{
    "fields": {
        "delivery_date": {
            "label": "Date of Infant Delivery:",
            "dateFormat": "yy-mm-dd",
            "datepicker": {
                "hideIfNoPrevNextType": true,
                "yearRange": "2010:+10",
                "changeMonth": true,
                "changeYear": true
            }
        },
        "first_visit": {
            "label": "First Visit to Clinic?",
            "type": "radio",
            "enum": [
                "Yes",
                "No"
            ],
            "removeDefaultNone": true
        },
        "hiv_known_pre_clinic": {
            "label": "HIV Status Known Before Clinic?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "hiv_tested_pre_clinic": {
            "label": "Tested for HIV Before Clinic?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "hiv_test": {
            "label": "HIV Test given?",
            "type": "radio",
            "enum": [
                "Yes",
                "No"
            ],
            "removeDefaultNone": true
        },
        "hiv_status": {
            "label": "HIV Status",
            "type": "radio"
        },
        "hiv_positive_first_test": {
            "label": "Tested HIV Positive on first test?",
            "type": "radio",
            "enum": [
                "Yes",
                "No"
            ],
            "removeDefaultNone": true
        },
        "hiv_known_pre_birth": {
            "label": "HIV Status Known Before Birth?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "hiv_test_during_labor": {
            "label": "Tested for HIV During Labor?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "hiv_test_post_labor": {
            "label": "Tested for HIV Post-Labor?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "medication_during_labor": {
            "label": "Medicine Taken During Labor:"
        },
        "referred_ctc": {
            "label": "Mother Referred To CTC?",
            "type": "radio",
            "enum": [
                "Yes",
                "No",
                "Unknown"
            ],
            "removeDefaultNone": true
        },
        "referral_date": {
            "label": "Referral Date (Or is This a Different Date?):",
            "dateFormat": "yy-mm-dd",
            "datepicker": {
                "hideIfNoPrevNextType": true,
                "yearRange": "2010:+10",
                "changeMonth": true,
                "changeYear": true
            }
        },
        "arv_therapy": {
            "label": "Currently Taking Anti-Retrovial Therapy?",
            "type": "radio",
            "enum": [
                "Yes",
                "No"
            ],
            "removeDefaultNone": true
        },
        "other_treatment": {
            "label": "If Any Treatment Given, Please Describe:",
            "type": "textarea"
        },
        "note": {
            "label": "Other Notes for This Visit:",
            "type": "textarea"
        }
    }
}