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        "title": "Question",
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                "system": "http://loinc.org",
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            ],
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            "text": "Phone Number",
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                "code": "phoneNumber",
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            "linkId": "g2",
            "type": "group",
            "text": "Race",
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                "system": "http://loinc.org",
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                "type": "boolean",
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                "type": "boolean",
                "text": "Native Hawaiian",
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                  "code": "LA10623-9",
                  "display": "Native Hawaiian",
                  "system": "http://loinc.org"
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                "linkId": "r2"
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              {
                "type": "boolean",
                "text": "Asian",
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                  "code": "LA6156-9",
                  "display": "Asian",
                  "system": "http://loinc.org"
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                "id": "id-783",
                "linkId": "r3"
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              {
                "type": "boolean",
                "text": "Pacific Islander",
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                  "code": "LA10624-7",
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                  "system": "http://loinc.org"
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                "linkId": "r4"
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                "type": "boolean",
                "text": "Black or African American",
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                  "code": "LA10610-6",
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                  "system": "http://loinc.org"
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                "id": "id-785",
                "linkId": "r5"
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              {
                "type": "boolean",
                "text": "White",
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                  "code": "LA4457-3",
                  "display": "White",
                  "system": "http://loinc.org"
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                "id": "id-786",
                "linkId": "r6"
              },
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                "type": "boolean",
                "text": "Other/Unknown/Prefer not to Answer",
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                  "code": "LA10613-0",
                  "display": "Other/Unknown/Prefer not to Answer",
                  "system": "http://loinc.org"
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                "linkId": "r7"
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            "id": "id-622",
            "linkId": "g3",
            "type": "choice",
            "text": "Ethnicity",
            "required": true,
            "code": [
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                "system": "http://loinc.org",
                "code": "54133-4",
                "display": "Ethnicity"
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                "valueCoding": {
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                "valueCoding": {
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                "valueCoding": {
                  "code": "LA10607-2",
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                  "system": "http://loinc.org"
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            "id": "id-599",
            "linkId": "q3",
            "type": "choice",
            "text": "Do you wish to share your result with your primary care provider or other healthcare practitioner?",
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                "code": "shareYourResult",
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                "valueCoding": {
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                  "system": "http://loinc.org"
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          {
            "id": "id-7",
            "linkId": "g4",
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            "text": "Why are you taking this test?",
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                "system": "Custom",
                "code": "takingThisTest",
                "display": "Why are you taking this test?"
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            ],
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                "linkId": "q4",
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                    "system": "Custom",
                    "code": "trackingHealth",
                    "display": "Tracking health on my own to improve my quality of life"
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                ]
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                "id": "id-9",
                "linkId": "q5",
                "type": "boolean",
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                    "system": "Custom",
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                    "system": "Custom",
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                "id": "id-11",
                "linkId": "q7",
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                "text": "Other",
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                    "code": "LA46-8",
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                    "system": "http://loinc.org"
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            ]
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            "type": "choice",
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                "code": "historyOfConditions",
                "display": "Do you have a history of any of the following conditions?"
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            "multiple": true,
            "required": true,
            "linkId": "g6",
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                  "display": "Anemia",
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                  "display": "Arthritis",
                  "system": "http://neelyx.com"
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                "valueCoding": {
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                  "display": "Asthma",
                  "system": "http://loinc.org"
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                "id": "id-22",
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                  "display": "Autoiminnune Disease",
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                "id": "id-23",
                "valueCoding": {
                  "code": "1000003-5",
                  "display": "Blood Disorder/ Disease",
                  "system": "http://neelyx.com"
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                "valueCoding": {
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                  "display": "Blood Transfusion",
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                "id": "id-25",
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                  "code": "LA10524-9",
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                "id": "id-260",
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                  "code": "LA10561-1",
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                  "system": "http://loinc.org"
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                "id": "id-27",
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                  "code": "94558-4",
                  "display": "SARS-CoV-2 (COVID-19) antigen, Respiratory",
                  "system": "http://loinc.org"
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                  "code": "LA10576-9",
                  "display": "Depression",
                  "system": "http://loinc.org"
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                "id": "id-280",
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                  "code": "LA10574-4",
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                  "system": "http://loinc.org"
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                  "display": "Eye Disorder/ Disease",
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                "id": "id-32",
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                  "code": "1000003-10",
                  "display": "Headaches/ Migraine",
                  "system": "http://neelyx.com"
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              },
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                "id": "id-33",
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                  "code": "LA10523-1",
                  "display": "Heart Disease",
                  "system": "http://loinc.org"
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                "id": "id-34",
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                  "code": "LA7444-8",
                  "display": "High Blood Pressure (Hypertension)",
                  "system": "http://loinc.org"
                }
              },
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                "id": "id-35",
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                  "code": "LA10526-4",
                  "display": "High Cholesterol/Hyperlipidemia",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-36",
                "valueCoding": {
                  "code": "1000003-11",
                  "display": "HIV/ AIDS",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-37",
                "valueCoding": {
                  "code": "LA10551-2",
                  "display": "Diabetes Type 1",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-370",
                "valueCoding": {
                  "code": "LA10552-0",
                  "display": "Diabetes Type 2",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-38",
                "valueCoding": {
                  "code": "LA10527-2",
                  "display": "Kidney Disease",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-39",
                "valueCoding": {
                  "code": "1000003-12",
                  "display": "Lyme Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-40",
                "valueCoding": {
                  "code": "1000003-13",
                  "display": "Liver Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-41",
                "valueCoding": {
                  "code": "1000003-14",
                  "display": "Osteoporosis",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-42",
                "valueCoding": {
                  "code": "1000003-15",
                  "display": "Other Psychiatric Disorder",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-43",
                "valueCoding": {
                  "code": "LA10563-7",
                  "display": "Pneumonia",
                  "system": "http://loinc.org"
                }
              },
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                "id": "id-44",
                "valueCoding": {
                  "code": "1000003-16",
                  "display": "Seizure or Epilepsy",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-45",
                "valueCoding": {
                  "code": "LA10522-3",
                  "display": "Stroke",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-46",
                "valueCoding": {
                  "code": "1000003-17",
                  "display": "Thyroid Disorder",
                  "system": "http://neelyx.com"
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              },
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                "id": "id-47",
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                  "code": "1000003-18",
                  "display": "Urologic Condition/Disease",
                  "system": "http://neelyx.com"
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              },
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                "id": "id-48",
                "valueCoding": {
                  "code": "1000003-19",
                  "display": "Lactose Intolerance",
                  "system": "http://neelyx.com"
                }
              },
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                "id": "id-49",
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                  "code": "1000003-20",
                  "display": "Food Allergy",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-50",
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                  "display": "Celiac Disease",
                  "system": "http://neelyx.com"
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                  "display": "Anemia",
                  "system": "http://neelyx.com"
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              },
              {
                "id": "id-200",
                "valueCoding": {
                  "code": "1000003-3",
                  "display": "Arthritis",
                  "system": "http://neelyx.com"
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              },
              {
                "id": "id-210",
                "valueCoding": {
                  "code": "LA10564-5",
                  "display": "Asthma",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-220",
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                  "code": "1000003-4",
                  "display": "Autoiminnune Disease",
                  "system": "http://neelyx.com"
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              },
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                "id": "id-230",
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                  "display": "Blood Disorder/ Disease",
                  "system": "http://neelyx.com"
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              },
              {
                "id": "id-240",
                "valueCoding": {
                  "code": "1000003-6",
                  "display": "Blood Transfusion",
                  "system": "http://neelyx.com"
                }
              },
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                "id": "id-250",
                "valueCoding": {
                  "code": "LA10524-9",
                  "display": "Cancer",
                  "system": "http://loinc.org"
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              },
              {
                "id": "id-260",
                "valueCoding": {
                  "code": "LA10559-5",
                  "display": "COPD",
                  "system": "http://loinc.org"
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              },
              {
                "id": "id-261",
                "valueCoding": {
                  "code": "LA10561-1",
                  "display": "Emphysema",
                  "system": "http://loinc.org"
                }
              },
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                "id": "id-270",
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                  "code": "94558-4",
                  "display": "SARS-CoV-2 (COVID-19) antigen, Respiratory",
                  "system": "http://loinc.org"
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              },
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                "id": "id-280",
                "valueCoding": {
                  "code": "LA10576-9",
                  "display": "Depression",
                  "system": "http://loinc.org"
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              },
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                "id": "id-281",
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                  "code": "LA10574-4",
                  "display": "Anxiety",
                  "system": "http://loinc.org"
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              },
              {
                "id": "id-290",
                "valueCoding": {
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                  "display": "Digestive Disorder",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-300",
                "valueCoding": {
                  "code": "1000003-8",
                  "display": "Deep Vein Thrombosis (DVT)/Pulmonary Embolism(PE)",
                  "system": "http://neelyx.com"
                }
              },
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                "id": "id-310",
                "valueCoding": {
                  "code": "1000003-9",
                  "display": "Eye Disorder/ Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-320",
                "valueCoding": {
                  "code": "1000003-10",
                  "display": "Headaches/ Migraine",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-330",
                "valueCoding": {
                  "code": "LA10523-1",
                  "display": "Heart Disease",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-340",
                "valueCoding": {
                  "code": "LA7444-8",
                  "display": "High Blood Pressure (Hypertension)",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-350",
                "valueCoding": {
                  "code": "LA10526-4",
                  "display": "High Cholesterol/Hyperlipidemia",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-360",
                "valueCoding": {
                  "code": "1000003-11",
                  "display": "HIV/ AIDS",
                  "system": "http://neelyx.com"
                }
              },
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                "id": "id-370",
                "valueCoding": {
                  "code": "LA10551-2",
                  "display": "Diabetes Type 1",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-371",
                "valueCoding": {
                  "code": "LA10552-0",
                  "display": "Diabetes Type 2",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-380",
                "valueCoding": {
                  "code": "LA10527-2",
                  "display": "Kidney Disease",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-390",
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                  "code": "1000003-12",
                  "display": "Lyme Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-400",
                "valueCoding": {
                  "code": "1000003-13",
                  "display": "Liver Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-410",
                "valueCoding": {
                  "code": "1000003-14",
                  "display": "Osteoporosis",
                  "system": "http://neelyx.com"
                }
              },
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                "id": "id-420",
                "valueCoding": {
                  "code": "1000003-15",
                  "display": "Other Psychiatric Disorder",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-430",
                "valueCoding": {
                  "code": "LA10563-7",
                  "display": "Pneumonia",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-440",
                "valueCoding": {
                  "code": "1000003-16",
                  "display": "Seizure or Epilepsy",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-450",
                "valueCoding": {
                  "code": "LA10522-3",
                  "display": "Stroke",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-460",
                "valueCoding": {
                  "code": "1000003-17",
                  "display": "Thyroid Disorder",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-470",
                "valueCoding": {
                  "code": "1000003-18",
                  "display": "Urologic Condition/Disease",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-480",
                "valueCoding": {
                  "code": "1000003-19",
                  "display": "Lactose Intolerance",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-490",
                "valueCoding": {
                  "code": "1000003-20",
                  "display": "Food Allergy",
                  "system": "http://neelyx.com"
                }
              },
              {
                "id": "id-500",
                "valueCoding": {
                  "code": "1000003-21",
                  "display": "Celiac Disease",
                  "system": "http://neelyx.com"
                }
              }
            ],
            "id": "id-170"
          },
          {
            "id": "id-55",
            "linkId": "q8",
            "type": "choice",
            "text": "How often do you engage in at least moderate physical activity?",
            "code": [
              {
                "code": "moderatePhysicalActivity",
                "display": "How often do you engage in at least moderate physical activity?"
              }
            ],
            "answerOption": [
              {
                "id": "id-55",
                "valueCoding": {
                  "code": "0TimesWeek",
                  "display": "0 times a week"
                }
              },
              {
                "id": "id-56",
                "valueCoding": {
                  "code": "12TimesWeek",
                  "display": "1-2 times a week"
                }
              },
              {
                "id": "id-57",
                "valueCoding": {
                  "code": "34TimesWeek",
                  "display": "3-4 times a week"
                }
              },
              {
                "id": "id-58",
                "valueCoding": {
                  "code": "5TimesWeek",
                  "display": "5+ times a week"
                }
              }
            ]
          },
          {
            "id": "id-56",
            "linkId": "q9",
            "type": "choice",
            "text": "How often do you smoke tobacco?",
            "code": [
              {
                "code": "smokeTobacco",
                "display": "How often do you smoke tobacco?"
              }
            ],
            "answerOption": [
              {
                "id": "id-59",
                "valueCoding": {
                  "code": "alFreq1",
                  "display": "Never"
                }
              },
              {
                "id": "id-60",
                "valueCoding": {
                  "code": "alFreq2",
                  "display": "Occasionally"
                }
              },
              {
                "id": "id-61",
                "valueCoding": {
                  "code": "alFreq3",
                  "display": "Currently/ Daily"
                }
              },
              {
                "id": "id-62",
                "valueCoding": {
                  "code": "alFreq4",
                  "display": "I formerly smoked"
                }
              }
            ]
          },
          {
            "id": "id-57",
            "linkId": "q10",
            "type": "choice",
            "text": "How often do you have alcohol containing drinks?",
            "code": [
              {
                "code": "alcoholDrinks",
                "display": "How often do you have alcohol containing drinks?"
              }
            ],
            "answerOption": [
              {
                "id": "id-63",
                "valueCoding": {
                  "code": "alFreq1",
                  "display": "Never"
                }
              },
              {
                "id": "id-64",
                "valueCoding": {
                  "code": "alFreq3",
                  "display": "Monthly or less"
                }
              },
              {
                "id": "id-65",
                "valueCoding": {
                  "code": "alFreq4",
                  "display": "2-4 times a month"
                }
              },
              {
                "id": "id-66",
                "valueCoding": {
                  "code": "alFreq5",
                  "display": "2-3 times a month"
                }
              },
              {
                "id": "id-67",
                "valueCoding": {
                  "code": "alFreq6",
                  "display": "4 or more times a week"
                }
              }
            ]
          },
          {
            "id": "id-58",
            "linkId": "q11",
            "type": "string",
            "text": "What other tests would you like to see Lumba offer?",
            "code": [
              {
                "code": "testsLumbaOffer",
                "display": "What other tests would you like to see Lumba offer?"
              }
            ]
          },
          {
            "id": "id-59",
            "linkId": "q12",
            "type": "choice",
            "required": true,
            "text": "Do you want to get real-time text/email updates on your test status and with Lumba for marketing purposes?",
            "code": [
              {
                "code": "realTimeUpdates",
                "display": "Do you want to get real-time text/email updates on your test status and with Lumba for marketing purposes?"
              }
            ],
            "answerOption": [
              {
                "id": "id-60",
                "valueCoding": {
                  "code": "LA33-6",
                  "display": "Yes",
                  "system": "http://loinc.org"
                }
              },
              {
                "id": "id-61",
                "valueCoding": {
                  "code": "LA32-8",
                  "display": "No",
                  "system": "http://loinc.org"
                }
              }
            ]
          },
          {
            "id": "id-61",
            "linkId": "g8",
            "type": "group",
            "required": true,
            "text": "I have read and accept the Product Consent, HIPPA Policy, and Statement of Privacy Practices Disclosure.",
            "code": [
              {
                "code": "privacyPolicy",
                "display": "I have read and accept the Product Consent, HIPPA Policy, and Statement of Privacy Practices Disclosure."
              }
            ],
            "item": [
              {
                "id": "id-62",
                "linkId": "q13",
                "required": true,
                "type": "boolean",
                "text": "Yes",
                "code": [
                  {
                    "code": "LA33-6",
                    "display": "Yes",
                    "system": "http://loinc.org"
                  }
                ]
              }
            ]
          }
        ],
        "name": "Question"
      }
    }
  ]
}