Name: TobaccoTemplate
Display Field: client_firstname
Type: Feature Layer
Geometry Type: esriGeometryPoint
Description:
Service Item Id: 0cf1d804d77f403ab0c4dea0b2a0456d
Copyright Text:
Default Visibility: true
MaxRecordCount: 2000
MaxSelectionCount: 2000
Supported Query Formats: JSON, geoJSON, PBF
Min Scale: 0.0
Max Scale: 0.0
Supports Advanced Queries: true
Supports Statistics: true
Has Labels: false
Can Modify Layer: true
Can Scale Symbols: false
Use Standardized Queries: true
Supports Datum Transformation: true
Extent:
XMin: 0.0
YMin: 0.0
XMax: 0.0
YMax: 0.0
Spatial Reference: 102100
(3857)
LatestVCSWkid(0)
Drawing Info:
Renderer:
Simple Renderer:
Symbol: Style: esriSMSCircle
Color: [36, 158, 76, 255]
Size: 4.0
Angle: 0.0
XOffset: 0
YOffset: 0
Outline:
Label: N/A
Description: N/A
Transparency: 0
Labeling Info:
Feature Draw Order:
Advanced Query Capabilities:
Supports Statistics: true
Supports OrderBy: true
Supports Distinct: true
Supports Pagination: true
Supports TrueCurve: true
Supports Returning Query Extent: true
Supports Query With Distance: true
Supports Sql Expression: true
Supports Query With ResultType: false
Supports Returning Geometry Centroid: false
Supports Binning LOD: false
Supports Query With LOD Spatial Reference: false
Supports Percentile Statistics: true
Supports Having Clause: true
Supports Count Distinct: true
Supports Time Relation: true
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: null
Fields:
-
OBJECTID
(
type: esriFieldTypeOID, alias: ObjectID
)
-
appt_date
(
type: esriFieldTypeDate, alias: Appointment Date, length: 8, precision: 1
)
-
client_firstname
(
type: esriFieldTypeString, alias: First Name, length: 255
)
-
client_lastname
(
type: esriFieldTypeString, alias: Last Name, length: 255
)
-
street_address
(
type: esriFieldTypeString, alias: Street Address, length: 255
)
-
city
(
type: esriFieldTypeString, alias: City, length: 255
)
-
zip_code
(
type: esriFieldTypeString, alias: Zip Code, length: 255
)
-
phone_number
(
type: esriFieldTypeString, alias: Contact Phone Number, length: 255
)
-
email
(
type: esriFieldTypeString, alias: Email Address, length: 255
)
-
contact_best
(
type: esriFieldTypeString, alias: Best Method & Time for Contact, length: 255
)
-
emergency_contact
(
type: esriFieldTypeString, alias: Emergency Contact, length: 255
)
-
ok_contact_all
(
type: esriFieldTypeString, alias: Is it okay for us to contact you at all of the above locations?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
no_contact_where
(
type: esriFieldTypeString, alias: Please specify where NOT to contact you, length: 255
)
-
ok_text
(
type: esriFieldTypeString, alias: Is it okay to contact you via text for appointment reminders?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dob
(
type: esriFieldTypeDate, alias: Date of Birth, length: 8, precision: 1
)
-
age
(
type: esriFieldTypeInteger, alias: Age
)
-
gender
(
type: esriFieldTypeString, alias: Gender, length: 255
, 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, length: 255
)
-
has_children
(
type: esriFieldTypeString, alias: Do you have children living with you?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
children_asthma
(
type: esriFieldTypeString, alias: Do any of your children have asthma?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
race_ethnicity
(
type: esriFieldTypeString, alias: What race/ethnicity best describes you?, length: 255
, Coded Values:
[white: Caucasian / White]
, [asian: Asian]
, [aian: American Indian / Alaskan Native]
, ...4 more...
)
-
race_other
(
type: esriFieldTypeString, alias: Please specify your race/ethnicity, length: 255
)
-
education
(
type: esriFieldTypeString, alias: Highest level of education completed, length: 255
, 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), length: 255
)
-
insurance
(
type: esriFieldTypeString, alias: What type of health insurance do you have?, length: 255
, 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?, length: 255
)
-
note_tobacco_use
(
type: esriFieldTypeString, alias: Over the past 6 months, select the type(s) of tobacco used and average amount per day., length: 255
)
-
tobacco_types
(
type: esriFieldTypeString, alias: What type(s) of tobacco have you used in the past 6 months?, length: 255
)
-
qty_cigarettes
(
type: esriFieldTypeDouble, alias: Cigarettes per day
)
-
qty_little_cigars
(
type: esriFieldTypeDouble, alias: Little cigars per day
)
-
qty_cigars
(
type: esriFieldTypeDouble, alias: Cigars per day
)
-
qty_pipe
(
type: esriFieldTypeDouble, alias: Pipefuls per day
)
-
qty_smokeless
(
type: esriFieldTypeDouble, alias: Cans/pouches per day (smokeless tobacco)
)
-
qty_snus
(
type: esriFieldTypeDouble, alias: Snus per day
)
-
qty_ecig
(
type: esriFieldTypeDouble, alias: E-cigarettes (mL or pods per day)
)
-
tobacco_other_type
(
type: esriFieldTypeString, alias: Other tobacco type (please specify), length: 255
)
-
qty_other
(
type: esriFieldTypeDouble, alias: Other tobacco — amount per day
)
-
age_first_use
(
type: esriFieldTypeInteger, alias: Age when you first started using tobacco regularly
)
-
tobacco_brand
(
type: esriFieldTypeString, alias: What brand of tobacco do you normally use?, length: 255
)
-
uses_menthol
(
type: esriFieldTypeString, alias: Do you use menthol?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
first_cig_timing
(
type: esriFieldTypeString, alias: How many minutes after waking do you use tobacco or nicotine?, length: 255
, 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?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
nights_per_week
(
type: esriFieldTypeDouble, alias: How many nights per week do you wake for tobacco?
)
-
caffeinated_drinks
(
type: esriFieldTypeInteger, alias: How many caffeinated drinks do you have per day (coffee, tea, soda)?
)
-
main_triggers
(
type: esriFieldTypeString, alias: What are your main triggers for tobacco/nicotine use?, length: 255
)
-
craving_times
(
type: esriFieldTypeString, alias: When do you crave tobacco the most? (Select all that apply), length: 255
)
-
craving_driving_time
(
type: esriFieldTypeString, alias: What time of day do you typically crave tobacco while driving?, length: 255
)
-
craving_break_time
(
type: esriFieldTypeString, alias: What time of day do you crave during work breaks?, length: 255
)
-
quit_intent
(
type: esriFieldTypeString, alias: Are you planning to stop using all tobacco?, length: 255
, 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, length: 8, precision: 1
)
-
readiness_scale
(
type: esriFieldTypeInteger, alias: On a scale of 1–10, how ready are you to quit in the next 6 months?
)
-
importance_scale
(
type: esriFieldTypeInteger, alias: On a scale of 1–10, how important is it to you to quit in the next 6 months?
)
-
confidence_scale
(
type: esriFieldTypeInteger, alias: On a scale of 1–10, how confident are you that you can stop using all tobacco?
)
-
quit_attempts
(
type: esriFieldTypeString, alias: How many serious quit attempts have you made?, length: 255
, 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?, length: 255
)
-
longest_quit_year
(
type: esriFieldTypeInteger, alias: What year did you stay quit the longest?
)
-
past_quit_methods
(
type: esriFieldTypeString, alias: What did you use to help you quit in the past? (medicine, counseling, etc.), length: 255
)
-
relapse_reason
(
type: esriFieldTypeString, alias: What triggered your relapse? Provide more details here., length: 255
)
-
nrt_past
(
type: esriFieldTypeString, alias: What medications/NRT did you use in past quit attempts?, length: 255
)
-
nrt_past_helpful
(
type: esriFieldTypeString, alias: What worked well or helped most? Describe any side effects., length: 255
)
-
nrt_current
(
type: esriFieldTypeString, alias: What nicotine replacement therapy or medications are you considering now?, length: 255
)
-
nrt_other_specify
(
type: esriFieldTypeString, alias: Please specify other medication/therapy, length: 255
)
-
household_smokers
(
type: esriFieldTypeString, alias: Who else in your household smokes or uses tobacco? (Select all that apply), length: 255
)
-
household_smokers_other
(
type: esriFieldTypeString, alias: Please specify other household members who smoke, length: 255
)
-
social_smokers
(
type: esriFieldTypeString, alias: How many of your family/friends (not living with you) smoke or use tobacco?, length: 255
, 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?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
smoking_in_car
(
type: esriFieldTypeString, alias: Is smoking or tobacco use allowed inside your vehicle?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
work_smoking_policy
(
type: esriFieldTypeString, alias: Is smoking allowed where you work?, length: 255
, 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?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
note_medical
(
type: esriFieldTypeString, alias: Please answer YES or NO for current or past diagnoses., length: 255
)
-
dx_depression
(
type: esriFieldTypeString, alias: Depression, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_anxiety
(
type: esriFieldTypeString, alias: Anxiety, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_schizophrenia
(
type: esriFieldTypeString, alias: Schizophrenia, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_bipolar
(
type: esriFieldTypeString, alias: Bipolar Disorder, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_seizure
(
type: esriFieldTypeString, alias: Seizure / Convulsions / Epilepsy, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_heart_attack_30d
(
type: esriFieldTypeString, alias: Heart attack within the last 30 days, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_stroke_30d
(
type: esriFieldTypeString, alias: Stroke or TIA (Temporary Stroke) within the last 30 days, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_pregnant
(
type: esriFieldTypeString, alias: Currently pregnant, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_under18
(
type: esriFieldTypeString, alias: Under 18 years of age, length: 255
, 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, length: 255
, 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), length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_nrt_rash
(
type: esriFieldTypeString, alias: Previous generalized rash over entire body related to NRT, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_patch_reaction
(
type: esriFieldTypeString, alias: Previous adverse reaction to patch medication or adhesive tape, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_jaw_dental
(
type: esriFieldTypeString, alias: Jaw or dental problems that limit chewing (gum only), length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_bupropion_nrt
(
type: esriFieldTypeString, alias: Planning to use Zyban/Bupropion along with NRT (patch, gum, lozenges), length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_uncontrolled_bp
(
type: esriFieldTypeString, alias: Have high blood pressure not controlled by medication, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_breastfeeding
(
type: esriFieldTypeString, alias: Currently breastfeeding (if female), length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
dx_planning_pregnancy
(
type: esriFieldTypeString, alias: Planning pregnancy within 3 months (if female), length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
medical_comments
(
type: esriFieldTypeString, alias: Additional comments about medical history, length: 255
)
-
note_mh
(
type: esriFieldTypeString, alias: Over the past TWO WEEKS, how often have you been bothered by the following?, length: 255
)
-
phq_little_interest
(
type: esriFieldTypeString, alias: Little interest or pleasure in doing things, length: 255
, 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, length: 255
, 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, length: 255
, 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)?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
tension_explain
(
type: esriFieldTypeString, alias: Please explain your tension symptoms, length: 255
)
-
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)?, length: 255
, Coded Values:
[yes: Yes]
, [no: No]
)
-
provider_name_location
(
type: esriFieldTypeString, alias: Provider's Name and Location, length: 255
)
-
additional_info
(
type: esriFieldTypeString, alias: Please provide any additional information that may be helpful, length: 255
)
-
Shape
(
type: esriFieldTypeGeometry, alias: Shape
)
-
GlobalID
(
type: esriFieldTypeGlobalID, alias: GlobalID, length: 38
)
-
created_user
(
type: esriFieldTypeString, alias: created_user, length: 255
)
-
created_date
(
type: esriFieldTypeDate, alias: created_date, length: 8
)
-
last_edited_user
(
type: esriFieldTypeString, alias: last_edited_user, length: 255
)
-
last_edited_date
(
type: esriFieldTypeDate, alias: last_edited_date, length: 8
)
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