# LimeSurvey Group Dump
# DBVersion 142
# This is a dumped group from the LimeSurvey Script
# http://www.limesurvey.org/
# Do not change this header!

#
# GROUPS TABLE
#
"gid","sid","group_name","group_order","description","language"
"17","84159","Section 1: Please tell us about you","0","<i>Estimated time to finish the section: 3 Min.</i>","en"

#
# QUESTIONS TABLE
#
"qid","sid","gid","type","title","question","preg","help","other","mandatory","lid","lid1","question_order","language"
"125","84159","17","S","YourName","Your Name","","Please put your name (and not the care receiver).","N","Y","0","0","0","en"
"126","84159","17","S","Youremail","Please provide your primary email address that will be used as your login ID. We communicate non-emergency reports like patient progress, feedback summary, invoicing etc. online. We will not share your email with any party and will never send you unwanted emails. <br />","/(\w[-._\w]*\w@\w[-._\w]*\w\.\w{2,3})/","","N","N","0","0","5","en"
"127","84159","17","M","ContactingYou","Best method to contact you.<br />","","For immediate service requests, i.e. services needed in less than 8 hrs from now, we strongly recommend using phone (unless your emails are as fast as ours!)<br />","N","Y","0","0","6","en"
"128","84159","17","T","serviceaddress","Please enter the exact address of the location where service is to be provided. Specify whether this is the a home, hospital, elder care center or a nursing home.","","Please avoid PO Boxes. We currently operate in Boston, MA and Martha's Vineyard, MA. Click here<a target=""_blank"" href=""http://www.blisshealthcare.com/serviceareas.html""> www.blisshealthcare.com/serviceareas.html</a> to see our service locations.","N","N","0","0","24","en"
"129","84159","17",";","Phone","Bliss uses your cell phone number for identification. Please enter your other phone numbers also for contact purposes.","","","N","Y","7","0","4","en"
"130","84159","17","Y","Registered Before","Have you used Bliss services before without changes in your contact details? If yes, then we will bypass the registration process and pick up your details from our records. Most clients sign up for multiple members of their families, who need different types of care.","","","N","Y","0","0","1","en"
"131","84159","17","Y","QuickFill","Have you already submitted patient's personal description before? Would like to pursue this later?","","You will bypass all the questions about description of your needs.","N","Y","0","0","13","en"
"132","84159","17","X","registrationstart","Don't worry! We will start with a few short questions to get started.","","","N","N","0","0","3","en"
"133","84159","17","M","ServiceRecepient","Who is the service recipient?","","","Y","N","0","0","15","en"
"134","84159","17","X","Carereceipient","Let us start with the service recipient.","","","N","N","0","0","14","en"
"135","84159","17","S","ServiceRecepientName","Name of the service recipient.","","","N","Y","0","0","12","en"
"136","84159","17","G","ServiceRecepientSex","Please enter the gender of the service recipient","","","N","Y","0","0","17","en"
"137","84159","17","M","ServiceRecepientStat","Which of the following best describes the care recipient's current living arrangement?","","","Y","Y","0","0","21","en"
"138","84159","17","M","ServiceRecepientStat","How does the service recipient feel about receiving assistance?","","","N","N","0","0","22","en"
"139","84159","17","X","registationcomplete","That's pretty much it to get you started. We will ask you for additional information if needed.","","","N","N","0","0","11","en"
"140","84159","17","T","billing address","Please enter your billing address.","","","N","Y","0","0","10","en"
"141","84159","17","Y","BillingServiceAddres","Is the service address the same as the mailing/billing address?","","","N","Y","0","0","23","en"
"142","84159","17","T","Youraddress","Your mailing address<br />","","","N","N","0","0","8","en"
"143","84159","17","X","emergency contact","Please enter up to 3 emergency contacts/information, in order of importance.","","","N","N","0","0","26","en"
"144","84159","17","!","#emergencycontacts","How many emergency contacts do you want to add? Please make sure you inform your contacts.","","","N","Y","0","0","27","en"
"145","84159","17","Q","EmergContactdetail1","Please enter the details of the emergency contact #1 below.","","","N","N","0","0","28","en"
"146","84159","17","Q","EmergContactdetail2","Please enter the details of the emergency contact #2 below.","","","N","Y","0","0","29","en"
"147","84159","17","Q","EmergContactdetail3","Please enter the details of the emergency contact #3 below.","","","N","Y","0","0","30","en"
"148","84159","17","Y","BillingMailingSame","Would you like to sign up for electronic invoices? You will have access to our personalized Web Portal where you can download your invoices anytime, for any period. Bliss also offers seasonal promotions for receiving electronic invoices that could include cash promotions and other incentives.","","","N","Y","0","0","9","en"
"149","84159","17","S","Phone number","Please enter phone number<br />","","","N","Y","0","0","7","en"
"150","84159","17","D","DOBServiceRecipient","Date of birth of the service recipient.<br />","","","N","Y","0","0","16","en"
"151","84159","17","N","Medicare#","Medicare Number","","","N","N","0","0","20","en"
"152","84159","17","S","SSNo","Social security number","","","N","N","0","0","19","en"
"153","84159","17","Y","InternetAccess","Does the service address have internet access?","","","N","Y","0","0","25","en"
"154","84159","17","!","status","Marital Situation","","","N","N","0","0","18","en"
"155","84159","17","S","BlissID","Enter Bliss Customer ID (normally your cell phone number).","","","N","N","0","0","2","en"
"156","84159","17","M","Funding","What funding source will be the primary payer for the service?","","","N","Y","0","0","31","en"
"157","84159","17","M","Budget","Bliss team will work hard with you to ensure maximum value for your money. How much have you budgeted for the expenses?","","","N","N","0","0","32","en"

#
# ANSWERS TABLE
#
"qid","code","answer","default_value","assessment_value","sortorder","language"
"127","1","E-mail","N","0","0","en"
"127","2","Cell Phone","N","0","1","en"
"127","3","Home Phone","N","0","2","en"
"127","4","Office Phone","N","0","3","en"
"127","5","Other Number","N","0","4","en"
"129","1","Phone","N","0","0","en"
"133","1","Parent","N","1","1","en"
"133","2","Spouse","N","2","2","en"
"133","3","Grandmother","N","3","3","en"
"133","4","Grandfather","N","4","4","en"
"133","5","Sibling","N","5","5","en"
"133","6","Child","N","6","6","en"
"137","1","At home and living independently","N","1","1","en"
"137","2","At home with some service in place","N","2","2","en"
"137","3","Assisted living facility","N","3","3","en"
"137","4","Skilled nursing facility/nursing home","N","4","4","en"
"137","5","Hospital or rehabilitation facility","N","5","5","en"
"138","1","Very Receptive","N","1","1","en"
"138","2","Resistant to help","N","2","2","en"
"138","3","Somewhat receptive","N","3","3","en"
"138","4","Unaware","N","4","4","en"
"144","1","Contact #1","N","0","1","en"
"144","2","Contact #2","N","0","2","en"
"144","3","Contact #3","N","0","3","en"
"145","1","Name","N","0","1","en"
"145","2","Phone","N","0","2","en"
"145","3","Relationship","N","0","3","en"
"146","1","Name","N","0","1","en"
"146","2","Phone","N","0","2","en"
"146","3","Relationship","N","0","3","en"
"147","1","Name","N","0","1","en"
"147","2","Phone","N","0","2","en"
"147","3","Relationship","N","0","3","en"
"154","1","Single","N","0","1","en"
"154","2","Married","N","0","2","en"
"154","3","Divorced","N","0","3","en"
"154","4","Living with partner","N","0","4","en"
"156","1","Private Pay","N","1","1","en"
"156","2","Medicaid/ Public Assistance","N","2","2","en"
"156","3","Medicare","N","3","3","en"
"156","4","Long-term care Insurance","N","4","4","en"
"157","1","< $250/week","N","1","1","en"
"157","2","$250-$500/week","N","2","2","en"
"157","3","$500-$1000/week","N","3","3","en"
"157","4","$1000-$1500/week","N","4","4","en"
"157","5","> $1500/week","N","5","5","en"
"157","6","Haven't decided yet","N","0","6","en"

#
# CONDITIONS TABLE
#
"cid","qid","scenario","cqid","cfieldname","method","value"
"207","149","1","127","84159X17X127","==","2"
"208","149","1","127","84159X17X127","==","3"
"209","149","1","127","84159X17X127","==","4"
"210","149","1","127","84159X17X127","==","5"
"293","139","1","127","84159X17X127","==","1"
"294","139","1","127","84159X17X127","==","2"
"295","139","1","127","84159X17X127","==","3"
"165","134","1","130","84159X17X130","==","N"
"203","132","1","130","84159X17X130","==","N"
"204","133","1","130","84159X17X130","==","N"
"211","126","1","130","84159X17X130","==","N"
"233","155","1","130","84159X17X130","==","Y"
"238","148","1","130","84159X17X130","==","N"
"246","142","1","130","84159X17X130","==","N"
"247","142","1","130","84159X17X130","==","N"
"248","142","1","130","84159X17X130","==","N"
"287","136","1","130","84159X17X130","==","N"
"289","137","1","130","84159X17X130","==","N"
"291","138","1","130","84159X17X130","==","N"
"296","127","1","130","84159X17X130","==","N"
"305","129","1","130","84159X17X130","==","N"
"306","129","1","130","84159X17X130","==","N"
"166","134","1","131","84159X17X131","==","N"
"205","133","1","131","84159X17X131","==","N"
"206","143","1","131","84159X17X131","==","N"
"213","156","1","131","84159X17X131","==","N"
"214","157","1","131","84159X17X131","==","N"
"231","154","1","131","84159X17X131","==","N"
"234","151","1","131","84159X17X131","==","N"
"235","152","1","131","84159X17X131","==","N"
"236","153","1","131","84159X17X131","==","N"
"237","150","1","131","84159X17X131","==","N"
"240","147","1","131","84159X17X131","==","N"
"241","145","1","131","84159X17X131","==","N"
"244","146","1","131","84159X17X131","==","N"
"245","144","1","131","84159X17X131","==","N"
"288","136","1","131","84159X17X131","==","N"
"290","137","1","131","84159X17X131","==","N"
"292","138","1","131","84159X17X131","==","N"
"297","128","1","131","84159X17X131","==","N"
"303","141","1","131","84159X17X131","==","N"
"304","141","1","131","84159X17X131","==","N"
"298","128","1","141","84159X17X141","==","N"
"299","128","1","141","84159X17X141","==","N"
"300","128","1","141","84159X17X141","==","N"
"239","147","1","144","84159X17X144","==","3"
"242","146","1","144","84159X17X144","==","2"
"243","146","1","144","84159X17X144","==","3"
"301","140","1","148","84159X17X148","==","N"
"302","140","1","148","84159X17X148","==","N"

#
# LABELSETS TABLE
#
"lid","label_name","languages"
"7","phonelocation","en"

#
# LABELS TABLE
#
"lid","code","title","sortorder","assessment_value","language"
"7","1","Cell Phone","1","0","en"
"7","2","Home Phone","2","0","en"
"7","3","Office/Work Phone","3","0","en"

#
# QUESTION_ATTRIBUTES TABLE
#
"qaid","qid","attribute","value"
"688","125","display_rows",""
"689","125","hidden","0"
"690","125","maximum_chars",""
"691","125","numbers_only","0"
"692","125","page_break","0"
"693","125","prefix",""
"694","125","suffix",""
"695","125","text_input_width",""
"696","125","time_limit",""
"697","125","time_limit_action","1"
"698","125","time_limit_message",""
"699","125","time_limit_message_delay",""
"700","125","time_limit_disable_next","0"
"701","125","time_limit_message_style",""
"702","125","time_limit_timer_style",""
"703","125","time_limit_warning",""
"704","125","time_limit_warning_display_time",""
"705","125","time_limit_warning_message",""
"706","125","time_limit_warning_style",""
"244","127","hide_tip","1"
"742","127","array_filter",""
"743","127","array_filter_exclude",""
"744","127","display_columns","2"
"745","127","exclude_all_others",""
"746","127","hidden","0"
"747","127","max_answers","1"
"748","127","min_answers","1"
"749","127","other_numbers_only","0"
"750","127","other_replace_text",""
"751","127","page_break","0"
"752","127","public_statistics","0"
"753","127","random_order","0"
"754","127","scale_export","0"
"215","128","display_rows","4"
"221","128","text_input_width","32"
"599","128","hidden","0"
"600","128","maximum_chars",""
"601","128","page_break","0"
"602","128","time_limit",""
"603","128","time_limit_action","1"
"604","128","time_limit_message",""
"605","128","time_limit_message_delay",""
"606","128","time_limit_disable_next","0"
"607","128","time_limit_message_style",""
"608","128","time_limit_timer_style",""
"609","128","time_limit_warning",""
"610","128","time_limit_warning_display_time",""
"611","128","time_limit_warning_message",""
"612","128","time_limit_warning_style",""
"220","129","text_input_width","12"
"275","129","answer_width","12"
"431","129","array_filter",""
"432","129","array_filter_exclude",""
"433","129","hidden","0"
"434","129","numbers_only","0"
"435","129","page_break","0"
"436","129","random_order","0"
"707","130","hidden","0"
"708","130","page_break","0"
"709","130","public_statistics","0"
"710","130","scale_export","0"
"502","131","hidden","0"
"503","131","page_break","0"
"504","131","public_statistics","0"
"505","131","scale_export","0"
"729","132","hidden","0"
"730","132","page_break","0"
"731","132","time_limit",""
"732","132","time_limit_action","1"
"733","132","time_limit_message",""
"734","132","time_limit_message_delay",""
"735","132","time_limit_disable_next","0"
"736","132","time_limit_message_style",""
"737","132","time_limit_timer_style",""
"738","132","time_limit_warning",""
"739","132","time_limit_warning_display_time",""
"740","132","time_limit_warning_message",""
"741","132","time_limit_warning_style",""
"217","133","display_columns","3"
"226","133","max_answers","1"
"268","133","hide_tip","1"
"519","133","array_filter",""
"520","133","array_filter_exclude",""
"521","133","exclude_all_others",""
"522","133","hidden","0"
"523","133","min_answers","1"
"524","133","other_numbers_only","0"
"525","133","other_replace_text","Other"
"526","133","page_break","0"
"527","133","public_statistics","0"
"528","133","random_order","0"
"529","133","scale_export","0"
"506","134","hidden","0"
"507","134","page_break","0"
"508","134","time_limit",""
"509","134","time_limit_action","1"
"510","134","time_limit_message",""
"511","134","time_limit_message_delay",""
"512","134","time_limit_disable_next","0"
"513","134","time_limit_message_style",""
"514","134","time_limit_timer_style",""
"515","134","time_limit_warning",""
"516","134","time_limit_warning_display_time",""
"517","134","time_limit_warning_message",""
"518","134","time_limit_warning_style",""
"483","135","display_rows",""
"484","135","hidden","0"
"485","135","maximum_chars",""
"486","135","numbers_only","0"
"487","135","page_break","0"
"488","135","prefix",""
"489","135","suffix",""
"490","135","text_input_width",""
"491","135","time_limit",""
"492","135","time_limit_action","1"
"493","135","time_limit_message",""
"494","135","time_limit_message_delay",""
"495","135","time_limit_disable_next","0"
"496","135","time_limit_message_style",""
"497","135","time_limit_timer_style",""
"498","135","time_limit_warning",""
"499","135","time_limit_warning_display_time",""
"500","135","time_limit_warning_message",""
"501","135","time_limit_warning_style",""
"530","136","display_columns","1"
"531","136","hidden","0"
"532","136","page_break","0"
"533","136","public_statistics","0"
"534","136","scale_export","0"
"218","137","display_columns","2"
"227","137","max_answers","1"
"267","137","hide_tip","1"
"572","137","array_filter",""
"573","137","array_filter_exclude",""
"574","137","exclude_all_others",""
"575","137","hidden","0"
"576","137","min_answers","1"
"577","137","other_numbers_only","0"
"578","137","other_replace_text","Other"
"579","137","page_break","0"
"580","137","public_statistics","0"
"581","137","random_order","0"
"582","137","scale_export","0"
"219","138","display_columns","1"
"228","138","display_columns","1"
"245","138","hide_tip","0"
"583","138","array_filter",""
"584","138","array_filter_exclude",""
"585","138","exclude_all_others",""
"586","138","hidden","0"
"587","138","max_answers",""
"588","138","min_answers",""
"589","138","other_numbers_only","0"
"590","138","other_replace_text",""
"591","138","page_break","0"
"592","138","public_statistics","0"
"593","138","random_order","0"
"594","138","scale_export","0"
"470","139","hidden","0"
"471","139","page_break","0"
"472","139","time_limit",""
"473","139","time_limit_action","1"
"474","139","time_limit_message",""
"475","139","time_limit_message_delay",""
"476","139","time_limit_disable_next","0"
"477","139","time_limit_message_style",""
"478","139","time_limit_timer_style",""
"479","139","time_limit_warning",""
"480","139","time_limit_warning_display_time",""
"481","139","time_limit_warning_message",""
"482","139","time_limit_warning_style",""
"269","140","display_rows","4"
"270","140","text_input_width","32"
"456","140","hidden","0"
"457","140","maximum_chars",""
"458","140","page_break","0"
"459","140","time_limit",""
"460","140","time_limit_action","1"
"461","140","time_limit_message",""
"462","140","time_limit_message_delay",""
"463","140","time_limit_disable_next","0"
"464","140","time_limit_message_style",""
"465","140","time_limit_timer_style",""
"466","140","time_limit_warning",""
"467","140","time_limit_warning_display_time",""
"468","140","time_limit_warning_message",""
"469","140","time_limit_warning_style",""
"595","141","hidden","0"
"596","141","page_break","0"
"597","141","public_statistics","0"
"598","141","scale_export","0"
"274","142","display_rows","4"
"437","142","hidden","0"
"438","142","maximum_chars",""
"439","142","page_break","0"
"440","142","text_input_width",""
"441","142","time_limit",""
"442","142","time_limit_action","1"
"443","142","time_limit_message",""
"444","142","time_limit_message_delay",""
"445","142","time_limit_disable_next","0"
"446","142","time_limit_message_style",""
"447","142","time_limit_timer_style",""
"448","142","time_limit_warning",""
"449","142","time_limit_warning_display_time",""
"450","142","time_limit_warning_message",""
"451","142","time_limit_warning_style",""
"617","143","hidden","0"
"618","143","page_break","0"
"619","143","time_limit",""
"620","143","time_limit_action","1"
"621","143","time_limit_message",""
"622","143","time_limit_message_delay",""
"623","143","time_limit_disable_next","0"
"624","143","time_limit_message_style",""
"625","143","time_limit_timer_style",""
"626","143","time_limit_warning",""
"627","143","time_limit_warning_display_time",""
"628","143","time_limit_warning_message",""
"629","143","time_limit_warning_style",""
"630","144","alphasort","0"
"631","144","category_separator",""
"632","144","hide_tip","1"
"633","144","hidden","0"
"634","144","other_comment_mandatory","0"
"635","144","other_replace_text","Other"
"636","144","page_break","0"
"637","144","public_statistics","0"
"638","144","random_order","0"
"639","144","scale_export","0"
"276","145","maximum_chars","32"
"640","145","display_rows",""
"641","145","hidden","0"
"642","145","numbers_only","0"
"643","145","page_break","0"
"644","145","prefix",""
"645","145","random_order","0"
"646","145","suffix",""
"647","145","text_input_width",""
"277","146","maximum_chars","32"
"648","146","display_rows",""
"649","146","hidden","0"
"650","146","numbers_only","0"
"651","146","page_break","0"
"652","146","prefix",""
"653","146","random_order","0"
"654","146","suffix",""
"655","146","text_input_width",""
"278","147","maximum_chars","32"
"656","147","display_rows",""
"657","147","hidden","0"
"658","147","numbers_only","0"
"659","147","page_break","0"
"660","147","prefix",""
"661","147","random_order","0"
"662","147","suffix",""
"663","147","text_input_width",""
"452","148","hidden","0"
"453","148","page_break","0"
"454","148","public_statistics","0"
"455","148","scale_export","0"
"564","151","hide_tip","0"
"565","151","hidden","0"
"566","151","maximum_chars",""
"567","151","page_break","0"
"568","151","prefix",""
"569","151","public_statistics","0"
"570","151","suffix",""
"571","151","text_input_width",""
"545","152","display_rows",""
"546","152","hidden","0"
"547","152","maximum_chars",""
"548","152","numbers_only","0"
"549","152","page_break","0"
"550","152","prefix",""
"551","152","suffix",""
"552","152","text_input_width",""
"553","152","time_limit",""
"554","152","time_limit_action","1"
"555","152","time_limit_message",""
"556","152","time_limit_message_delay",""
"557","152","time_limit_disable_next","0"
"558","152","time_limit_message_style",""
"559","152","time_limit_timer_style",""
"560","152","time_limit_warning",""
"561","152","time_limit_warning_display_time",""
"562","152","time_limit_warning_message",""
"563","152","time_limit_warning_style",""
"613","153","hidden","0"
"614","153","page_break","0"
"615","153","public_statistics","0"
"616","153","scale_export","0"
"535","154","alphasort","0"
"536","154","category_separator",""
"537","154","hide_tip","1"
"538","154","hidden","0"
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