', a.value, NULL))), CONCAT(max(if(a.field_name = 'suspectestab', a.value, NULL)))) as value FROM redcap_data a WHERE a.project_id=2934 GROUP BY a.record ORDER BY value;","REDCap ID | Complaint Date | Establishment Name","autocomplete",null,null,null,"[link_num] >0",null,"RH"]
["link_id1_calc","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:3em; font-weight:lighter\">Linked ID Calc 1","[link_id1]",null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["link_id2","foodborne_illness_complaint_form",null,"sql","<div style=\"padding-left:3em; font-weight:lighter\">Select the ID of the second linked complaint","SELECT a.record, CONCAT_WS(' | ', CONCAT('ID: ', max(if(a.field_name = 'redcapid', a.value, NULL))), CONCAT(max(if(a.field_name = 'rec_date', a.value, NULL))), CONCAT(max(if(a.field_name = 'suspectestab', a.value, NULL)))) as value FROM redcap_data a WHERE a.project_id=88 GROUP BY a.record ORDER BY value;","REDCap ID | Complaint Date | Establishment Name","autocomplete",null,null,null,"[link_num] >1",null,"RH"]
["link_id2_calc","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:3em; font-weight:lighter\">Linked ID Calc 2","[link_id2]",null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["link_id3","foodborne_illness_complaint_form",null,"sql","<div style=\"padding-left:3em; font-weight:lighter\">Select the ID of the third linked complaint","SELECT a.record, CONCAT_WS(' | ', CONCAT('ID: ', max(if(a.field_name = 'redcapid', a.value, NULL))), CONCAT(max(if(a.field_name = 'rec_date', a.value, NULL))), CONCAT(max(if(a.field_name = 'suspectestab', a.value, NULL)))) as value FROM redcap_data a WHERE a.project_id=88 GROUP BY a.record ORDER BY value;","REDCap ID | Complaint Date | Establishment Name","autocomplete",null,null,null,"[link_num] >2",null,"RH"]
["link_id3_calc","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:3em; font-weight:lighter\">Linked ID Calc 3","[link_id3]",null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["link_id4","foodborne_illness_complaint_form",null,"sql","<div style=\"padding-left:3em; font-weight:lighter\">Select the ID of the fourth linked complaint","SELECT a.record, CONCAT_WS(' | ', CONCAT('ID: ', max(if(a.field_name = 'redcapid', a.value, NULL))), CONCAT(max(if(a.field_name = 'rec_date', a.value, NULL))), CONCAT(max(if(a.field_name = 'suspectestab', a.value, NULL)))) as value FROM redcap_data a WHERE a.project_id=88 GROUP BY a.record ORDER BY value;","REDCap ID | Complaint Date | Establishment Name","autocomplete",null,null,null,"[link_num] >3",null,"RH"]
["link_id4_calc","foodborne_illness_complaint_form",null,"calc","<div style=\"padding-left:3em; font-weight:lighter\">Linked ID Calc 4","[link_id4]",null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["copypaste1","foodborne_illness_complaint_form",null,"descriptive","<div>\nCopy and paste the link(s) below to open linked complaint(s): </div><div style=\"font-weight:lighter\">\nhttps://redcap.health.tn.gov/redcap/redcap_v6.16.6/DataEntry/index.php?pid=88&page=foodborne_illness_complaint_form&id=[link_id1_calc]\n\n</div>",null,null,null,null,null,null,"[link_num] >0"]
["copypaste2","foodborne_illness_complaint_form",null,"descriptive","<div style=\"font-weight:lighter\">https://redcap.health.tn.gov/redcap/redcap_v6.16.6/DataEntry/index.php?pid=88&page=foodborne_illness_complaint_form&id=[link_id2_calc]\n\n</div>",null,null,null,null,null,null,"[link_num] >1"]
["copypaste3","foodborne_illness_complaint_form",null,"descriptive","<div style=\"font-weight:lighter\">https://redcap.health.tn.gov/redcap/redcap_v6.16.6/DataEntry/index.php?pid=88&page=foodborne_illness_complaint_form&id=[link_id3_calc]\n\n</div>",null,null,null,null,null,null,"[link_num] >2"]
["copypaste4","foodborne_illness_complaint_form",null,"descriptive","<div style=\"font-weight:lighter\">https://redcap.health.tn.gov/redcap/redcap_v6.16.6/DataEntry/index.php?pid=88&page=foodborne_illness_complaint_form&id=[link_id4_calc]\n\n</div>",null,null,null,null,null,null,"[link_num] >3"]
["outbreak_result","foodborne_illness_complaint_form",null,"yesno","Did this complaint result in an outbreak?",null,null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN-SURVEY"]
["triage_step","foodborne_illness_complaint_form",null,"checkbox","What were the next steps taken for triage?","1, Quarantined | 2, Pushed to region/county | 3, Epi notified",null,null,null,null,null,null,null,null,null,null,null," @HIDDEN-SURVEY"]
["rec_region","foodborne_illness_complaint_form",null,"dropdown","Public health region","1, CHR - Chattanooga Hamilton County | 2, ETR - East Tennessee Region | 3, JMR - Jackson Madison County | 4, KKR - Knoxville Knox County | 5, MCR - Mid-Cumberland Region | 6, MSR - Memphis Shelby County | 7, NDR - Nashville Davidson County | 8, NER - Northeast Region | 9, NWR - Northwest Region | 10, SCR - South Central Region | 11, SER - Southeast Region | 12, SWR - Southwest Region | 13, UCR - Upper Cumberland Region | 14, CO - Central Office | 15, Unknown | 16, TN Dept. of Ag",null,null,null,null,null,null,null,null,null,null,null," @HIDDEN-SURVEY"]
["rec_region_calc","foodborne_illness_complaint_form",null,"calc","Calculated public health region","if ([estab_county]='Hamilton',1,\nif ([estab_county]='Anderson',2,\nif ([estab_county]='Blount',2,\nif ([estab_county]='Campbell',2,\nif ([estab_county]='Claiborne',2,\nif ([estab_county]='Cocke',2,\nif ([estab_county]='Grainger',2,\nif ([estab_county]='Hamblen',2,\nif ([estab_county]='Jefferson',2,\nif ([estab_county]='Loudon',2,\nif ([estab_county]='Monroe',2,\nif ([estab_county]='Morgan',2,\nif ([estab_county]='Roane',2,\nif ([estab_county]='Scott',2,\nif ([estab_county]='Sevier',2,\nif ([estab_county]='Union',2,\nif ([estab_county]='Madison',3,\nif ([estab_county]='Knox',4,\nif ([estab_county]='Cheatham',5,\nif ([estab_county]='Dickson',5,\nif ([estab_county]='Houston',5,\nif ([estab_county]='Humphreys',5,\nif ([estab_county]='Montgomery',5,\nif ([estab_county]='Robertson',5,\nif ([estab_county]='Rutherford',5,\nif ([estab_county]='Stewart',5,\nif ([estab_county]='Sumner',5,\nif ([estab_county]='Trousdale',5,\nif ([estab_county]='Williamson',5,\nif ([estab_county]='Wilson',5,\nif ([estab_county]='Shelby',6,\nif ([estab_county]='Davidson',7,\nif ([estab_county]='Carter',8,\nif ([estab_county]='Greene',8,\nif ([estab_county]='Hancock',8,\nif ([estab_county]='Hawkins',8,\nif ([estab_county]='Johnson',8,\nif ([estab_county]='Sullivan',8,\nif ([estab_county]='Unicoi',8,\nif ([estab_county]='Washington',8,\nif ([estab_county]='Benton',9,\nif ([estab_county]='Carroll',9,\nif ([estab_county]='Crockett',9,\nif ([estab_county]='Dyer',9,\nif ([estab_county]='Gibson',9,\nif ([estab_county]='Henry',9,\nif ([estab_county]='Lake',9,\nif ([estab_county]='Obion',9,\nif ([estab_county]='Weakley',9,\nif ([estab_county]='Bedford',10,\nif ([estab_county]='Coffee',10,\nif ([estab_county]='Giles',10,\nif ([estab_county]='Hickman',10,\nif ([estab_county]='Lawrence',10,\nif ([estab_county]='Lewis',10,\nif ([estab_county]='Lincoln',10,\nif ([estab_county]='Marshall',10,\nif ([estab_county]='Maury',10,\nif ([estab_county]='Moore',10,\nif ([estab_county]='Perry',10,\nif ([estab_county]='Wayne',10,\nif ([estab_county]='Bledsoe',11,\nif ([estab_county]='Bradley',11,\nif ([estab_county]='Franklin',11,\nif ([estab_county]='Grundy',11,\nif ([estab_county]='Marion',11,\nif ([estab_county]='McMinn',11,\nif ([estab_county]='Meigs',11,\nif ([estab_county]='Polk',11,\nif ([estab_county]='Rhea',11,\nif ([estab_county]='Sequatchie',11,\nif ([estab_county]='Chester',12,\nif ([estab_county]='Decatur',12,\nif ([estab_county]='Fayette',12,\nif ([estab_county]='Hardeman',12,\nif ([estab_county]='Hardin',12,\nif ([estab_county]='Haywood',12,\nif ([estab_county]='Henderson',12,\nif ([estab_county]='Lauderdale',12,\nif ([estab_county]='McNairy',12,\nif ([estab_county]='Tipton',12,\nif ([estab_county]='Van Buren',13,\nif ([estab_county]='Cannon',13,\nif ([estab_county]='Clay',13,\nif ([estab_county]='Cumberland',13,\nif ([estab_county]='DeKalb',13,\nif ([estab_county]='Fentress',13,\nif ([estab_county]='Jackson',13,\nif ([estab_county]='Macon',13,\nif ([estab_county]='Overton',13,\nif ([estab_county]='Pickett',13,\nif ([estab_county]='Putnam',13,\nif ([estab_county]='Smith',13,\nif ([estab_county]='Warren',13,\nif ([estab_county]='White',13,\"\"\n)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))"]
["rec_agency","foodborne_illness_complaint_form",null,"text","Public health agency received by",null,null,null,null,null,null,null,"y",null,null,null,null," @HIDDEN"]
["fed_complaint","foodborne_illness_complaint_form",null,"yesno","Did a federal partner (USDA, FDA, CDC, etc.) initially receive the complaint?",null,null,null,null,null,null,null,null,null,null,null,null," @HIDDEN"]
["fed_complaint2","foodborne_illness_complaint_form",null,"dropdown","Which federal partner initially received the complaint?","1, USDA | 2, FDA | 3, CDC",null,null,null,null,null,"[fed_complaint] = '1'",null,null,null,null,null," @HIDDEN"]
["rec_staff","foodborne_illness_complaint_form",null,"text","Staff member received by",null,"Name",null,null,null,null,null,"y",null,null,null,null," @HIDDEN"]
["incubation_days_repeat","foodborne_illness_complaint_form",null,"calc","Incubation time between illness onset and suspect meal (days)","[incubation_days]","Days",null,null,null,null,null,null,null,null,null,null," @HIDDEN"]
["transfer","foodborne_illness_complaint_form",null,"radio","<font color=\"red\">Does this complaint need to be transferred to another region for follow-up?","1, Yes | 2, No",null,null,null,null,null,null,null,"RH",null,null,null," @HIDDEN"]
["trans_region","foodborne_illness_complaint_form",null,"dropdown","<div style=\"padding-left:3em;\">Transfer to:","CHR, Chattanooga - Hamilton County (CHR) | ETR, East Tennessee Region (ETR) | JMR, Jackson - Madison County (JMR) | KKR, Knoxville - Knox County (KKR) | MCR, Mid-Cumberland Region (MCR) | MSR, Memphis - Shelby County (MSR) | NDR, Nashville - Davidson County (NDR) | NER, Northeast Region (NER) | NWR, Northwest Region (NWR) | SCR, South Central Region (SCR) | SER, Southeast Region (SER) | SWR, Southwest Region (SWR) | UCR, Upper Cumberland Region (UCR)",null,"autocomplete",null,null,null,"[transfer] = '1'","y","RH",null,null,null," @HIDDEN"]
["trans_date","foodborne_illness_complaint_form",null,"text","<div style=\"padding-left:3em;\">Date of transfer",null,null,"date_mdy",null,null,null,"[transfer] = '1'","y","RH",null,null,null," @HIDDEN"]
["env_id","foodborne_illness_complaint_form",null,"text","Environmentalist ID Number",null,null,"number",null,9999,null,null,null,null,null,null,null," @HIDDEN"]
["link_notes","foodborne_illness_complaint_form",null,"notes","Notes regarding linked cases",null,null,null,null,null,null,"[linked_reports] = '1'",null,"LV"]