All Layers and Tables (PublicHealth/TobaccoFormTemplate)

Layers:

Layer: TobaccoTemplate (0)

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Copyright Text:

Default Visibility: true

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Supports Advanced Queries:

Supports Statistics:

Can Scale Symbols:

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Supports ValidateSQL:

Supports Calculate:

Supports Datum Transformation:

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Simple Renderer:

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Feature Draw Order:

N/A

Advanced Query Capabilities:

HasZ: false

HasM: false

Has Attachments:

HTML Popup Type:

Type ID Field:

Fields:

OBJECTID ( type: esriFieldTypeOID, alias: ObjectID, editable: false, nullable: false, defaultValue: null, modelName: OBJECTID )
appt_date ( type: esriFieldTypeDate, alias: Appointment Date, editable: true, nullable: true, length: 8, defaultValue: null, precision: 1, modelName: appt_date )
client_firstname ( type: esriFieldTypeString, alias: First Name, editable: true, nullable: true, length: 255, defaultValue: null, modelName: client_firstname )
client_lastname ( type: esriFieldTypeString, alias: Last Name, editable: true, nullable: true, length: 255, defaultValue: null, modelName: client_lastname )
street_address ( type: esriFieldTypeString, alias: Street Address, editable: true, nullable: true, length: 255, defaultValue: null, modelName: street_address )
city ( type: esriFieldTypeString, alias: City, editable: true, nullable: true, length: 255, defaultValue: null, modelName: city )
zip_code ( type: esriFieldTypeString, alias: Zip Code, editable: true, nullable: true, length: 255, defaultValue: null, modelName: zip_code )
phone_number ( type: esriFieldTypeString, alias: Contact Phone Number, editable: true, nullable: true, length: 255, defaultValue: null, modelName: phone_number )
email ( type: esriFieldTypeString, alias: Email Address, editable: true, nullable: true, length: 255, defaultValue: null, modelName: email )
contact_best ( type: esriFieldTypeString, alias: Best Method & Time for Contact, editable: true, nullable: true, length: 255, defaultValue: null, modelName: contact_best )
emergency_contact ( type: esriFieldTypeString, alias: Emergency Contact, editable: true, nullable: true, length: 255, defaultValue: null, modelName: emergency_contact )
ok_contact_all ( type: esriFieldTypeString, alias: Is it okay for us to contact you at all of the above locations?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: ok_contact_all , Coded Values: [yes: Yes] , [no: No] )
no_contact_where ( type: esriFieldTypeString, alias: Please specify where NOT to contact you, editable: true, nullable: true, length: 255, defaultValue: null, modelName: no_contact_where )
ok_text ( type: esriFieldTypeString, alias: Is it okay to contact you via text for appointment reminders?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: ok_text , Coded Values: [yes: Yes] , [no: No] )
dob ( type: esriFieldTypeDate, alias: Date of Birth, editable: true, nullable: true, length: 8, defaultValue: null, precision: 1, modelName: dob )
age ( type: esriFieldTypeInteger, alias: Age, editable: true, nullable: true, defaultValue: null, modelName: age )
gender ( type: esriFieldTypeString, alias: Gender, editable: true, nullable: true, length: 255, defaultValue: null, modelName: gender , Coded Values: [female: Female] , [male: Male] , [non_binary: Non-binary / Third gender] , ...2 more... )
gender_self_describe ( type: esriFieldTypeString, alias: Please self-describe your gender, editable: true, nullable: true, length: 255, defaultValue: null, modelName: gender_self_describe )
has_children ( type: esriFieldTypeString, alias: Do you have children living with you?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: has_children , Coded Values: [yes: Yes] , [no: No] )
children_asthma ( type: esriFieldTypeString, alias: Do any of your children have asthma?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: children_asthma , Coded Values: [yes: Yes] , [no: No] )
race_ethnicity ( type: esriFieldTypeString, alias: What race/ethnicity best describes you?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: race_ethnicity , Coded Values: [white: Caucasian / White] , [asian: Asian] , [aian: American Indian / Alaskan Native] , ...4 more... )
race_other ( type: esriFieldTypeString, alias: Please specify your race/ethnicity, editable: true, nullable: true, length: 255, defaultValue: null, modelName: race_other )
education ( type: esriFieldTypeString, alias: Highest level of education completed, editable: true, nullable: true, length: 255, defaultValue: null, modelName: education , 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 ( type: esriFieldTypeString, alias: How would you describe your work status? (Select all that apply), editable: true, nullable: true, length: 255, defaultValue: null, modelName: work_status )
insurance ( type: esriFieldTypeString, alias: What type of health insurance do you have?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: insurance , Coded Values: [medicare: Medicare] , [medicaid: Medicaid] , [both: Both Medicare and Medicaid] , ...3 more... )
program_referral ( type: esriFieldTypeString, alias: How did you learn about our quitting program?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: program_referral )
note_tobacco_use ( type: esriFieldTypeString, alias: Over the past 6 months, select the type(s) of tobacco used and average amount per day., editable: true, nullable: true, length: 255, defaultValue: null, modelName: note_tobacco_use )
tobacco_types ( type: esriFieldTypeString, alias: What type(s) of tobacco have you used in the past 6 months?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: tobacco_types )
qty_cigarettes ( type: esriFieldTypeDouble, alias: Cigarettes per day, editable: true, nullable: true, defaultValue: null, modelName: qty_cigarettes )
qty_little_cigars ( type: esriFieldTypeDouble, alias: Little cigars per day, editable: true, nullable: true, defaultValue: null, modelName: qty_little_cigars )
qty_cigars ( type: esriFieldTypeDouble, alias: Cigars per day, editable: true, nullable: true, defaultValue: null, modelName: qty_cigars )
qty_pipe ( type: esriFieldTypeDouble, alias: Pipefuls per day, editable: true, nullable: true, defaultValue: null, modelName: qty_pipe )
qty_smokeless ( type: esriFieldTypeDouble, alias: Cans/pouches per day (smokeless tobacco), editable: true, nullable: true, defaultValue: null, modelName: qty_smokeless )
qty_snus ( type: esriFieldTypeDouble, alias: Snus per day, editable: true, nullable: true, defaultValue: null, modelName: qty_snus )
qty_ecig ( type: esriFieldTypeDouble, alias: E-cigarettes (mL or pods per day), editable: true, nullable: true, defaultValue: null, modelName: qty_ecig )
tobacco_other_type ( type: esriFieldTypeString, alias: Other tobacco type (please specify), editable: true, nullable: true, length: 255, defaultValue: null, modelName: tobacco_other_type )
qty_other ( type: esriFieldTypeDouble, alias: Other tobacco — amount per day, editable: true, nullable: true, defaultValue: null, modelName: qty_other )
age_first_use ( type: esriFieldTypeInteger, alias: Age when you first started using tobacco regularly, editable: true, nullable: true, defaultValue: null, modelName: age_first_use )
tobacco_brand ( type: esriFieldTypeString, alias: What brand of tobacco do you normally use?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: tobacco_brand )
uses_menthol ( type: esriFieldTypeString, alias: Do you use menthol?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: uses_menthol , Coded Values: [yes: Yes] , [no: No] )
first_cig_timing ( type: esriFieldTypeString, alias: How many minutes after waking do you use tobacco or nicotine?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: first_cig_timing , Coded Values: [immediately: Immediately upon waking] , [5_to_30: 5–30 minutes] , [31_to_60: 31–60 minutes] , ...1 more... )
wakes_for_tobacco ( type: esriFieldTypeString, alias: Do you sometimes wake up at night to use tobacco?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: wakes_for_tobacco , Coded Values: [yes: Yes] , [no: No] )
nights_per_week ( type: esriFieldTypeDouble, alias: How many nights per week do you wake for tobacco?, editable: true, nullable: true, defaultValue: null, modelName: nights_per_week )
caffeinated_drinks ( type: esriFieldTypeInteger, alias: How many caffeinated drinks do you have per day (coffee, tea, soda)?, editable: true, nullable: true, defaultValue: null, modelName: caffeinated_drinks )
main_triggers ( type: esriFieldTypeString, alias: What are your main triggers for tobacco/nicotine use?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: main_triggers )
craving_times ( type: esriFieldTypeString, alias: When do you crave tobacco the most? (Select all that apply), editable: true, nullable: true, length: 255, defaultValue: null, modelName: craving_times )
craving_driving_time ( type: esriFieldTypeString, alias: What time of day do you typically crave tobacco while driving?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: craving_driving_time )
craving_break_time ( type: esriFieldTypeString, alias: What time of day do you crave during work breaks?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: craving_break_time )
quit_intent ( type: esriFieldTypeString, alias: Are you planning to stop using all tobacco?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: quit_intent , 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 ( type: esriFieldTypeDate, alias: Date you last used tobacco, editable: true, nullable: true, length: 8, defaultValue: null, precision: 1, modelName: quit_date_already )
readiness_scale ( type: esriFieldTypeInteger, alias: On a scale of 1–10, how ready are you to quit in the next 6 months?, editable: true, nullable: true, defaultValue: null, modelName: readiness_scale )
importance_scale ( type: esriFieldTypeInteger, alias: On a scale of 1–10, how important is it to you to quit in the next 6 months?, editable: true, nullable: true, defaultValue: null, modelName: importance_scale )
confidence_scale ( type: esriFieldTypeInteger, alias: On a scale of 1–10, how confident are you that you can stop using all tobacco?, editable: true, nullable: true, defaultValue: null, modelName: confidence_scale )
quit_attempts ( type: esriFieldTypeString, alias: How many serious quit attempts have you made?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: quit_attempts , Coded Values: [0: 0 — No prior attempts] , [1: 1] , [2: 2] , ...3 more... )
longest_quit ( type: esriFieldTypeString, alias: What is the longest you have stayed quit?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: longest_quit )
longest_quit_year ( type: esriFieldTypeInteger, alias: What year did you stay quit the longest?, editable: true, nullable: true, defaultValue: null, modelName: longest_quit_year )
past_quit_methods ( type: esriFieldTypeString, alias: What did you use to help you quit in the past? (medicine, counseling, etc.), editable: true, nullable: true, length: 255, defaultValue: null, modelName: past_quit_methods )
relapse_reason ( type: esriFieldTypeString, alias: What triggered your relapse? Provide more details here., editable: true, nullable: true, length: 255, defaultValue: null, modelName: relapse_reason )
nrt_past ( type: esriFieldTypeString, alias: What medications/NRT did you use in past quit attempts?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: nrt_past )
nrt_past_helpful ( type: esriFieldTypeString, alias: What worked well or helped most? Describe any side effects., editable: true, nullable: true, length: 255, defaultValue: null, modelName: nrt_past_helpful )
nrt_current ( type: esriFieldTypeString, alias: What nicotine replacement therapy or medications are you considering now?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: nrt_current )
nrt_other_specify ( type: esriFieldTypeString, alias: Please specify other medication/therapy, editable: true, nullable: true, length: 255, defaultValue: null, modelName: nrt_other_specify )
household_smokers ( type: esriFieldTypeString, alias: Who else in your household smokes or uses tobacco? (Select all that apply), editable: true, nullable: true, length: 255, defaultValue: null, modelName: household_smokers )
household_smokers_other ( type: esriFieldTypeString, alias: Please specify other household members who smoke, editable: true, nullable: true, length: 255, defaultValue: null, modelName: household_smokers_other )
social_smokers ( type: esriFieldTypeString, alias: How many of your family/friends (not living with you) smoke or use tobacco?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: social_smokers , Coded Values: [none: None] , [few: A few] , [many: Many] , ...1 more... )
smoking_in_home ( type: esriFieldTypeString, alias: Is smoking or tobacco use allowed inside your home?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: smoking_in_home , Coded Values: [yes: Yes] , [no: No] )
smoking_in_car ( type: esriFieldTypeString, alias: Is smoking or tobacco use allowed inside your vehicle?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: smoking_in_car , Coded Values: [yes: Yes] , [no: No] )
work_smoking_policy ( type: esriFieldTypeString, alias: Is smoking allowed where you work?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: work_smoking_policy , Coded Values: [inside_outside: Yes — inside and outside] , [outside_only: Yes — outside only] , [no: No] , ...1 more... )
smokes_at_work ( type: esriFieldTypeString, alias: Do you smoke during the workday?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: smokes_at_work , Coded Values: [yes: Yes] , [no: No] )
note_medical ( type: esriFieldTypeString, alias: Please answer YES or NO for current or past diagnoses., editable: true, nullable: true, length: 255, defaultValue: null, modelName: note_medical )
dx_depression ( type: esriFieldTypeString, alias: Depression, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_depression , Coded Values: [yes: Yes] , [no: No] )
dx_anxiety ( type: esriFieldTypeString, alias: Anxiety, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_anxiety , Coded Values: [yes: Yes] , [no: No] )
dx_schizophrenia ( type: esriFieldTypeString, alias: Schizophrenia, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_schizophrenia , Coded Values: [yes: Yes] , [no: No] )
dx_bipolar ( type: esriFieldTypeString, alias: Bipolar Disorder, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_bipolar , Coded Values: [yes: Yes] , [no: No] )
dx_seizure ( type: esriFieldTypeString, alias: Seizure / Convulsions / Epilepsy, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_seizure , Coded Values: [yes: Yes] , [no: No] )
dx_heart_attack_30d ( type: esriFieldTypeString, alias: Heart attack within the last 30 days, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_heart_attack_30d , Coded Values: [yes: Yes] , [no: No] )
dx_stroke_30d ( type: esriFieldTypeString, alias: Stroke or TIA (Temporary Stroke) within the last 30 days, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_stroke_30d , Coded Values: [yes: Yes] , [no: No] )
dx_pregnant ( type: esriFieldTypeString, alias: Currently pregnant, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_pregnant , Coded Values: [yes: Yes] , [no: No] )
dx_under18 ( type: esriFieldTypeString, alias: Under 18 years of age, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_under18 , Coded Values: [yes: Yes] , [no: No] )
dx_arrhythmia_6mo ( type: esriFieldTypeString, alias: Diagnosed within the last 6 months with very rapid or irregular heartbeat requiring change in activities or medication, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_arrhythmia_6mo , Coded Values: [yes: Yes] , [no: No] )
dx_angina_6mo ( type: esriFieldTypeString, alias: Diagnosed within the last 6 months with serious or worsening angina (chest pain), editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_angina_6mo , Coded Values: [yes: Yes] , [no: No] )
dx_nrt_rash ( type: esriFieldTypeString, alias: Previous generalized rash over entire body related to NRT, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_nrt_rash , Coded Values: [yes: Yes] , [no: No] )
dx_patch_reaction ( type: esriFieldTypeString, alias: Previous adverse reaction to patch medication or adhesive tape, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_patch_reaction , Coded Values: [yes: Yes] , [no: No] )
dx_jaw_dental ( type: esriFieldTypeString, alias: Jaw or dental problems that limit chewing (gum only), editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_jaw_dental , Coded Values: [yes: Yes] , [no: No] )
dx_bupropion_nrt ( type: esriFieldTypeString, alias: Planning to use Zyban/Bupropion along with NRT (patch, gum, lozenges), editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_bupropion_nrt , Coded Values: [yes: Yes] , [no: No] )
dx_uncontrolled_bp ( type: esriFieldTypeString, alias: Have high blood pressure not controlled by medication, editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_uncontrolled_bp , Coded Values: [yes: Yes] , [no: No] )
dx_breastfeeding ( type: esriFieldTypeString, alias: Currently breastfeeding (if female), editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_breastfeeding , Coded Values: [yes: Yes] , [no: No] )
dx_planning_pregnancy ( type: esriFieldTypeString, alias: Planning pregnancy within 3 months (if female), editable: true, nullable: true, length: 255, defaultValue: null, modelName: dx_planning_pregnancy , Coded Values: [yes: Yes] , [no: No] )
medical_comments ( type: esriFieldTypeString, alias: Additional comments about medical history, editable: true, nullable: true, length: 255, defaultValue: null, modelName: medical_comments )
note_mh ( type: esriFieldTypeString, alias: Over the past TWO WEEKS, how often have you been bothered by the following?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: note_mh )
phq_little_interest ( type: esriFieldTypeString, alias: Little interest or pleasure in doing things, editable: true, nullable: true, length: 255, defaultValue: null, modelName: phq_little_interest , 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 ( type: esriFieldTypeString, alias: Feeling down, depressed, or hopeless, editable: true, nullable: true, length: 255, defaultValue: null, modelName: phq_feeling_down , Coded Values: [not_at_all: Not at all] , [several_days: Several days] , [more_than_half: More than half the days] , ...1 more... )
phq_anxious ( type: esriFieldTypeString, alias: Being anxious, nervous, restless, or fidgety, editable: true, nullable: true, length: 255, defaultValue: null, modelName: phq_anxious , Coded Values: [not_at_all: Not at all] , [several_days: Several days] , [more_than_half: More than half the days] , ...1 more... )
tension_physical ( type: esriFieldTypeString, alias: Do you have physical signs of excess tension (headaches, difficulty sleeping, upset stomach)?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: tension_physical , Coded Values: [yes: Yes] , [no: No] )
tension_explain ( type: esriFieldTypeString, alias: Please explain your tension symptoms, editable: true, nullable: true, length: 255, defaultValue: null, modelName: tension_explain )
ok_contact_provider ( type: esriFieldTypeString, alias: Is it okay for the tobacco treatment facilitator to contact your medical provider to discuss your quit plan (via fax/phone)?, editable: true, nullable: true, length: 255, defaultValue: null, modelName: ok_contact_provider , Coded Values: [yes: Yes] , [no: No] )
provider_name_location ( type: esriFieldTypeString, alias: Provider's Name and Location, editable: true, nullable: true, length: 255, defaultValue: null, modelName: provider_name_location )
additional_info ( type: esriFieldTypeString, alias: Please provide any additional information that may be helpful, editable: true, nullable: true, length: 255, defaultValue: null, modelName: additional_info )
GlobalID ( type: esriFieldTypeGlobalID, alias: GlobalID, editable: false, nullable: false, length: 38, defaultValue: null, modelName: GlobalID )
created_user ( type: esriFieldTypeString, alias: created_user, editable: false, nullable: true, length: 255, defaultValue: null, modelName: created_user )
created_date ( type: esriFieldTypeDate, alias: created_date, editable: false, nullable: true, length: 8, defaultValue: null, modelName: created_date )
last_edited_user ( type: esriFieldTypeString, alias: last_edited_user, editable: false, nullable: true, length: 255, defaultValue: null, modelName: last_edited_user )
last_edited_date ( type: esriFieldTypeDate, alias: last_edited_date, editable: false, nullable: true, length: 8, defaultValue: null, modelName: last_edited_date )

Name: TobaccoTemplate
Description:
Prototype:
Drawing Tool: esriFeatureEditToolPoint