Title
FoRSE Demographic Information Form V2
instrumentId
B3RH
Description
FoRSE Demographic Form V2
Instructions

Questions

Q1: Age at Admission

Critical Item A valid answer must be supplied for this question or the entire survey will be rejected. "Not Answered" is NOT allowed.
 
Question Number Q1
Allow 'Not Answered'? No
Question Type input_box
Answer Type number
Maximum Characters 3
Min 0.00
Max 89.00

Q2: Gender

Critical Item A valid answer must be supplied for this question or the entire survey will be rejected. "Not Answered" is NOT allowed.
 
Question Number Q2
Allow 'Not Answered'? No
Question Type pick_multiple
Answer Options pick_multiple
Value Text
1 Female
2 Male
3 Nonbinary
4 Transgender
5 Gender not listed here
6 Unknown

Q3: Sexual orientation

Critical Item A valid answer must be supplied for this question or the entire survey will be rejected. "Not Answered" is NOT allowed.
 
Question Number Q3
Allow 'Not Answered'? No
Question Type pick_multiple
Answer Options pick_multiple
Value Text
1 Bisexual
2 Lesbian or gay
3 Straight or heterosexual
4 Sexual orientation not listed here
5 Unknown

Q4: Race/Ethnicity (choose all that apply)

Critical Item A valid answer must be supplied for this question or the entire survey will be rejected. "Not Answered" is NOT allowed.
 
Question Number Q4
Allow 'Not Answered'? No
Question Type pick_multiple
Answer Options pick_multiple
Value Text
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Hispanic or Latinx
5 Middle Eastern or North African
6 Native Hawaiian or Other Pacific Islander
7 White
8 Other

Scoring

The scoring details below are for information only. The scoring for this survey happens on our side. Please do not provide survey scores.

JSON Instrument Definition for developers

{
    "instrumentId": "B3RH",
    "title": "FoRSE Demographic Information Form V2",
    "description": "FoRSE Demographic Form V2",
    "instructions": "",
    "questions": [
        {
            "assign_qnum": "y",
            "instrumentId": "B3RH",
            "include_in_export": "y",
            "allow_NotAnswered": "n",
            "question_status": "ACTIVE",
            "question_text": "Age at Admission",
            "question_order": 1,
            "question_type": "input_box",
            "textbox_max_chars": 3,
            "textbox_input_type": "number",
            "textbox_min_value": "0.00",
            "textbox_max_value": "89.00",
            "date_created": "2023-12-30 12:57:08",
            "qNum": "Q1",
            "answer_options": []
        },
        {
            "assign_qnum": "y",
            "instrumentId": "B3RH",
            "include_in_export": "y",
            "allow_NotAnswered": "n",
            "question_status": "ACTIVE",
            "question_text": "Gender",
            "question_order": 2,
            "question_type": "pick_multiple",
            "textbox_max_chars": null,
            "textbox_input_type": null,
            "textbox_min_value": null,
            "textbox_max_value": null,
            "date_created": "2023-12-30 12:57:08",
            "qNum": "Q2",
            "answer_options": [
                {
                    "answer_text": "Female",
                    "answer_order": 1,
                    "answer_severity": null,
                    "answer_value": "1.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_female",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Male",
                    "answer_order": 2,
                    "answer_severity": null,
                    "answer_value": "2.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_male",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Nonbinary",
                    "answer_order": 3,
                    "answer_severity": null,
                    "answer_value": "3.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_nonbinary",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Transgender",
                    "answer_order": 4,
                    "answer_severity": null,
                    "answer_value": "4.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_transgender",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Gender not listed here",
                    "answer_order": 5,
                    "answer_severity": null,
                    "answer_value": "5.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_unlisted",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Unknown",
                    "answer_order": 6,
                    "answer_severity": null,
                    "answer_value": "6.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_gender_unknown",
                    "date_created": "2023-12-30 12:57:08"
                }
            ]
        },
        {
            "assign_qnum": "y",
            "instrumentId": "B3RH",
            "include_in_export": "y",
            "allow_NotAnswered": "n",
            "question_status": "ACTIVE",
            "question_text": "Sexual orientation",
            "question_order": 3,
            "question_type": "pick_multiple",
            "textbox_max_chars": null,
            "textbox_input_type": null,
            "textbox_min_value": null,
            "textbox_max_value": null,
            "date_created": "2023-12-30 12:57:08",
            "qNum": "Q3",
            "answer_options": [
                {
                    "answer_text": "Bisexual",
                    "answer_order": 1,
                    "answer_severity": null,
                    "answer_value": "1.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_sexual_bisexual",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Lesbian or gay",
                    "answer_order": 2,
                    "answer_severity": null,
                    "answer_value": "2.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_sexual_gay",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Straight or heterosexual",
                    "answer_order": 3,
                    "answer_severity": null,
                    "answer_value": "3.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_sexual_hetero",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Sexual orientation not listed here",
                    "answer_order": 4,
                    "answer_severity": null,
                    "answer_value": "4.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_sexual_not_listed",
                    "date_created": "2023-12-30 12:57:08"
                },
                {
                    "answer_text": "Unknown",
                    "answer_order": 5,
                    "answer_severity": null,
                    "answer_value": "5.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_sexual_unknown",
                    "date_created": "2023-12-30 12:57:09"
                }
            ]
        },
        {
            "assign_qnum": "y",
            "instrumentId": "B3RH",
            "include_in_export": "y",
            "allow_NotAnswered": "n",
            "question_status": "ACTIVE",
            "question_text": "Race\/Ethnicity (choose all that apply)",
            "question_order": 4,
            "question_type": "pick_multiple",
            "textbox_max_chars": null,
            "textbox_input_type": null,
            "textbox_min_value": null,
            "textbox_max_value": null,
            "date_created": "2023-12-30 12:57:09",
            "qNum": "Q4",
            "answer_options": [
                {
                    "answer_text": "American Indian or Alaska Native",
                    "answer_order": 1,
                    "answer_severity": null,
                    "answer_value": "1.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_american_native",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Asian",
                    "answer_order": 2,
                    "answer_severity": null,
                    "answer_value": "2.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_asian",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Black or African American",
                    "answer_order": 3,
                    "answer_severity": null,
                    "answer_value": "3.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_black",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Hispanic or Latinx",
                    "answer_order": 4,
                    "answer_severity": null,
                    "answer_value": "4.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_hispanic",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Middle Eastern or North African",
                    "answer_order": 5,
                    "answer_severity": null,
                    "answer_value": "5.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_middle_eastern",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Native Hawaiian or Other Pacific Islander",
                    "answer_order": 6,
                    "answer_severity": null,
                    "answer_value": "6.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_islander",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "White",
                    "answer_order": 7,
                    "answer_severity": null,
                    "answer_value": "7.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_white",
                    "date_created": "2023-12-30 12:57:09"
                },
                {
                    "answer_text": "Other",
                    "answer_order": 8,
                    "answer_severity": null,
                    "answer_value": "8.00",
                    "answer_status": "ACTIVE",
                    "clients_colName": "is_race_other",
                    "date_created": "2023-12-30 12:57:09"
                }
            ]
        }
    ]
}

Example Push for developers

URL Endpoint:

https://naatpdata.com/v2/api/surveys.php

Authentication

$FACILITY_ID = '123DEMO'; Provided By Us
$SECRET_KEY = 'aaaaaabbbbbbbbccccccccdddddddeeeeeefffffgggggg'; Provided By Us
$API_DATE = gmdate( time() ); Current UNIX UTC time = 1743749025
$API_SIGNATURE = hash_hmac('sha256', $API_DATE . $FACILITY_ID, $SECRET_KEY); 083531287e8e33d1b5f349a755a67b7d2cb220265d9ee3d80300cbf6f3a34fea
 

Complete Post

{
    "facilityId": "123DEMO",
    "apiDate": "1743749025",
    "apiSignature": "083531287e8e33d1b5f349a755a67b7d2cb220265d9ee3d80300cbf6f3a34fea",
    "surveys": [
        {
            "instrumentId": "B3RH",
            "sessionId": "123session",
            "clientId": "123client",
            "assignedToType": "Client",
            "yearOfAdmit": "2024",
            "yearCompleted": "2024",
            "daysFromAdmit": -99,
            "daysFromDischarge": 180,
            "completedWhile": "postDischarge",
            "answerStyle": "byText",
            "Q1": 80,
            "Q2": "Female|Male",
            "Q3": "Lesbian or gay|Sexual orientation not listed here",
            "Q4": "Asian|Other"
        },
        {
            "instrumentId": "B3RH",
            "sessionId": "123session",
            "clientId": "123client",
            "assignedToType": "Client",
            "yearOfAdmit": "2024",
            "yearCompleted": "2024",
            "daysFromAdmit": 30,
            "daysFromDischarge": -99,
            "completedWhile": "inTreatment",
            "answerStyle": "byValue",
            "Q1": 21,
            "Q2": "1|3",
            "Q3": "2|3",
            "Q4": "6|7"
        }
    ]
}