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功能 #13636 » 健康署「糞便抗原檢測胃幽門螺旋桿菌服務」管理紀錄表.json

健康署「糞便抗原檢測胃幽門螺旋桿菌服務」管理紀錄表 - Laura Huang, 2026/09/14 上午07:48

 
{
"locale": "zh-tw",
"title": "健康署「糞便抗原檢測胃幽門螺旋桿菌服務」管理紀錄表",
"description": "本項經費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",
"completedHtml": "<h3>表單填寫完成</h3>",
"pages": [
{
"name": "exam_info",
"title": "檢查資訊",
"elements": [
{
"type": "checkbox",
"name": "payment_method",
"title": "支付方式",
"isRequired": true,
"choices": [
{
"value": "preventive",
"text": "預防保健"
},
{
"value": "nhi",
"text": "健保醫療給付"
},
{
"value": "other_subsidy",
"text": "其他公務預算補助"
},
{
"value": "self_pay",
"text": "自費健康檢查"
},
{
"value": "other",
"text": "其他"
}
],
"colCount": 3
},
{
"type": "text",
"name": "institution_name",
"title": "採檢單位",
"defaultValue": "亞洲大學附屬醫院",
"isRequired": true
},
{
"type": "text",
"name": "institution_code",
"startWithNewLine": false,
"title": "醫事機構代碼",
"defaultValue": "1303180011",
"isRequired": true
}
]
},
{
"name": "basic_info",
"title": "基本資料",
"elements": [
{
"type": "text",
"name": "patient_name",
"title": "姓名",
"isRequired": true,
"placeholder": "請輸入姓名"
},
{
"type": "radiogroup",
"name": "gender",
"startWithNewLine": false,
"title": "性別",
"isRequired": true,
"choices": [
{
"value": "male",
"text": "男"
},
{
"value": "female",
"text": "女"
}
],
"colCount": 2
},
{
"type": "radiogroup",
"name": "is_indigenous",
"title": "原住民",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "否"
},
{
"value": "yes",
"text": "是"
}
],
"colCount": 2
},
{
"type": "text",
"name": "indigenous_tribe",
"visibleIf": "{is_indigenous} = 'yes'",
"startWithNewLine": false,
"title": "族別",
"isRequired": true,
"placeholder": "請輸入族別"
},
{
"type": "text",
"name": "id_number",
"title": "身分證字號",
"isRequired": true,
"placeholder": "身分證字號或居留證號"
},
{
"type": "panel",
"name": "birth_date_panel",
"title": "出生日期",
"elements": [
{
"type": "text",
"name": "birth_year",
"title": "年（民國）",
"isRequired": true,
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "民國年"
},
{
"type": "dropdown",
"name": "birth_month",
"startWithNewLine": false,
"title": "月份",
"isRequired": true,
"choices": [
{
"value": 1,
"text": "1 月"
},
{
"value": 2,
"text": "2 月"
},
{
"value": 3,
"text": "3 月"
},
{
"value": 4,
"text": "4 月"
},
{
"value": 5,
"text": "5 月"
},
{
"value": 6,
"text": "6 月"
},
{
"value": 7,
"text": "7 月"
},
{
"value": 8,
"text": "8 月"
},
{
"value": 9,
"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": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31
],
"placeholder": "請選擇日期"
}
]
},
{
"type": "panel",
"name": "visit_date_panel",
"title": "門診日期",
"elements": [
{
"type": "text",
"name": "visit_year",
"title": "年（民國）",
"isRequired": true,
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "民國年"
},
{
"type": "dropdown",
"name": "visit_month",
"startWithNewLine": false,
"title": "月份",
"isRequired": true,
"choices": [
{
"value": 1,
"text": "1 月"
},
{
"value": 2,
"text": "2 月"
},
{
"value": 3,
"text": "3 月"
},
{
"value": 4,
"text": "4 月"
},
{
"value": 5,
"text": "5 月"
},
{
"value": 6,
"text": "6 月"
},
{
"value": 7,
"text": "7 月"
},
{
"value": 8,
"text": "8 月"
},
{
"value": 9,
"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": "visit_day",
"startWithNewLine": false,
"title": "日期",
"isRequired": true,
"choices": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31
],
"placeholder": "請選擇日期"
}
]
},
{
"type": "html",
"name": "second_visit_note",
"html": "<p style='color:#666; font-size:0.9em;'>若糞便抗原檢測首次檢驗結果為「檢測失效」，請填寫第二次門診日期</p>"
},
{
"type": "panel",
"name": "second_visit_date_panel",
"title": "第二次門診日期（檢測失效時填寫）",
"elements": [
{
"type": "text",
"name": "second_visit_year",
"title": "年（民國）",
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "民國年"
},
{
"type": "dropdown",
"name": "second_visit_month",
"startWithNewLine": false,
"title": "月份",
"choices": [
{
"value": 1,
"text": "1 月"
},
{
"value": 2,
"text": "2 月"
},
{
"value": 3,
"text": "3 月"
},
{
"value": 4,
"text": "4 月"
},
{
"value": 5,
"text": "5 月"
},
{
"value": 6,
"text": "6 月"
},
{
"value": 7,
"text": "7 月"
},
{
"value": 8,
"text": "8 月"
},
{
"value": 9,
"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": "second_visit_day",
"startWithNewLine": false,
"title": "日期",
"choices": [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27,
28,
29,
30,
31
],
"placeholder": "請選擇日期"
}
]
},
{
"type": "text",
"name": "phone",
"title": "聯絡電話",
"placeholder": "區碼 + 電話號碼"
},
{
"type": "text",
"name": "mobile",
"startWithNewLine": false,
"title": "手機",
"placeholder": "手機號碼"
},
{
"type": "radiogroup",
"name": "religion",
"title": "宗教",
"choices": [
{
"value": "none",
"text": "無"
},
{
"value": "catholic",
"text": "天主教"
},
{
"value": "christian",
"text": "基督教"
},
{
"value": "buddhism",
"text": "佛教"
},
{
"value": "taoism",
"text": "道教"
},
{
"value": "yiguandao",
"text": "一貫道"
}
],
"showOtherItem": true,
"otherPlaceholder": "請輸入宗教",
"otherText": "其他",
"colCount": 4
},
{
"type": "panel",
"name": "address_panel",
"title": "現居住地址",
"elements": [
{
"type": "text",
"name": "address_district_code",
"title": "鄉鎮市區代碼",
"placeholder": "四碼代碼"
},
{
"type": "dropdown",
"name": "address_county",
"startWithNewLine": false,
"title": "縣市",
"choices": [
"臺北市",
"新北市",
"桃園市",
"臺中市",
"臺南市",
"高雄市",
"基隆市",
"新竹市",
"嘉義市",
"新竹縣",
"苗栗縣",
"彰化縣",
"南投縣",
"雲林縣",
"嘉義縣",
"屏東縣",
"宜蘭縣",
"花蓮縣",
"臺東縣",
"澎湖縣",
"金門縣",
"連江縣"
],
"placeholder": "請選擇縣市"
},
{
"type": "text",
"name": "address_detail",
"title": "詳細地址",
"placeholder": "鄉鎮市區、村里、路街、段巷弄號樓"
}
]
},
{
"type": "radiogroup",
"name": "education",
"title": "教育",
"isRequired": true,
"choices": [
{
"value": "none",
"text": "無"
},
{
"value": "elementary",
"text": "小學"
},
{
"value": "junior_high",
"text": "國（初）中"
},
{
"value": "senior_high",
"text": "高中（職）"
},
{
"value": "college",
"text": "專科、大學"
},
{
"value": "graduate",
"text": "研究所以上"
},
{
"value": "refused",
"text": "拒答"
}
],
"colCount": 4
},
{
"type": "radiogroup",
"name": "has_job",
"title": "職業",
"isRequired": true,
"choices": [
{
"value": "yes",
"text": "有"
},
{
"value": "no",
"text": "無"
},
{
"value": "refused",
"text": "拒答"
}
],
"colCount": 3
},
{
"type": "text",
"name": "job_title",
"visibleIf": "{has_job} = 'yes'",
"title": "職業名稱",
"isRequired": true,
"placeholder": "請輸入職業"
},
{
"type": "radiogroup",
"name": "marital_status",
"title": "婚姻狀況",
"isRequired": true,
"choices": [
{
"value": "single",
"text": "未婚"
},
{
"value": "married",
"text": "已婚"
},
{
"value": "other",
"text": "其他"
}
],
"colCount": 3
}
]
},
{
"name": "personal_history",
"title": "個人病史",
"elements": [
{
"type": "checkbox",
"name": "personal_disease_history",
"title": "1. 個人（曾經）疾病史",
"isRequired": true,
"choices": [
{
"value": "gastritis",
"text": "胃炎"
},
{
"value": "gastric_ulcer",
"text": "胃潰瘍"
},
{
"value": "duodenal_ulcer",
"text": "十二指腸潰瘍"
},
{
"value": "gerd",
"text": "胃食道逆流"
},
{
"value": "gastric_tumor",
"text": "胃腫瘤"
},
{
"value": "gastric_cancer",
"text": "胃癌"
},
{
"value": "hp_infection",
"text": "胃幽門桿菌感染"
}
],
"showOtherItem": true,
"showNoneItem": true,
"otherPlaceholder": "請說明其他疾病",
"noneText": "無",
"otherText": "其他",
"colCount": 3
},
{
"type": "panel",
"name": "disease_onset_panel",
"visibleIf": "{personal_disease_history} notempty and {personal_disease_history} notcontains 'none'",
"title": "發病年份",
"elements": [
{
"type": "text",
"name": "disease_onset_year",
"visibleIf": "{disease_onset_unknown} empty",
"title": "民國年",
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "民國年"
},
{
"type": "checkbox",
"name": "disease_onset_unknown",
"startWithNewLine": false,
"titleLocation": "hidden",
"choices": [
{
"value": "unknown",
"text": "不詳"
}
]
}
]
},
{
"type": "radiogroup",
"name": "hp_eradication",
"title": "2. 曾接受胃幽門桿菌除菌治療",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "radiogroup",
"name": "gastroscopy",
"title": "3. 曾接受過胃鏡檢查",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "panel",
"name": "gastroscopy_year_panel",
"visibleIf": "{gastroscopy} = 'yes'",
"title": "胃鏡檢查年份",
"elements": [
{
"type": "text",
"name": "gastroscopy_year",
"visibleIf": "{gastroscopy_year_unknown} empty",
"title": "民國年",
"inputType": "number",
"min": 1,
"max": 150,
"placeholder": "民國年"
},
{
"type": "checkbox",
"name": "gastroscopy_year_unknown",
"startWithNewLine": false,
"titleLocation": "hidden",
"choices": [
{
"value": "unknown",
"text": "不詳"
}
]
}
]
},
{
"type": "radiogroup",
"name": "ppi_usage",
"title": "4. 近一個月內是否使用潰瘍／胃食道逆流特效藥（一日一顆）",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "radiogroup",
"name": "drug_allergy",
"title": "5. 藥物過敏",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "text",
"name": "drug_allergy_detail",
"visibleIf": "{drug_allergy} = 'yes'",
"title": "藥物名稱",
"isRequired": true,
"placeholder": "請輸入藥物名稱"
}
]
},
{
"name": "family_history",
"title": "家族病史",
"elements": [
{
"type": "radiogroup",
"name": "family_hp",
"title": "1. 幽門桿菌家族史",
"isRequired": true,
"choices": [
{
"value": "unknown",
"text": "不詳"
},
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 3
},
{
"type": "checkbox",
"name": "family_hp_members",
"visibleIf": "{family_hp} = 'yes'",
"title": "幽門桿菌家族成員（可複選）",
"isRequired": true,
"choices": [
{
"value": "father",
"text": "父"
},
{
"value": "mother",
"text": "母"
},
{
"value": "spouse",
"text": "夫妻"
},
{
"value": "siblings",
"text": "兄弟姊妹"
},
{
"value": "children",
"text": "子女"
},
{
"value": "other",
"text": "其他"
}
],
"colCount": 3
},
{
"type": "text",
"name": "family_hp_siblings_count",
"visibleIf": "{family_hp} = 'yes' and {family_hp_members} contains 'siblings'",
"title": "兄弟姊妹人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "text",
"name": "family_hp_children_count",
"visibleIf": "{family_hp} = 'yes' and {family_hp_members} contains 'children'",
"startWithNewLine": false,
"title": "子女人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "text",
"name": "family_hp_other_detail",
"visibleIf": "{family_hp} = 'yes' and {family_hp_members} contains 'other'",
"title": "其他親屬說明",
"placeholder": "請說明"
},
{
"type": "text",
"name": "family_hp_other_count",
"visibleIf": "{family_hp} = 'yes' and {family_hp_members} contains 'other'",
"startWithNewLine": false,
"title": "人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "radiogroup",
"name": "family_peptic_ulcer",
"title": "2. 消化性潰瘍家族史（胃或十二指腸）",
"isRequired": true,
"choices": [
{
"value": "unknown",
"text": "不詳"
},
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 3
},
{
"type": "checkbox",
"name": "family_peptic_ulcer_members",
"visibleIf": "{family_peptic_ulcer} = 'yes'",
"title": "消化性潰瘍家族成員（可複選）",
"isRequired": true,
"choices": [
{
"value": "father",
"text": "父"
},
{
"value": "mother",
"text": "母"
},
{
"value": "spouse",
"text": "夫妻"
},
{
"value": "siblings",
"text": "兄弟姊妹"
},
{
"value": "children",
"text": "子女"
},
{
"value": "other",
"text": "其他"
}
],
"colCount": 3
},
{
"type": "text",
"name": "family_peptic_ulcer_siblings_count",
"visibleIf": "{family_peptic_ulcer} = 'yes' and {family_peptic_ulcer_members} contains 'siblings'",
"title": "兄弟姊妹人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "text",
"name": "family_peptic_ulcer_children_count",
"visibleIf": "{family_peptic_ulcer} = 'yes' and {family_peptic_ulcer_members} contains 'children'",
"startWithNewLine": false,
"title": "子女人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "text",
"name": "family_peptic_ulcer_other_detail",
"visibleIf": "{family_peptic_ulcer} = 'yes' and {family_peptic_ulcer_members} contains 'other'",
"title": "其他親屬說明",
"placeholder": "請說明"
},
{
"type": "text",
"name": "family_peptic_ulcer_other_count",
"visibleIf": "{family_peptic_ulcer} = 'yes' and {family_peptic_ulcer_members} contains 'other'",
"startWithNewLine": false,
"title": "人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "radiogroup",
"name": "family_gastric_cancer",
"title": "3. 胃癌家族史",
"isRequired": true,
"choices": [
{
"value": "unknown",
"text": "不詳"
},
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 3
},
{
"type": "checkbox",
"name": "family_gastric_cancer_members",
"visibleIf": "{family_gastric_cancer} = 'yes'",
"title": "胃癌家族成員（可複選）",
"isRequired": true,
"choices": [
{
"value": "father",
"text": "父"
},
{
"value": "mother",
"text": "母"
},
{
"value": "spouse",
"text": "夫妻"
},
{
"value": "siblings",
"text": "兄弟姊妹"
},
{
"value": "children",
"text": "子女"
},
{
"value": "other",
"text": "其他"
}
],
"colCount": 3
},
{
"type": "text",
"name": "family_gc_siblings_count",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'siblings' and {family_gc_siblings_unknown} empty",
"title": "兄弟姊妹人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "checkbox",
"name": "family_gc_siblings_unknown",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'siblings'",
"startWithNewLine": false,
"titleLocation": "hidden",
"choices": [
{
"value": "unknown",
"text": "不詳"
}
]
},
{
"type": "text",
"name": "family_gc_children_count",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'children' and {family_gc_children_unknown} empty",
"title": "子女人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "checkbox",
"name": "family_gc_children_unknown",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'children'",
"startWithNewLine": false,
"titleLocation": "hidden",
"choices": [
{
"value": "unknown",
"text": "不詳"
}
]
},
{
"type": "text",
"name": "family_gc_other_detail",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'other'",
"title": "其他親屬說明",
"placeholder": "請說明"
},
{
"type": "text",
"name": "family_gc_other_count",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'other' and {family_gc_other_unknown} empty",
"startWithNewLine": false,
"title": "人數",
"inputType": "number",
"min": 1,
"placeholder": "人數"
},
{
"type": "checkbox",
"name": "family_gc_other_unknown",
"visibleIf": "{family_gastric_cancer} = 'yes' and {family_gastric_cancer_members} contains 'other'",
"startWithNewLine": false,
"titleLocation": "hidden",
"choices": [
{
"value": "unknown",
"text": "不詳"
}
]
}
]
},
{
"name": "medication_history",
"title": "用藥史",
"elements": [
{
"type": "radiogroup",
"name": "recent_medication",
"title": "最近三個月有無服用下列藥物",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "checkbox",
"name": "medication_types",
"visibleIf": "{recent_medication} = 'yes'",
"title": "藥物種類（可複選）",
"isRequired": true,
"choices": [
{
"value": "painkiller",
"text": "止痛藥"
},
{
"value": "steroid",
"text": "類固醇"
},
{
"value": "antiplatelet",
"text": "抗血小板藥物"
},
{
"value": "anticoagulant",
"text": "抗凝血劑"
},
{
"value": "diabetes",
"text": "糖尿病用藥"
},
{
"value": "iron",
"text": "使用鐵劑治療貧血"
}
],
"colCount": 3
},
{
"type": "checkbox",
"name": "antiplatelet_detail",
"visibleIf": "{medication_types} contains 'antiplatelet'",
"title": "抗血小板藥物細項",
"isRequired": true,
"choices": [
{
"value": "aspirin",
"text": "阿斯匹靈（aspirin）"
},
{
"value": "plavix",
"text": "保栓通（plavix）"
}
],
"showOtherItem": true,
"otherPlaceholder": "請輸入藥物名稱",
"otherText": "其他",
"colCount": 3
},
{
"type": "checkbox",
"name": "anticoagulant_detail",
"visibleIf": "{medication_types} contains 'anticoagulant'",
"title": "抗凝血劑細項",
"isRequired": true,
"choices": [
{
"value": "coumadin",
"text": "可邁丁（coumadin）"
}
],
"showOtherItem": true,
"otherPlaceholder": "請輸入藥物名稱",
"otherText": "其他",
"colCount": 2
},
{
"type": "checkbox",
"name": "diabetes_detail",
"visibleIf": "{medication_types} contains 'diabetes'",
"title": "糖尿病用藥細項",
"isRequired": true,
"choices": [
{
"value": "oral",
"text": "口服型控制血糖"
},
{
"value": "insulin",
"text": "注射型胰島素"
}
],
"colCount": 2
}
]
},
{
"name": "lifestyle",
"title": "生活型態",
"elements": [
{
"type": "radiogroup",
"name": "smoking",
"title": "1. 您有無吸菸習慣？",
"isRequired": true,
"choices": [
{
"value": "never",
"text": "從不"
},
{
"value": "quit",
"text": "已戒"
},
{
"value": "current",
"text": "目前有吸"
}
],
"showOtherItem": true,
"otherPlaceholder": "請說明",
"otherText": "其他",
"colCount": 4
},
{
"type": "radiogroup",
"name": "drinking",
"title": "2. 您有無喝酒習慣？",
"isRequired": true,
"choices": [
{
"value": "never",
"text": "從不"
},
{
"value": "quit",
"text": "已戒"
},
{
"value": "current",
"text": "目前有喝"
}
],
"showOtherItem": true,
"otherPlaceholder": "請說明",
"otherText": "其他",
"colCount": 4
},
{
"type": "radiogroup",
"name": "betel_nut",
"title": "3. 您有無嚼檳榔習慣？",
"isRequired": true,
"choices": [
{
"value": "never",
"text": "從不"
},
{
"value": "quit",
"text": "已戒"
},
{
"value": "current",
"text": "目前有嚼"
}
],
"showOtherItem": true,
"otherPlaceholder": "請說明",
"otherText": "其他",
"colCount": 4
},
{
"type": "radiogroup",
"name": "pickled_food",
"title": "4. 您是否常常（每週 3 次或以上）食用醃漬食物如鹹魚、醬瓜、豆瓣醬、酸菜等？",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "radiogroup",
"name": "smoked_grilled_food",
"title": "5. 您是否常常（每週 3 次或以上）食用煙燻、燒烤、高香料的肉類如香腸、烤肉等？",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
},
{
"type": "radiogroup",
"name": "raw_food",
"title": "6. 您是否常常（每週 3 次或以上）食用生食如生肉、生魚等？",
"isRequired": true,
"choices": [
{
"value": "no",
"text": "無"
},
{
"value": "yes",
"text": "有"
}
],
"colCount": 2
}
]
},
{
"name": "consent_confirm",
"title": "同意聲明與確認",
"elements": [
{
"type": "html",
"name": "consent_text",
"html": "<div style='background:#f8f9fa; padding:12px; border-radius:6px; border-left:4px solid #0d6efd; margin-bottom:12px;'><p>本人同意接受以糞便抗原檢測胃幽門螺旋桿菌檢查，相關資料將作為衛生單位政策評估或個案追蹤健康管理使用。</p></div>"
},
{
"type": "checkbox",
"name": "consent_agree",
"title": "受檢者確認",
"isRequired": true,
"choices": [
{
"value": "agree",
"text": "確認以上資料正確無誤"
}
]
},
{
"type": "html",
"name": "upload_note",
"html": "<p style='color:#666; font-size:0.85em; margin-top:8px;'>※ 本表由採檢單位上傳至癌症篩檢與追蹤管理資訊整合系統。</p>"
}
]
}
],
"questionErrorLocation": "bottom",
"checkErrorsMode": "onComplete",
"pagePrevText": "上一頁",
"pageNextText": "下一頁",
"completeText": "提交"
}
(2-2/2)