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功能 #13599 » 健康署婦女乳房X光攝影檢查服務之篩檢疑似異常個案報告表.json

Laura Huang, 2026/09/07 上午02:37

 
{
"locale": "zh-tw",
"title": "健康署婦女乳房X光攝影檢查服務之篩檢疑似異常個案報告表",
"description": "本檢查「由衛生福利部國民健康署運用菸品健康福利捐／公務預算補助」（114 年 1 月修訂）",
"pages": [
{
"name": "exam_info",
"title": "檢查資訊",
"elements": [
{
"type": "text",
"name": "medical_record_number",
"title": "病歷號",
"isRequired": true,
"placeholder": "請輸入病歷號"
},
{
"type": "text",
"name": "patient_name",
"title": "姓名",
"isRequired": true,
"placeholder": "請輸入姓名"
},
{
"type": "text",
"name": "id_number",
"startWithNewLine": false,
"title": "身分證統一編號／統一證號（外籍）",
"isRequired": true,
"placeholder": "請輸入身分證字號或統一證號"
},
{
"type": "panel",
"name": "birth_date_panel",
"title": "出生日期",
"elements": [
{
"type": "text",
"name": "birth_year",
"title": "民國年",
"isRequired": true,
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "例：70"
},
{
"type": "dropdown",
"name": "birth_month",
"startWithNewLine": false,
"title": "月份",
"isRequired": true,
"choices": [
{
"value": "01",
"text": "1 月"
},
{
"value": "02",
"text": "2 月"
},
{
"value": "03",
"text": "3 月"
},
{
"value": "04",
"text": "4 月"
},
{
"value": "05",
"text": "5 月"
},
{
"value": "06",
"text": "6 月"
},
{
"value": "07",
"text": "7 月"
},
{
"value": "08",
"text": "8 月"
},
{
"value": "09",
"text": "9 月"
},
{
"value": "10",
"text": "10 月"
},
{
"value": "11",
"text": "11 月"
},
{
"value": "12",
"text": "12 月"
}
],
"placeholder": "請選擇月份"
},
{
"type": "dropdown",
"name": "birth_day",
"startWithNewLine": false,
"title": "日期",
"isRequired": true,
"choices": [
{
"value": "01",
"text": "1 日"
},
{
"value": "02",
"text": "2 日"
},
{
"value": "03",
"text": "3 日"
},
{
"value": "04",
"text": "4 日"
},
{
"value": "05",
"text": "5 日"
},
{
"value": "06",
"text": "6 日"
},
{
"value": "07",
"text": "7 日"
},
{
"value": "08",
"text": "8 日"
},
{
"value": "09",
"text": "9 日"
},
{
"value": "10",
"text": "10 日"
},
{
"value": "11",
"text": "11 日"
},
{
"value": "12",
"text": "12 日"
},
{
"value": "13",
"text": "13 日"
},
{
"value": "14",
"text": "14 日"
},
{
"value": "15",
"text": "15 日"
},
{
"value": "16",
"text": "16 日"
},
{
"value": "17",
"text": "17 日"
},
{
"value": "18",
"text": "18 日"
},
{
"value": "19",
"text": "19 日"
},
{
"value": "20",
"text": "20 日"
},
{
"value": "21",
"text": "21 日"
},
{
"value": "22",
"text": "22 日"
},
{
"value": "23",
"text": "23 日"
},
{
"value": "24",
"text": "24 日"
},
{
"value": "25",
"text": "25 日"
},
{
"value": "26",
"text": "26 日"
},
{
"value": "27",
"text": "27 日"
},
{
"value": "28",
"text": "28 日"
},
{
"value": "29",
"text": "29 日"
},
{
"value": "30",
"text": "30 日"
},
{
"value": "31",
"text": "31 日"
}
],
"placeholder": "請選擇日期"
}
]
},
{
"type": "panel",
"name": "xray_date_panel",
"title": "攝影日期",
"elements": [
{
"type": "text",
"name": "xray_year",
"title": "民國年",
"isRequired": true,
"inputType": "number",
"min": 100,
"max": 150,
"placeholder": "例：114"
},
{
"type": "dropdown",
"name": "xray_month",
"startWithNewLine": false,
"title": "月份",
"isRequired": true,
"choices": [
{
"value": "01",
"text": "1 月"
},
{
"value": "02",
"text": "2 月"
},
{
"value": "03",
"text": "3 月"
},
{
"value": "04",
"text": "4 月"
},
{
"value": "05",
"text": "5 月"
},
{
"value": "06",
"text": "6 月"
},
{
"value": "07",
"text": "7 月"
},
{
"value": "08",
"text": "8 月"
},
{
"value": "09",
"text": "9 月"
},
{
"value": "10",
"text": "10 月"
},
{
"value": "11",
"text": "11 月"
},
{
"value": "12",
"text": "12 月"
}
],
"placeholder": "請選擇月份"
},
{
"type": "dropdown",
"name": "xray_day",
"startWithNewLine": false,
"title": "日期",
"isRequired": true,
"choices": [
{
"value": "01",
"text": "1 日"
},
{
"value": "02",
"text": "2 日"
},
{
"value": "03",
"text": "3 日"
},
{
"value": "04",
"text": "4 日"
},
{
"value": "05",
"text": "5 日"
},
{
"value": "06",
"text": "6 日"
},
{
"value": "07",
"text": "7 日"
},
{
"value": "08",
"text": "8 日"
},
{
"value": "09",
"text": "9 日"
},
{
"value": "10",
"text": "10 日"
},
{
"value": "11",
"text": "11 日"
},
{
"value": "12",
"text": "12 日"
},
{
"value": "13",
"text": "13 日"
},
{
"value": "14",
"text": "14 日"
},
{
"value": "15",
"text": "15 日"
},
{
"value": "16",
"text": "16 日"
},
{
"value": "17",
"text": "17 日"
},
{
"value": "18",
"text": "18 日"
},
{
"value": "19",
"text": "19 日"
},
{
"value": "20",
"text": "20 日"
},
{
"value": "21",
"text": "21 日"
},
{
"value": "22",
"text": "22 日"
},
{
"value": "23",
"text": "23 日"
},
{
"value": "24",
"text": "24 日"
},
{
"value": "25",
"text": "25 日"
},
{
"value": "26",
"text": "26 日"
},
{
"value": "27",
"text": "27 日"
},
{
"value": "28",
"text": "28 日"
},
{
"value": "29",
"text": "29 日"
},
{
"value": "30",
"text": "30 日"
},
{
"value": "31",
"text": "31 日"
}
],
"placeholder": "請選擇日期"
}
]
},
{
"type": "text",
"name": "hospital_name",
"title": "醫院名稱",
"isRequired": true,
"placeholder": "請輸入醫院名稱"
},
{
"type": "text",
"name": "radiologist",
"startWithNewLine": false,
"title": "放射科醫師",
"isRequired": true,
"placeholder": "請輸入醫師姓名"
}
]
},
{
"name": "abnormal_result",
"title": "乳房X光攝影疑似異常結果",
"elements": [
{
"type": "radiogroup",
"name": "bi_rads_category",
"title": "BI-RADS 分類",
"isRequired": true,
"choices": [
{
"value": "0",
"text": "Category 0: Need Additional Imaging Evaluation"
},
{
"value": "3",
"text": "Category 3: Probably Benign Finding — Short Interval Follow-up Is Suggested"
},
{
"value": "4",
"text": "Category 4: Suspicious Abnormality — Biopsy Should Be Considered"
},
{
"value": "5",
"text": "Category 5: Highly Suggestive of Malignancy — Appropriate Action Should Be Taken"
}
]
},
{
"type": "radiogroup",
"name": "category4_sub",
"visibleIf": "{bi_rads_category} = '4'",
"title": "Category 4 分級",
"isRequired": true,
"choices": [
{
"value": "a",
"text": "a. Low suspicion"
},
{
"value": "b",
"text": "b. Moderate suspicion"
},
{
"value": "c",
"text": "c. High suspicion"
}
]
}
]
},
{
"name": "lesion_selection",
"title": "病灶勾選",
"elements": [
{
"type": "paneldynamic",
"name": "lesion_groups",
"title": "病灶資料",
"description": "如單側多處病灶或兩側皆有病灶，請點擊下方按鈕新增另一組病灶分開填寫",
"templateElements": [
{
"type": "checkbox",
"name": "lesion_types",
"title": "病灶類型（可複選）",
"isRequired": true,
"choices": [
{
"value": "mass",
"text": "1. Mass（腫塊）"
},
{
"value": "calcifications",
"text": "2. Calcifications（鈣化）"
},
{
"value": "asymmetry",
"text": "3. Asymmetry（不對稱）"
},
{
"value": "architectural_distortion",
"text": "4. Architectural Distortion（結構扭曲）"
},
{
"value": "skin_thickening",
"text": "5. Thickening or retraction of the skin and/or nipple（皮膚／乳頭增厚或凹陷）"
},
{
"value": "axillary_lns",
"text": "6. Dense or enlarged axillary LNs（腋下淋巴結腫大）"
},
{
"value": "dilated_ducts",
"text": "7. Dilated lactiferous ducts（乳管擴張）"
},
{
"value": "diffuse_thickening",
"text": "8. Diffuse thickening of the skin and increased density（瀰漫性皮膚增厚及密度增加）"
},
{
"value": "others",
"text": "9. Others（其他）"
}
]
},
{
"type": "panel",
"name": "mass_panel",
"visibleIf": "{panel.lesion_types} contains 'mass'",
"title": "1. Mass（腫塊）詳細資料",
"elements": [
{
"type": "radiogroup",
"name": "mass_side",
"title": "側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
},
{
"value": "multiple_unilateral",
"text": "Multiple, Unilateral（單側多處）"
},
{
"value": "multiple_bilateral",
"text": "Multiple, Bilateral（雙側）"
}
]
},
{
"type": "checkbox",
"name": "mass_location",
"title": "位置（Location）",
"isRequired": true,
"choices": [
{
"value": "uoq",
"text": "UOQ（外上象限）"
},
{
"value": "uiq",
"text": "UIQ（內上象限）"
},
{
"value": "loq",
"text": "LOQ（外下象限）"
},
{
"value": "liq",
"text": "LIQ（內下象限）"
},
{
"value": "subareolar",
"text": "Subareolar（乳暈下方）"
},
{
"value": "axillary_tail",
"text": "Axillary tail（腋尾）"
}
]
},
{
"type": "checkbox",
"name": "mass_location_one_view",
"title": "位置 — One view only",
"choices": [
{
"value": "upper_hemisphere",
"text": "Upper Hemisphere"
},
{
"value": "lower_hemisphere",
"text": "Lower Hemisphere"
},
{
"value": "outer_hemisphere",
"text": "Outer Hemisphere"
},
{
"value": "inner_hemisphere",
"text": "Inner Hemisphere"
}
]
},
{
"type": "radiogroup",
"name": "mass_size",
"title": "大小（Size）",
"isRequired": true,
"choices": [
{
"value": "lt_1cm",
"text": "< 1.0 cm"
},
{
"value": "1_2cm",
"text": "1–2 cm"
},
{
"value": "2_3cm",
"text": "2–3 cm"
},
{
"value": "3_4cm",
"text": "3–4 cm"
},
{
"value": "gt_4cm",
"text": "> 4 cm"
}
],
"colCount": 5
},
{
"type": "radiogroup",
"name": "mass_shape",
"title": "形狀（Shape）",
"isRequired": true,
"choices": [
{
"value": "round",
"text": "Round"
},
{
"value": "oval",
"text": "Oval"
},
{
"value": "lobular",
"text": "Lobular"
},
{
"value": "irregular",
"text": "Irregular"
}
],
"colCount": 4
},
{
"type": "radiogroup",
"name": "mass_margin",
"title": "邊緣（Margin）",
"isRequired": true,
"choices": [
{
"value": "circumscribed",
"text": "Circumscribed"
},
{
"value": "microlobulated",
"text": "Microlobulated"
},
{
"value": "obscured",
"text": "Obscured"
},
{
"value": "indistinct",
"text": "Indistinct"
},
{
"value": "spiculated",
"text": "Spiculated"
}
],
"colCount": 5
},
{
"type": "radiogroup",
"name": "mass_density",
"title": "密度（Density）",
"isRequired": true,
"choices": [
{
"value": "high",
"text": "High density"
},
{
"value": "equal",
"text": "Equal density"
},
{
"value": "low",
"text": "Low density"
},
{
"value": "fat_containing",
"text": "Fat-containing"
}
],
"colCount": 4
}
]
},
{
"type": "panel",
"name": "calcifications_panel",
"visibleIf": "{panel.lesion_types} contains 'calcifications'",
"title": "2. Calcifications（鈣化）詳細資料",
"elements": [
{
"type": "radiogroup",
"name": "calc_side",
"title": "側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
},
{
"value": "multiple_unilateral",
"text": "Multiple, Unilateral（單側多處）"
},
{
"value": "multiple_bilateral",
"text": "Multiple, Bilateral（雙側）"
}
]
},
{
"type": "checkbox",
"name": "calc_location",
"title": "位置（Location）",
"isRequired": true,
"choices": [
{
"value": "uoq",
"text": "UOQ（外上象限）"
},
{
"value": "uiq",
"text": "UIQ（內上象限）"
},
{
"value": "loq",
"text": "LOQ（外下象限）"
},
{
"value": "liq",
"text": "LIQ（內下象限）"
},
{
"value": "subareolar",
"text": "Subareolar（乳暈下方）"
},
{
"value": "axillary_tail",
"text": "Axillary tail（腋尾）"
}
]
},
{
"type": "checkbox",
"name": "calc_location_one_view",
"title": "位置 — One view only",
"choices": [
{
"value": "upper_hemisphere",
"text": "Upper Hemisphere"
},
{
"value": "lower_hemisphere",
"text": "Lower Hemisphere"
},
{
"value": "outer_hemisphere",
"text": "Outer Hemisphere"
},
{
"value": "inner_hemisphere",
"text": "Inner Hemisphere"
}
]
},
{
"type": "radiogroup",
"name": "calc_distribution",
"title": "分布（Distribution）",
"isRequired": true,
"choices": [
{
"value": "grouped",
"text": "Grouped"
},
{
"value": "linear",
"text": "Linear"
},
{
"value": "segmental",
"text": "Segmental"
},
{
"value": "regional",
"text": "Regional"
},
{
"value": "diffuse",
"text": "Diffuse"
}
],
"colCount": 5
},
{
"type": "radiogroup",
"name": "calc_morphology",
"title": "型態（Morphology）",
"isRequired": true,
"choices": [
{
"value": "amorphous",
"text": "Amorphous"
},
{
"value": "coarse_heterogeneous",
"text": "Coarse Heterogeneous"
},
{
"value": "fine_pleomorphic",
"text": "Fine Pleomorphic"
},
{
"value": "fine_linear_branching",
"text": "Fine Linear Branching"
}
],
"colCount": 4
}
]
},
{
"type": "panel",
"name": "asymmetry_panel",
"visibleIf": "{panel.lesion_types} contains 'asymmetry'",
"title": "3. Asymmetry（不對稱）詳細資料",
"elements": [
{
"type": "radiogroup",
"name": "asymmetry_side",
"title": "側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "radiogroup",
"name": "asymmetry_type",
"startWithNewLine": false,
"title": "類型",
"isRequired": true,
"choices": [
{
"value": "asymmetry",
"text": "Asymmetry"
},
{
"value": "focal_asymmetry",
"text": "Focal asymmetry"
},
{
"value": "developing_asymmetry",
"text": "Developing asymmetry"
}
]
},
{
"type": "checkbox",
"name": "asymmetry_location",
"title": "位置（Location）",
"isRequired": true,
"choices": [
{
"value": "uoq",
"text": "UOQ（外上象限）"
},
{
"value": "uiq",
"text": "UIQ（內上象限）"
},
{
"value": "loq",
"text": "LOQ（外下象限）"
},
{
"value": "liq",
"text": "LIQ（內下象限）"
},
{
"value": "subareolar",
"text": "Subareolar（乳暈下方）"
},
{
"value": "axillary_tail",
"text": "Axillary tail（腋尾）"
}
]
},
{
"type": "checkbox",
"name": "asymmetry_location_one_view",
"title": "位置 — One view only",
"choices": [
{
"value": "upper_hemisphere",
"text": "Upper Hemisphere"
},
{
"value": "lower_hemisphere",
"text": "Lower Hemisphere"
},
{
"value": "outer_hemisphere",
"text": "Outer Hemisphere"
},
{
"value": "inner_hemisphere",
"text": "Inner Hemisphere"
}
]
}
]
},
{
"type": "panel",
"name": "architectural_distortion_panel",
"visibleIf": "{panel.lesion_types} contains 'architectural_distortion'",
"title": "4. Architectural Distortion（結構扭曲）詳細資料",
"elements": [
{
"type": "radiogroup",
"name": "distortion_side",
"title": "側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "checkbox",
"name": "distortion_location",
"title": "位置（Location）",
"isRequired": true,
"choices": [
{
"value": "uoq",
"text": "UOQ（外上象限）"
},
{
"value": "uiq",
"text": "UIQ（內上象限）"
},
{
"value": "loq",
"text": "LOQ（外下象限）"
},
{
"value": "liq",
"text": "LIQ（內下象限）"
},
{
"value": "subareolar",
"text": "Subareolar（乳暈下方）"
},
{
"value": "axillary_tail",
"text": "Axillary tail（腋尾）"
}
]
},
{
"type": "checkbox",
"name": "distortion_location_one_view",
"title": "位置 — One view only",
"choices": [
{
"value": "upper_hemisphere",
"text": "Upper Hemisphere"
},
{
"value": "lower_hemisphere",
"text": "Lower Hemisphere"
},
{
"value": "outer_hemisphere",
"text": "Outer Hemisphere"
},
{
"value": "inner_hemisphere",
"text": "Inner Hemisphere"
}
]
}
]
},
{
"type": "radiogroup",
"name": "skin_thickening_side",
"visibleIf": "{panel.lesion_types} contains 'skin_thickening'",
"title": "5. Thickening or retraction of the skin and/or nipple — 側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "radiogroup",
"name": "axillary_lns_side",
"visibleIf": "{panel.lesion_types} contains 'axillary_lns'",
"title": "6. Dense or enlarged axillary LNs — 側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "radiogroup",
"name": "dilated_ducts_side",
"visibleIf": "{panel.lesion_types} contains 'dilated_ducts'",
"title": "7. Dilated lactiferous ducts — 側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "radiogroup",
"name": "diffuse_thickening_side",
"visibleIf": "{panel.lesion_types} contains 'diffuse_thickening'",
"title": "8. Diffuse thickening of the skin and increased density — 側別",
"isRequired": true,
"choices": [
{
"value": "rt",
"text": "Rt.（右側）"
},
{
"value": "lt",
"text": "Lt.（左側）"
}
]
},
{
"type": "text",
"name": "others_text",
"visibleIf": "{panel.lesion_types} contains 'others'",
"title": "9. Others — 請說明",
"isRequired": true,
"placeholder": "請輸入其他病灶說明"
}
],
"templateTitle": "病灶組 {panelIndex}",
"panelCount": 1,
"minPanelCount": 1,
"addPanelText": "＋ 新增另一組病灶",
"removePanelText": "刪除此組病灶"
}
]
}
],
"questionErrorLocation": "bottom",
"showTOC": true,
"checkErrorsMode": "onComplete"
}
(2-2/2)