Layers:

Layer: chatham_tobacco_initial_assessment (0)

Name: chatham_tobacco_initial_assessment

Display Field: objectid

Type: Feature Layer

Geometry Type: esriGeometryPoint

Description:

Service Item Id: 5188ee9d07ea40deae20038894e3388b

Copyright Text:

Default Visibility: true

MaxRecordCount: 1000

MaxSelectionCount: 0

Supported Query Formats: JSON, geoJSON, PBF

Min Scale: 0.0

Max Scale: 0.0

Supports Advanced Queries: true

Supports Statistics: true

Use Standardized Queries: true

Supports ValidateSQL: true

Supports Calculate: true

Extent:
XMin: -180.0
YMin: -90.0
XMax: 180.0
YMax: 90.0
Spatial Reference: 4326  (0)  LatestVCSWkid(0)



Drawing Info:
Renderer:
Simple Renderer:
Symbol:
Style: esriSMSCircle
Color: [255, 0, 0, 255]
Size: 8.0
Angle: 0.0
XOffset: 0
YOffset: 0
Outline:
[255, 255, 0, 255] Width: 1
Label: Tobacco Cessation Program Initial Assessment Form
Description: Survey Data Locations
Transparency: 0
Labeling Info:
Feature Draw Order:
N/A
Advanced Query Capabilities:
Supports Statistics: true
Supports OrderBy: true
Supports Distinct: true
Supports Pagination: true
Supports TrueCurve: false
Supports Returning Query Extent: true
Supports Query With Distance: true
Supports Sql Expression: true
Supports Query With ResultType: true
Supports Returning Geometry Centroid: false
Supports Binning LOD: true
Supports Query With LOD Spatial Reference: true
Supports Percentile Statistics: true
Supports Having Clause: true
Supports Count Distinct: true
Supports Time Relation: false
Supports Sql Format: false
Supports Query Analytic: true
Supports Query With Current User: true


HasZ: false

HasM: false

Has Attachments: false

HTML Popup Type: esriServerHTMLPopupTypeAsHTMLText

Type ID Field:

Fields:
• objectid ( nullable: false, editable: false, defaultValue: null, length: 4, type: esriFieldTypeOID, alias: ObjectID )
• globalid ( nullable: false, editable: false, defaultValue: null, length: 38, type: esriFieldTypeGlobalID, alias: GlobalID )
• appt_date ( nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Appointment Date, type: esriFieldTypeDate )
• client_name ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Client Name, type: esriFieldTypeString )
• street_address ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Street Address, type: esriFieldTypeString )
• city ( nullable: true, editable: true, defaultValue: null, length: 255, alias: City, type: esriFieldTypeString )
• zip_code ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Zip Code, type: esriFieldTypeString )
• phone_number ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Contact Phone Number, type: esriFieldTypeString )
• email ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Email Address, type: esriFieldTypeString )
• contact_best ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Best Method & Time for Contact, type: esriFieldTypeString )
• emergency_contact ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Emergency Contact, type: esriFieldTypeString )
• ok_contact_all ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay for us to contact you at all of the above locations?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• no_contact_where ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify where NOT to contact you, type: esriFieldTypeString )
• ok_text ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay to contact you via text for appointment reminders?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dob ( nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Date of Birth, type: esriFieldTypeDate )
• age ( nullable: true, editable: true, defaultValue: null, alias: Age, type: esriFieldTypeInteger )
• gender ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Gender, type: esriFieldTypeString , Coded Values: [female: Female] , [male: Male] , [non_binary: Non-binary / Third gender] , ...2 more... )
• gender_self_describe ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please self-describe your gender, type: esriFieldTypeString )
• has_children ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you have children living with you?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• children_asthma ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do any of your children have asthma?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• race_ethnicity ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What race/ethnicity best describes you?, type: esriFieldTypeString , Coded Values: [white: Caucasian / White] , [asian: Asian] , [aian: American Indian / Alaskan Native] , ...4 more... )
• race_other ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify your race/ethnicity, type: esriFieldTypeString )
• education ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Highest level of education completed, type: esriFieldTypeString , Coded Values: [grade11_or_less: Grade 11 or less] , [hs_diploma_ged: High school diploma or GED] , [some_college: Some college / Technical school] , ...4 more... )
• work_status ( nullable: true, editable: true, defaultValue: null, length: 255, alias: How would you describe your work status? (Select all that apply), type: esriFieldTypeString )
• insurance ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What type of health insurance do you have?, type: esriFieldTypeString , Coded Values: [medicare: Medicare] , [medicaid: Medicaid] , [both: Both Medicare and Medicaid] , ...3 more... )
• program_referral ( nullable: true, editable: true, defaultValue: null, length: 255, alias: How did you learn about our cessation program?, type: esriFieldTypeString )
• note_tobacco_use ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Over the past 6 months, indicate the type(s) of tobacco used and average amount per day., type: esriFieldTypeString )
• tobacco_types ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What type(s) of tobacco have you used in the past 6 months?, type: esriFieldTypeString )
• qty_cigarettes ( nullable: true, editable: true, defaultValue: null, alias: Cigarettes per day, type: esriFieldTypeDouble )
• qty_little_cigars ( nullable: true, editable: true, defaultValue: null, alias: Little cigars per day, type: esriFieldTypeDouble )
• qty_cigars ( nullable: true, editable: true, defaultValue: null, alias: Cigars per day, type: esriFieldTypeDouble )
• qty_pipe ( nullable: true, editable: true, defaultValue: null, alias: Pipefuls per day, type: esriFieldTypeDouble )
• qty_smokeless ( nullable: true, editable: true, defaultValue: null, alias: Cans/pouches per day (smokeless tobacco), type: esriFieldTypeDouble )
• qty_snus ( nullable: true, editable: true, defaultValue: null, alias: Snus per day, type: esriFieldTypeDouble )
• qty_ecig ( nullable: true, editable: true, defaultValue: null, alias: E-cigarettes (mL or pods per day), type: esriFieldTypeDouble )
• tobacco_other_type ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Other tobacco type (please specify), type: esriFieldTypeString )
• qty_other ( nullable: true, editable: true, defaultValue: null, alias: Other tobacco — amount per day, type: esriFieldTypeDouble )
• age_first_use ( nullable: true, editable: true, defaultValue: null, alias: Age when you first started using tobacco regularly, type: esriFieldTypeInteger )
• tobacco_brand ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What brand of tobacco do you normally use?, type: esriFieldTypeString )
• uses_menthol ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you use menthol?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• first_cig_timing ( nullable: true, editable: true, defaultValue: null, length: 255, alias: How many minutes after waking do you smoke your first cigarette?, type: esriFieldTypeString , Coded Values: [immediately: Immediately upon waking] , [5_to_30: 5–30 minutes] , [31_to_60: 31–60 minutes] , ...1 more... )
• wakes_for_tobacco ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you sometimes wake up at night to use tobacco?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• nights_per_week ( nullable: true, editable: true, defaultValue: null, alias: How many nights per week do you wake for tobacco?, type: esriFieldTypeDouble )
• caffeinated_drinks ( nullable: true, editable: true, defaultValue: null, alias: How many caffeinated drinks do you have per day (coffee, tea, soda)?, type: esriFieldTypeInteger )
• main_triggers ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What are your main triggers for tobacco/nicotine use?, type: esriFieldTypeString )
• craving_times ( nullable: true, editable: true, defaultValue: null, length: 255, alias: When do you crave tobacco the most? (Select all that apply), type: esriFieldTypeString )
• craving_driving_time ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What time of day do you typically crave tobacco while driving?, type: esriFieldTypeString )
• craving_break_time ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What time of day do you crave during work breaks?, type: esriFieldTypeString )
• quit_intent ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you planning to stop using all tobacco?, type: esriFieldTypeString , Coded Values: [already_stopped: Yes — I have already stopped] , [at_this_appointment: Yes — at this appointment] , [within_30_days: Yes — in the next 30 days] , ...3 more... )
• quit_date_already ( nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Date you last used tobacco, type: esriFieldTypeDate )
• readiness_scale ( nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how ready are you to quit in the next 6 months?, type: esriFieldTypeInteger )
• importance_scale ( nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how important is it to you to quit in the next 6 months?, type: esriFieldTypeInteger )
• confidence_scale ( nullable: true, editable: true, defaultValue: null, alias: On a scale of 1–10, how confident are you that you can stop using all tobacco?, type: esriFieldTypeInteger )
• quit_attempts ( nullable: true, editable: true, defaultValue: null, length: 255, alias: How many serious quit attempts have you made?, type: esriFieldTypeString , Coded Values: [0: 0 — No prior attempts] , [1: 1] , [2: 2] , ...3 more... )
• longest_quit ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the longest you have stayed quit?, type: esriFieldTypeString )
• longest_quit_year ( nullable: true, editable: true, defaultValue: null, alias: What year did you stay quit the longest?, type: esriFieldTypeInteger )
• past_quit_methods ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What did you use to help you quit in the past? (medicine, counseling, etc.), type: esriFieldTypeString )
• relapse_reason ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Why did you relapse?, type: esriFieldTypeString )
• nrt_past ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What medications/NRT did you use in past quit attempts?, type: esriFieldTypeString )
• nrt_past_helpful ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What worked well or helped most? Describe any side effects., type: esriFieldTypeString )
• nrt_current ( nullable: true, editable: true, defaultValue: null, length: 255, alias: What nicotine replacement therapy or medications are you considering now?, type: esriFieldTypeString )
• nrt_other_specify ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify other medication/therapy, type: esriFieldTypeString )
• household_smokers ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Who else in your household smokes or uses tobacco? (Select all that apply), type: esriFieldTypeString )
• household_smokers_other ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please specify other household members who smoke, type: esriFieldTypeString )
• social_smokers ( nullable: true, editable: true, defaultValue: null, length: 255, alias: How many of your family/friends (not living with you) smoke or use tobacco?, type: esriFieldTypeString , Coded Values: [none: None] , [few: A few] , [many: Many] , ...1 more... )
• smoking_in_home ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking or tobacco use allowed inside your home?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• smoking_in_car ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking or tobacco use allowed inside your vehicle?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• work_smoking_policy ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is smoking allowed where you work?, type: esriFieldTypeString , Coded Values: [inside_outside: Yes — inside and outside] , [outside_only: Yes — outside only] , [no: No] , ...1 more... )
• smokes_at_work ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you smoke during the workday?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• note_medical ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please answer YES or NO for current or past diagnoses., type: esriFieldTypeString )
• dx_depression ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Depression, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_anxiety ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Anxiety, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_schizophrenia ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Schizophrenia, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_bipolar ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Bipolar Disorder, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_seizure ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Seizure / Convulsions / Epilepsy, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_heart_attack_30d ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Heart attack within the last 30 days, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_stroke_30d ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Stroke or TIA (Temporary Stroke) within the last 30 days, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_pregnant ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Currently pregnant, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_under18 ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Under 18 years of age, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_arrhythmia_6mo ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Diagnosed within the last 6 months with very rapid or irregular heartbeat requiring change in activities or medication, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_angina_6mo ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Diagnosed within the last 6 months with serious or worsening angina (chest pain), type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_nrt_rash ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Previous generalized rash over entire body related to NRT, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_patch_reaction ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Previous adverse reaction to patch medication or adhesive tape, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_jaw_dental ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Jaw or dental problems that limit chewing (gum only), type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_bupropion_nrt ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Planning to use Zyban/Bupropion along with NRT (patch, gum, lozenges), type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_uncontrolled_bp ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Have high blood pressure not controlled by medication, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_breastfeeding ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Currently breastfeeding (if female), type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• dx_planning_pregnancy ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Planning pregnancy within 3 months (if female), type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• medical_comments ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Additional comments about medical history, type: esriFieldTypeString )
• note_mh ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Over the past TWO WEEKS, how often have you been bothered by the following?, type: esriFieldTypeString )
• phq_little_interest ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Little interest or pleasure in doing things, type: esriFieldTypeString , Coded Values: [not_at_all: Not at all] , [several_days: Several days] , [more_than_half: More than half the days] , ...1 more... )
• phq_feeling_down ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Feeling down, depressed, or hopeless, type: esriFieldTypeString , Coded Values: [not_at_all: Not at all] , [several_days: Several days] , [more_than_half: More than half the days] , ...1 more... )
• phq_anxious ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Being anxious, nervous, restless, or fidgety, type: esriFieldTypeString , Coded Values: [not_at_all: Not at all] , [several_days: Several days] , [more_than_half: More than half the days] , ...1 more... )
• tension_physical ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you have physical signs of excess tension (headaches, difficulty sleeping, upset stomach)?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• tension_explain ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please explain your tension symptoms, type: esriFieldTypeString )
• ok_contact_provider ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Is it okay for the tobacco treatment facilitator to contact your medical provider to discuss your quit plan (via fax/phone)?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• provider_name_location ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Provider's Name and Location, type: esriFieldTypeString )
• additional_info ( nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide any additional information that may be helpful, type: esriFieldTypeString )
• created_user ( nullable: true, editable: false, defaultValue: null, length: 255, alias: created_user, type: esriFieldTypeString )
• created_date ( nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: created_date, type: esriFieldTypeDate )
• last_edited_user ( nullable: true, editable: false, defaultValue: null, length: 255, alias: last_edited_user, type: esriFieldTypeString )
• last_edited_date ( nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: last_edited_date, type: esriFieldTypeDate )
Templates:
• Name: New Feature
  Description:
  Prototype:
  Drawing Tool: N/A