Default - General Intake default 1 Generic question set used when no equipment-specific template is configured.

]]> 10 Who is calling? (self / family / caregiver / other) caller_relationship char 20 Is the service address the same as the contact address on file? address_match boolean 30 Was this equipment purchased from us? purchased_from_us boolean 40 Approximate purchase date (if known) purchase_date date 50 Describe the issue in your own words issue_summary text 60 Does this issue affect anyone's safety right now? safety_concern boolean 70 Anything the technician should know about access? (stairs, parking, gate code, pet) access_notes text e.g. "dog in front yard, use side gate" Hospital Bed - Intake hospital_bed 10 10 Is the bed plugged in and does it power on? powered selection Yes - powers on normally No - no lights/sound at all Powers on but won't move 20 Does the remote control respond when buttons are pressed? remote_works boolean 30 Which motor seems affected? (head, foot, height, all) motor_side char motor 40 Are the side rails functioning normally? rails_ok boolean rail,side 50 Is the mattress included in this issue? mattress_involved boolean Stairlift - Intake stairlift 20 10 Does the stairlift power on? (any lights, beeps) powered boolean 20 Is there an error code displayed? (note the number/letter shown) error_code char error code 30 Is anyone currently stuck on the stairlift? person_stuck boolean If yes, this is a safety issue - escalate immediately. 40 Does it stop partway up or down the track? stops_midway boolean stops midway 50 Any burning smell, smoke, or unusual noise? burning_smell boolean burning smell,smoke Porch Lift - Intake porch_lift 30 10 Does the lift respond when you press the call/send button? powered boolean 20 Are all gate and door safety switches fully closed? gate_switches boolean 30 Is anyone currently stuck on the lift? person_stuck boolean 40 Is the lift outdoors exposed to weather? outdoor boolean Wheelchair - Intake wheelchair 40 10 Do the brakes engage and hold the wheelchair? brakes_ok boolean brake 20 Are both tires inflated and undamaged? tires_ok boolean 30 Is there any visible damage to the frame or footrests? frame_damage boolean 40 For power chairs: does the battery hold a charge? battery_holds_charge boolean battery,charge 50 For power chairs: any error code shown on the joystick display? joystick_error char Walker / Rollator - Intake walker_rollator 50 10 Do all wheels roll freely? wheels_roll boolean 20 Do the brakes lock when engaged? (rollator only) brakes_lock boolean 30 Is the frame stable, with no wobble or loose parts? frame_stable boolean Medical Mattress - Intake mattress 60 10 Is the pump plugged in and showing any indicator lights? pump_powered boolean 20 Is the mattress leaking or losing air? leak boolean leak,deflate 30 Is the pump showing an error code or alarm? alarm char