{ "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" }