---
title: Leicester Cough Questionnaire
product: PDF Generator
description: Get a printable Leicester Cough Questionnaire in PDF. Export editable or prefilled patient assessment forms from JSON using SurveyJS PDF Generator.
framework: Vanilla JS
source: https://surveyjs.io/pdf-generator/examples/pdf-healthcare-leicester-cough-questionnaire-template/vanillajs
index: https://surveyjs.io/pdf-generator/examples/overview.md
---

# Leicester Cough Questionnaire (Vanilla JS)

## Files

### `public/index.html`

```html
<div style="display: flex;">
    <div id="surveyElement" style="flex: 1 1 0%; height: 100%; min-width: 0;"></div>
    <div id="pdf-preview" style="flex: 0.7 0.7 0%; display: none">
        <embed id="pdf-preview-frame" type="application/pdf" style="width:100%; height:100%;" />
    </div>
</div>
```

### `src/index.css`

```css
/* You can add your custom CSS here. */
```

### `src/index.js`

```js
import { Model } from "survey-core";
import "survey-js-ui";
import { SurveyPDF } from "survey-pdf";
import "survey-core/survey-core.min.css";
import "./index.css";
import { json } from "./json";

function createSurveyPdfModel (surveyModel) {
    const surveyPDF = new SurveyPDF(json);
    if (surveyModel) {
        surveyPDF.data = surveyModel.data;
        surveyPDF.locale = surveyModel.locale;
        
        
    }
    
    return surveyPDF;
}
function saveSurveyToPdf (filename, surveyModel) {
    const pdfDoc = createSurveyPdfModel(surveyModel);
    if (!pdfDoc) return;

    pdfDoc.save(filename);
}

const previewDiv = document.getElementById("pdf-preview");
const previewEmbed = document.getElementById("pdf-preview-frame");
let pdfBlobUrl;

function showPdfPreview(surveyModel) {
    if (!previewDiv || !previewEmbed) return;

    const pdfDoc = createSurveyPdfModel(surveyModel);
    if (!pdfDoc) return;

    pdfDoc.raw("blob").then((blob) => {
        if (pdfBlobUrl) {
            URL.revokeObjectURL(pdfBlobUrl);
        }
        pdfBlobUrl = URL.createObjectURL(blob);
        previewEmbed.setAttribute("src", pdfBlobUrl);
        previewDiv.style.display = "block";
    });
}

function previewPdf(surveyModel) {
    if (!previewDiv) return;

    if (previewDiv.style.display !== "none") {
        previewDiv.style.display = "none";
        return;
    }

    showPdfPreview(surveyModel);
}

const survey = new Model(json);
survey.showCompleteButton = false;
survey.navigationButtonsLocation = "topBottom";
survey.addNavigationItem({
    id: "survey_save_as_file",
    title: "Download PDF",
    action: () => {
        saveSurveyToPdf("surveyResult.pdf", survey);
    }
});
survey.addNavigationItem({
    id: "survey_pdf_preview",
    title: "Preview PDF",
    visible: window.navigator.pdfViewerEnabled,
    action: () => {
        previewPdf(survey);
    }
});
survey.render(document.getElementById("surveyElement"));
```

### `src/json.js`

```js
export const json = {
  "title": "Leicester Cough Questionnaire",
  "pages": [
    {
      "name": "physical_symptoms_page",
      "title": "Physical Symptoms",
      "elements": [
        {
          "type": "matrixdropdown",
          "name": "cough_physical_symptoms",
          "title": "Physical symptoms over the last two weeks",
          "showHeader": false,
          "columns": [
            {
              "name": "frequency_rating",
              "cellType": "rating",
              "rateCount": 7,
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            }
          ],
          "rows": [
            {
              "value": "chest_or_stomach_pain",
              "text": "Have you had chest or stomach pains as a result of your cough?"
            },
            {
              "value": "sputum_production",
              "text": "Have you been bothered by sputum (phlegm) production when you cough?"
            },
            {
              "value": "fatigue_due_to_cough",
              "text": "Have you been tired because of your cough?"
            },
            {
              "value": "feeling_in_control",
              "text": "Have you felt in control of your cough?"
            }
          ]
        }
      ]
    },
    {
      "name": "social_and_additional_factors_page",
      "title": "Social & Additional Factors",
      "description": "Answer the following questions about how your cough has impacted your social life and energy levels in the last 2 weeks.",
      "elements": [
        {
          "type": "matrixdropdown",
          "name": "cough_social_impact",
          "title": "Social distress factors over the last two weeks",
          "showHeader": false,
          "columns": [
            {
              "name": "frequency_rating",
              "cellType": "rating",
              "rateCount": 7,
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            }
          ],
          "rows": [
            {
              "value": "embarrassment",
              "text": "How often have you felt embarrassed by your coughing?"
            },
            {
              "value": "anxiety",
              "text": "How often has your cough made you feel anxious?"
            },
            {
              "value": "work_interference",
              "text": "How often has your cough interfered with your job or other daily tasks?"
            },
            {
              "value": "reduced_life_enjoyment",
              "text": "How often have you felt that your cough interfered with the overall enjoyment of your life?"
            },
            {
              "value": "concern_about_others_opinion",
              "text": "Have you been concerned that other people think something is wrong with you because of your cough?"
            },
            {
              "value": "conversation_interruption",
              "text": "How often has your cough interrupted conversations or phone calls?"
            },
            {
              "value": "annoyed_others",
              "text": "How often has your cough annoyed your partner, family, or friends?"
            }
          ]
        },
        {
          "type": "matrixdropdown",
          "name": "cough_additional_factors",
          "title": "Additional factors over the last two weeks",
          "showHeader": false,
          "columns": [
            {
              "name": "frequency_rating",
              "cellType": "rating",
              "rateCount": 7,
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            }
          ],
          "rows": [
            {
              "value": "triggered_by_fumes",
              "text": "Has exposure to paints or fumes made you cough?"
            },
            {
              "value": "coughing_bouts_per_day",
              "text": "How many times a day have you had coughing bouts?"
            },
            {
              "value": "energy_level",
              "text": "Have you had a lot of energy?"
            }
          ]
        },
        {
          "type": "boolean",
          "name": "cough_with_wheezing",
          "title": "In the last 2 weeks, has your coughing been accompanied by wheezing?",
          "description": "This question is relevant for individuals who generally have mild chest/stomach pain, mild sputum production, infrequent coughing bouts, and relatively high energy levels."
        }
      ]
    }
  ],
  "questionsOnPageMode": "singlePage",
  "headerView": "advanced"
};
```

### `src/theme.js`

```js
export const themeJson = {};
```

### `package.json`

```json
{
  "dependencies": {
    "survey-core": "latest",
    "survey-js-ui": "latest",
    "survey-pdf": "latest"
  }
}
```

## Other Frameworks

- [Angular](https://surveyjs.io/pdf-generator/examples/pdf-healthcare-leicester-cough-questionnaire-template/angular.md)
- [React](https://surveyjs.io/pdf-generator/examples/pdf-healthcare-leicester-cough-questionnaire-template/reactjs.md)
- [Vue 3](https://surveyjs.io/pdf-generator/examples/pdf-healthcare-leicester-cough-questionnaire-template/vue3js.md)
- [jQuery](https://surveyjs.io/pdf-generator/examples/pdf-healthcare-leicester-cough-questionnaire-template/jquery.md)