As a logged in user, I want to fill an intake form for a participant to capture all the data.

[serpient]

Questions/Things to consider

• How often does the data get saved
• What is the process for capturing the data?

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Acceptance Criteria

• [ ] The form order / structure follows the user's existing google form. https://docs.google.com/forms/d/1Ix5XJ2AtaI3ZP9glU3dE67jK3NdLpSwZ3RkmQMRFjew/viewform?ts=5c3d611c&edit_requested=true
• [ ] The first 2 fields will be: source of referral ( plain text), date of intake. This is to replace the clinic name and clinic date
• [ ] The user has visual cues for all the required fields
• [ ] Required Fields (DOB, First & Last Name, Veteran, Ethnicity, Age, Race , Gender)

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Below is Assigned to #135 Update Intake Form for Requested Changes

• Add “ID” to “Drivers License” label (for those without DL)
• Add Secondary contact (email & phone)
• Family Status
  • Keep first three options from google form (aka, remove “Former Foster Care + Transitional Age Youth)
  • Keep how many kids 18 and under
• Housing Status: Change to radio buttons
• Chronic Homelessness question: Remove “Maybe” option
• Referral Source: Add “DPSS”
• Add a Notes field to take misc notes

[abregorivas]

Related issue #110