textInput("SeroTestNameSpecified",h4("Specify name of other diagnostic test"),
value=""))
),
HTML(paste("","",sep="<br/>")),
HTML(paste("","",sep="<br/>")),
fluidRow(
column(3,
radioButtons("SeroTestOutcome",
h4("Outcome of the serological test"),
choices=list("Positive to Covid-19"=1,
"Negative to Covid-19"=2),
selected=NA)),
column(3,
textInput("PreviouslyTestedPositive",h4("Previously tested Covid19-positive by other tests (e.g., swab)?"),
value="If yes specify test"))
),
HTML(paste("","",sep="<br/>")),
HTML(paste("","",sep="<br/>")),
h3(strong("Generalities")),
fluidRow(
column(3,
radioButtons("gender",
h4("Gender"),
choices=list("Female"=1,
"Male"=2,
"Other"=3),
selected=NA)),
column(3,
numericInput("age",
h4("Age"),
value=NA)),
column(3,
textInput("MedicalCondition",h4("Medical conditions"),value="separated by comma"))
),
HTML(paste("","",sep="<br/>")),
HTML(paste("","",sep="<br/>")),
h3(strong("Demographics")),
fluidRow(
column(3,
radioButtons("LivingArea",
h4("Living area"),
choices=list("City"=1,
"Residential"=2,
"Countryside"=3),
selected=NA)),
column(3,
textInput("ZIP",h4("ZIP code"),
value="Enter ZIP code"))
),
h3(strong("Everyday practices")),
fluidRow(
column(3,
radioButtons("UseMask",
h4("Use of protection mask"),
choices=list("Frequent"=1,
"Sometimes"=2,
"Never"=3),
selected=NA)),
column(3,
radioButtons("UseHandCleaner",
h4("Use of hand cleaner"),
choices=list("Frequent"=1,
"Sometimes"=2,
"Never"=3),
selected=NA)),
column(3,
radioButtons("RespectingRules",
h4("Respecting health authorities advice"),
choices=list("Strong"=1,
"Middle"=2,
"Weak"=3),
selected=NA))
),
HTML(paste("","",sep="<br/>")),
HTML(paste("","",sep="<br/>")),
h3(strong("Private life")),
fluidRow(
column(3,
numericInput("NumberFamilyContacts",
h4("Number of family contacts"),
value=NA)),
column(3,
numericInput("NumberNonFamilyContacts",
h4("Number of non-family contacts"),
value=NA)),
column(3,
numericInput("HoursAtHome",
h4("Hours per day at home"),
value=NA))
),
HTML(paste("","",sep="<br/>")),
HTML(paste("","",sep="<br/>")),
h3(strong("Work life")),
fluidRow(
column(3,
radioButtons("Mobility",
h4("Mobility"),
choices=list("Public transportation"=1,
"Private car/motorbike"=2,
"Bike"=3),
selected=NA)),
column(3,
radioButtons("Homeworking",
h4("Homeworking"),
choices=list("Yes"=1,
"No"=2,
"Partially"=3),
selected=NA))
),
fluidRow(
column(4,
h4("Further involvement"),
helpText("I wish to contribute further to the fight against Covid19 and I am available for further questionnaires/studies (you can opt out at any moment)")),