{
  "fields": {
    "vaccine_dispensed": {
      "label": "Medication Dispensed:",
      "type": "checkbox"
    },
    "vaccine_effect": {
      "label": "Immediate Effect of Vaccination:",
      "type": "select"
    },
    "vaccine_other_reaction": {
      "label": "If Other Vaccine Reaction, Please Describe:"
    },
    "anaphylaxis": {
      "label": "Anaphylaxis Present?",
      "type": "radio",
      "enum": [
        "Yes",
        "No"
      ],
      "removeDefaultNone": true
    },
    "side_effect_counseling": {
      "label": "Describe Any Counseling Given Regarding Side-Effects:",
      "type": "textarea"
    },
    "pregnant": {
      "label": "Pregnant?",
      "type": "radio",
      "enum": [
        "Yes",
        "No"
      ],
      "removeDefaultNone": true
    }
  }
}