SEP enrollment fields

[mariekers]

Add non-participant fields from the SEP registration form to the participant form on the front end:

• What zip code do you live in or spend the most time in (5 digit varchar)
• Housing: □ Permanently Housed □ Temporarily Housed □ Shelter □ Street □ At Risk for Homelessness
• What drug do you inject most often? □Heroin only □Heroin and cocaine □Cocaine only □Fentanyl □Crack □Amphetamines, Speed, Crystal Meth, Ice □Hormones □Steroids □Silicone □ Botox □Other:____________ □Do not Inject
• Are you in drug treatment? □Yes □No
• If yes, is it: □Methadone □Suboxone □Vivitrol □IOP □Recovery House (can this be a multi select similar to the site object?)
• Do you have health insurance? □Medicare □Medicaid □No □Other:___________
• Have you ever been tested for Hepatitis C? ___________
  • If so, when? ___________________
• Have you ever been tested for HIV? ___________
  • If so, when? ___________________
• Do you have Narcan today? □Yes □No

FOR STAFF ONLY: □ Participant Received Harm Reduction Counseling □ Participant left with Narcan □ Participant Received Overdose Prevention Counseling □ Participant left with mobile site schedule □ Participant was referred to HIV/HCV testing

Dependent on #488