{ "ui:hideItemTitle": true, "ui:row": true, "secondary_findings_opt_out": { "ui:column": "col-sm-6", "ui:widget": "select" }, "NDD_ICD10_CODES": { "ui:title": "Rare Disease Reason for testing and ICD-10 codes", "ui:field": "typeAheadField", "ui:typeahead": { "allowNew": true, "choices": [ "F80.9 Development disorder of speech & language, unspecified", "F84.9 Pervasive developmental disorder, unspecified", "R62.0 Delayed milestone in childhood", "Z13.40 Encounter for screening for unspecified developmental delays", "F82 Specific developmental disorder of motor function", "F84.0 Autistic disorder", "Q75.3 Macrocephaly", "F70 Mild intellectual disability", "F71 Moderate intellectual disability", "F72 Severe intellectual disability", "F73 Profound intellectual disability", "Q89.9 Congenital malformation, unspecified", "F88.0 Other disorders of psychological development (GDD)", "G40.001 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus", "G40.009 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus", "G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus", "G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus", "G40.101 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus", "G40.109 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus", "G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus", "G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus", "G40.201 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus", "G40.209 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus", "G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus", "G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus", "G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus", "G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus", "G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus", "G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus", "G40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus", "G40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus", "G40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus", "G40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus", "G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder", "G40.501 Epileptic seizures related to external causes, not intractable, with status epilepticus", "G40.509 Epileptic seizures related to external causes, not intractable, without status epilepticus", "G40.801 Other epilepsy, not intractable, with status epilepticus", "G40.802 Other epilepsy, not intractable, without status epilepticus", "G40.803 Other epilepsy, intractable, with status epilepticus", "G40.804 Other epilepsy, intractable, without status epilepticus", "G40.811 Lennox-Gastaut syndrome, not intractable, with status epilepticus", "G40.812 Lennox-Gastaut syndrome, not intractable, without status epilepticus", "G40.813 Lennox-Gastaut syndrome, intractable, with status epilepticus", "G40.814 Lennox-Gastaut syndrome, intractable, without status epilepticus", "G40.821 Epileptic spasms, not intractable, with status epilepticus", "G40.822 Epileptic spasms, not intractable, without status epilepticus", "G40.823 Epileptic spasms, intractable, with status epilepticus", "G40.824 Epileptic spasms, intractable, without status epilepticus", "G40.833 Dravet syndrome, intractable, with status epilepticus", "G40.834 Dravet syndrome, intractable, without status epilepticus", "G40.841 KCNQ2-related epilepsy, not intractable, with status epilepticus", "G40.842 KCNQ2-related epilepsy, not intractable, without status epilepticus", "G40.843 KCNQ2-related epilepsy, intractable, with status epilepticus", "G40.844 KCNQ2-related epilepsy, intractable, without status epilepticus", "G40.89 Other seizures", "G40.901 Epilepsy, unspecified, not intractable, with status epilepticus", "G40.909 Epilepsy, unspecified, not intractable, without status epilepticus", "G40.911 Epilepsy, unspecified, intractable, with status epilepticus", "G40.919 Epilepsy, unspecified, intractable, without status epilepticus", "G40.A01 Absence epileptic syndrome, not intractable, with status epilepticus", "G40.A09 Absence epileptic syndrome, not intractable, without status epilepticus", "G40.A11 Absence epileptic syndrome, intractable, with status epilepticus", "G40.A19 Absence epileptic syndrome, intractable, without status epilepticus", "G40.B01 Juvenile myoclonic epilepsy, not intractable, with status epilepticus", "G40.B09 Juvenile myoclonic epilepsy, not intractable, without status epilepticus", "G40.B11 Juvenile myoclonic epilepsy, intractable, with status epilepticus", "G40.B19 Juvenile myoclonic epilepsy, intractable, without status epilepticus", "G40.C01 Lafora progressive myoclonus epilepsy, not intractable, with status epilepticus", "G40.C09 Lafora progressive myoclonus epilepsy, not intractable, without status epilepticus", "G40.C11 Lafora progressive myoclonus epilepsy, intractable, with status epilepticus", "G40.C19 Lafora progressive myoclonus epilepsy, intractable, without status epilepticus", "P92.01 Bilious vomiting of newborn", "P92.09 Other vomiting of newborn", "P92.1 Regurgitation and rumination of newborn", "P92.2 Slow feeding of newborn", "P92.3 Underfeeding of newborn", "P92.4 Overfeeding of newborn", "P92.5 Neonatal difficulty in feeding at breast", "P92.6 Failure to thrive in newborn", "P92.8 Other feeding problems of newborn", "P92.9 Feeding problem of newborn, unspecified", "Z81.0 Family history of intellectual disabilities", "Z81.1 Family history of alcohol abuse and dependence", "Z81.2 Family history of tobacco abuse and dependence", "Z81.3 Family history of other psychoactive substance abuse and dependence", "Z81.4 Family history of other substance abuse and dependence", "Z81.8 Family history of other mental and behavioral disorders", "Z82.0 Family history of epilepsy and other diseases of the nervous system", "Z82.79 Family history of other congenital malformations, deformations and chromosomal abnormalities", "Z84.81 Family history of carrier of genetic disease", "Z84.82 Family history of sudden infant death syndrome" ] } }, "CLINICAL_PHENOTYPES__DEVELOPMENTAL_BEHAVIORAL": { "ui:widget": "hidden", "ui:field": "typeAheadField", "ui:typeahead": { "choices": [ "Attention deficit hyperactivity disorder", "Anxiety", "Autism", "Austistic behavior", "Behavioral abnormality", "Bipolar affective disorder", "Delayed motor 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"Syndactyly", "Talipes equinovarus (club foot)" ] } }, "CLINICAL_PHENOTYPES__CUTANEOUS": { "ui:widget": "hidden", "ui:field": "typeAheadField", "ui:typeahead": { "choices": [ "Caf\u00e9 au lait spots", "Eczema", "Hyperpigmentation of the skin", "Hypopigmentation of the skin" ] } }, "CLINICAL_PHENOTYPES__GASTROINTESTINAL": { "ui:widget": "hidden", "ui:field": "typeAheadField", "ui:typeahead": { "choices": [ "Aganglionic megacolon (Hirschsprung)", "Anal atresia", "Congential diaphragmatic hernia", "Gastroschisis", "Meconium ileus", "Omphalocele", "Pyloric stenosis", "Tracheoesophageal fistul" ] } }, "CLINICAL_PHENOTYPES__GENITOURINARY": { "ui:widget": "hidden", "ui:field": "typeAheadField", "ui:typeahead": { "choices": [ "Abnormal renal morphology", "Ambiguous genitalia", "Cryptorchidism", "Hydronephrosis", "Hypospadias" ], "additionalInfoNeeded": [ "Abnormal renal morphology" ] } }, "CLINICAL_PHENOTYPES__GROWTH": { "ui:widget": "hidden", "ui:field": "typeAheadField", "ui:typeahead": { "choices": [ "Delayed puberty", "Failure to thrive", "Obesity", "Precocious puberty", "Short stature", "Tall stature" ] } }, "CLINICAL_PHENOTYPES__OTHER": { "ui:field": "typeAheadField", "ui:typeahead": { "allowNew": true, "choices": [] } } }