I. Physical Measures (respondent)
I. Physical Measures (respondent) module of HRS 2008
Start of I. Physical Measures (respondent)
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LI800
Physical measures ftf iw
ENTER CURRENT MODE OF INTERVIEW
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Phone
2. F-t-f
Blank. Inapplicable; partial interview
ENTER CURRENT MODE OF INTERVIEW
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Phone
2. F-t-f
Blank. Inapplicable; partial interview
If Prefered mode of iwer (LX090_R) = ENHANCEDFTF »
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If Physical measures ftf iw (LI800) = 2. F-t-f and R in nursing home (LA028) = NO and LANGUAGE = SPANISH or ENGLISH »
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LI802
Physical measures consent form
NOW I AM GOING TO ASK YOU TO DO A FEW SIMPLE ACTIVITIES FOR ME. RESEARCHERS ARE INTERESTED IN HOW PERFORMANCE ON THESE ACTIVITIES RELATES TO SOME OF THE OTHER FACTORS I HAVE ASKED YOU ABOUT IN THE INTERVIEW. I WILL ASK YOU TO DO THESE ACTIVITIES: A BREATHING TEST, A TEST OF HAND STRENGTH, [ A WALKING TEST, ] A BALANCE TEST, AND BLOOD PRESSURE, HEIGHT, [WEIGHT] AND WAIST MEASUREMENTS. MY PRIMARY CONCERN IS FOR YOUR SAFETY, SO I WILL ASK YOU IF YOU FEEL IT WOULD BE SAFE FOR YOU TO COMPLETE EACH ACTIVITY. IF YOU HAVE ANY CONCERNS ABOUT THE ACTIVITY, PLEASE LET ME KNOW AND WE WILL SKIP IT. PLEASE DO NOT EAT, DRINK, SMOKE, OR BRUSH YOUR TEETH WHILE WE ARE CONDUCTING THE MEASUREMENTS. I WILL ALSO BE ASKING YOU TO REMOVE BULKY CLOTHING AND TO TAKE OFF YOUR SHOES DURING THE MEASUREMENTS. BEFORE WE BEGIN, I'D LIKE TO HAVE YOU READ AND SIGN A FORM EXPLAINING YOUR RIGHTS AS A PARTICIPANT IN THIS PART OF THE STUDY.
SHOW R THE FIRST CONSENT FORM IN THE PHYSICAL MEASURES & BIOMARKER BOOKLET. IF R REFUSES TO SIGN THE CONSENT FORM, ENTER CTRL-R. OTHERWISE, ENTER 1 TO CONTINUE.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Continue
9. Refused
Blank. Inapplicable; partial interview
NOW I AM GOING TO ASK YOU TO DO A FEW SIMPLE ACTIVITIES FOR ME. RESEARCHERS ARE INTERESTED IN HOW PERFORMANCE ON THESE ACTIVITIES RELATES TO SOME OF THE OTHER FACTORS I HAVE ASKED YOU ABOUT IN THE INTERVIEW. I WILL ASK YOU TO DO THESE ACTIVITIES: A BREATHING TEST, A TEST OF HAND STRENGTH, [ A WALKING TEST, ] A BALANCE TEST, AND BLOOD PRESSURE, HEIGHT, [WEIGHT] AND WAIST MEASUREMENTS. MY PRIMARY CONCERN IS FOR YOUR SAFETY, SO I WILL ASK YOU IF YOU FEEL IT WOULD BE SAFE FOR YOU TO COMPLETE EACH ACTIVITY. IF YOU HAVE ANY CONCERNS ABOUT THE ACTIVITY, PLEASE LET ME KNOW AND WE WILL SKIP IT. PLEASE DO NOT EAT, DRINK, SMOKE, OR BRUSH YOUR TEETH WHILE WE ARE CONDUCTING THE MEASUREMENTS. I WILL ALSO BE ASKING YOU TO REMOVE BULKY CLOTHING AND TO TAKE OFF YOUR SHOES DURING THE MEASUREMENTS. BEFORE WE BEGIN, I'D LIKE TO HAVE YOU READ AND SIGN A FORM EXPLAINING YOUR RIGHTS AS A PARTICIPANT IN THIS PART OF THE STUDY.
SHOW R THE FIRST CONSENT FORM IN THE PHYSICAL MEASURES & BIOMARKER BOOKLET. IF R REFUSES TO SIGN THE CONSENT FORM, ENTER CTRL-R. OTHERWISE, ENTER 1 TO CONTINUE.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Continue
9. Refused
Blank. Inapplicable; partial interview
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If Physical measures consent form (LI802) = 1. Continue »
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LI854
Blood pressure complete
BLOOD PRESSURE
DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BLOOD PRESSURE
DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
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If Blood pressure complete (LI854) = 5. No »
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LI855
Blood pressure not complete
BLOOD PRESSURE
WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had a rash, cast, edema, etc. on arm; other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE
WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had a rash, cast, edema, etc. on arm; other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
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ElseIf Blood pressure complete (LI854) = 1. Yes »
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LI857
Bloodpressure time
BLOOD PRESSURE - 1ST TIME
FIRST READING TIME OF READING
ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable
BLOOD PRESSURE - 1ST TIME
FIRST READING TIME OF READING
ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable
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LI859
Bloodpressure 1 systolic
BLOOD PRESSURE - 1ST SYSTOLIC
FIRST READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 1ST SYSTOLIC
FIRST READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
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993. R tried but was unable to do it
998. Don't know; not ascertained
999. Refused
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If Bloodpressure 1 systolic (LI859) != 9993 and Bloodpressure 1 systolic (LI859) != 999. Refused »
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LI860
Bloodpressure 1 diastolic
BLOOD PRESSURE - 1ST DIASTOLIC
FIRST READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 1ST DIASTOLIC
FIRST READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI861
Bloodpressure 1 pulse
BLOOD PRESSURE - 1ST PULSE
FIRST READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 1ST PULSE
FIRST READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI862
Blood pressure 2 time
BLOOD PRESSURE - 2ND TIME
SECOND READING TIME OF READING
IWER: ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable
BLOOD PRESSURE - 2ND TIME
SECOND READING TIME OF READING
IWER: ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable
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LI864
Bloodpressure 2 systolic
BLOOD PRESSURE - 2ND SYSTOLIC
SECOND READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
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993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
BLOOD PRESSURE - 2ND SYSTOLIC
SECOND READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
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993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
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If Bloodpressure 2 systolic (LI864) != 9993 and Bloodpressure 2 systolic (LI864) != 999. R chose not to do it »
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LI865
Bloodpressure 2 diastolic
BLOOD PRESSURE - 2ND DIASTOLIC
SECOND READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 2ND DIASTOLIC
SECOND READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI866
Bloodpressure 2 pulse
BLOOD PRESSURE - 2ND PULSE
SECOND READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 2ND PULSE
SECOND READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI867
Bloodpressure 3 time
BLOOD PRESSURE - 3RD TIME
THIRD READING TIME OF READING
IWER: ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE - 3RD TIME
THIRD READING TIME OF READING
IWER: ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.
USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-09:59:00. Actual Value
99999998. Don't Know; Not Ascertained
99999999. Refused
Blank. Inapplicable; partial interview
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LI869
Bloodpressure 3 systolic
BLOOD PRESSURE - 3RD SYSTOLIC
THIRD READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
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993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
BLOOD PRESSURE - 3RD SYSTOLIC
THIRD READING SYSTOLIC
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
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If Bloodpressure 3 systolic (LI869) != 9993 and Bloodpressure 3 systolic (LI869) != 999. R chose not to do it »
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LI870
Bloodpressure 3 diastolic
BLOOD PRESSURE - 3RD DIASTOLIC
THIRD READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 3RD DIASTOLIC
THIRD READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI871
Bloodpressure 3 pulse
BLOOD PRESSURE - 3RD PULSE
THIRD READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
BLOOD PRESSURE - 3RD PULSE
THIRD READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
998. Don't know; not ascertained
999. Refused
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LI872
Bloodpressure arm
BLOOD PRESSURE - ARM
WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Left arm
2. Right arm
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE - ARM
WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Left arm
2. Right arm
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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LI873
Bloodpressure compliance
BLOOD PRESSURE - COMPLIANCE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE - COMPLIANCE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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LI874
Bloodpressure position
BLOOD PRESSURE - POSITION
WHAT WAS R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE - POSITION
WHAT WAS R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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LI875
Bloodpressure smoke etc
BLOOD PRESSURE - SMOKE ETC.
DID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30 MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD PRESSURE - SMOKE ETC.
DID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30 MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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LI804
Breath complete at least one trial
BREATHING TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BREATHING TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
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If Breath complete at least one trial (LI804) != 1. Yes »
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LI805
Breath test reason not complete
BREATHING TEST
WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R could not participate due to health reasons
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BREATHING TEST
WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R could not participate due to health reasons
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
If Breath complete at least one trial (LI804) = 1. Yes »
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LI807
Puff test 1
BREATHING TEST
FIRST READING:
SECOND READING:
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
BREATHING TEST
FIRST READING:
SECOND READING:
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
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LI808
Puff test 2
BREATHING TEST
FIRST READING: [PUFF TEST 1]
SECOND READING:
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
BREATHING TEST
FIRST READING: [PUFF TEST 1]
SECOND READING:
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
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| | | |
LI809
Puff test 3
BREATHING TEST
FIRST READING: [PUFF TEST 1]
SECOND READING: [PUFF TEST 2]
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
BREATHING TEST
FIRST READING: [PUFF TEST 1]
SECOND READING: [PUFF TEST 2]
THIRD READING:
ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
USER NOTE: BREATHING TEST IS MEASURED IN LITERS PER MIN (L/MIN).
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to do it
998. Don't know; not ascertained
999. R chose not to do it
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| | | |
LI810
R breathing test effort
BREATHING TEST
HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BREATHING TEST
HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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| | | |
LI811
Breathing test r position
BREATHING TEST
WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BREATHING TEST
WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
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| | |
LI812
Hand strength complete at least one trial
HAND STRENGTH TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Hand strength complete at least one trial (LI812) != 1. Yes »
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| | | |
LI813
Hand strength test reason not complete
HAND STRENGTH TEST
WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R could not participate due to surgery, swelling, etc.; other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R could not participate due to surgery, swelling, etc.; other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
Else If Hand strength complete at least one trial (LI812) = 1. Yes »
| | | | ========================================================================
| | | |
LI815
Grip dominant hand
HAND STRENGTH TEST
RECORD R'S DOMINANT HAND.
USER NOTE: GRIP STRENGTH IS MEASURED IN KILOGRAMS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Right hand
2. Left hand
3. Both hands equally dominant
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
RECORD R'S DOMINANT HAND.
USER NOTE: GRIP STRENGTH IS MEASURED IN KILOGRAMS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Right hand
2. Left hand
3. Both hands equally dominant
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI816
Left hand first
HAND STRENGTH TEST
LEFT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9998. Don't know; not ascertained
9999. R chose not to do it
HAND STRENGTH TEST
LEFT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9998. Don't know; not ascertained
9999. R chose not to do it
| | | | ========================================================================
| | | |
LI851
Right hand first
HAND STRENGTH TEST
RIGHT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
HAND STRENGTH TEST
RIGHT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
| | | | ========================================================================
| | | |
LI852
Left hand second
HAND STRENGTH TEST
LEFT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
HAND STRENGTH TEST
LEFT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
| | | | ========================================================================
| | | |
LI853
Right hand second
HAND STRENGTH TEST
RIGHT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: [LEFT SECOND] RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
HAND STRENGTH TEST
RIGHT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: [LEFT SECOND] RIGHT HAND, SECOND MEASUREMENT:
ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 9993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 9999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to complete the test
9999. R chose not to do it
| | | | ========================================================================
| | | |
LI817
Grip r effort
HAND STRENGTH TEST
HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI818
Hand strength test r position
HAND STRENGTH TEST
WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI819
Hand strength rest arm
HAND STRENGTH TEST
DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
HAND STRENGTH TEST
DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | ========================================================================
| | |
LI876
Balance test - semi-tandem stand
BALANCE TEST - SEMI-TANDEM STAND
DID R COMPLETE THE SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BALANCE TEST - SEMI-TANDEM STAND
DID R COMPLETE THE SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Balance test - semi-tandem stand (LI876) != 1. Yes »
| | | | ========================================================================
| | | |
LI877
Balance semi-tandem reason not comp
BALANCE TEST - SEMI-TANDEM STAND
WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BALANCE TEST - SEMI-TANDEM STAND
WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
ElseIf Balance test - semi-tandem stand (LI876) = 1. Yes »
| | | | ========================================================================
| | | |
LI879
Balance test semi-tandem hold full time
BALANCE TEST - SEMI-TANDEM STAND
DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
BALANCE TEST - SEMI-TANDEM STAND
DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
| | | |
If Balance test semi-tandem hold full time (LI879) = 1. Yes »
| | | | | ========================================================================
| | | | |
LI880
Balance test semi-tandem time
BALANCE TEST - SEMI-TANDEM STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to do it
BALANCE TEST - SEMI-TANDEM STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
- - - - - - - - - - - - - - - - - - - - - - - - -
9993. R tried but was unable to do it
| | | |
If Balance test semi-tandem hold full time (LI879) != 999. R chose not to do it and Balance test semi-tandem hold full time (LI879) != 993. R tried but was unable »
| | | | | ========================================================================
| | | | |
LI881
Balance test semi-tandem compensatory
BALANCE TEST - SEMI-TANDEM STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
BALANCE TEST - SEMI-TANDEM STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
| | |
If Balance test - semi-tandem stand (LI876) = 5. No or Balance test semi-tandem hold full time (LI879) != 1. Yes »
| | | | ========================================================================
| | | |
LI883
Balance test s-b-s complete
BALANCE TEST - SIDE-BY-SIDE STAND
DID R COMPLETE THE SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
DID R COMPLETE THE SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | |
If Balance test s-b-s complete (LI883) != 1. Yes »
| | | | | ========================================================================
| | | | |
LI884
Balance test sbs stand reason not comp
BALANCE TEST - SIDE-BY-SIDE STAND
WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | | |
ElseIf Balance test s-b-s complete (LI883) = 1. Yes »
| | | | | ========================================================================
| | | | |
LI886
Balance test s-b-s hold full time
BALANCE TEST - SIDE-BY-SIDE STAND
DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
| | | | |
If Balance test s-b-s hold full time (LI886) = 1. Yes »
| | | | | | ========================================================================
| | | | | |
LI887
Balance test side-by-side time
BALANCE TEST - SIDE-BY-SIDE STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
BALANCE TEST - SIDE-BY-SIDE STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
| | | | |
If Balance test s-b-s hold full time (LI886) != 993. R tried but was unable and Balance test s-b-s hold full time (LI886) != 999. R chose not to do it »
| | | | | | ========================================================================
| | | | | |
LI888
Balance test side-by-side compensatory
BALANCE TEST - SIDE-BY-SIDE STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
| | | | | | ========================================================================
| | | | | |
LI889
Balance test s-b-s floor surface
BALANCE TEST - SIDE-BY-SIDE STAND
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
| | | | | | ========================================================================
| | | | | |
LI891
Balance test s-b-s compliance
BALANCE TEST - SIDE-BY-SIDE STAND
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
BALANCE TEST - SIDE-BY-SIDE STAND
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | |
Else
| | | | ========================================================================
| | | |
LI893
Balance test full tandem complete
BALANCE TEST - FULL TANDEM STAND
DID R COMPLETE THE FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BALANCE TEST - FULL TANDEM STAND
DID R COMPLETE THE FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | |
If Balance test full tandem complete (LI893) != 1. Yes »
| | | | | ========================================================================
| | | | |
LI894
Balance full tandem stand-not complete
BALANCE TEST - FULL TANDEM STAND
WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BALANCE TEST - FULL TANDEM STAND
WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from completing the test
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | | |
Else
| | | | | ========================================================================
| | | | |
LI896
Balance test full tandem hold full time
BALANCE TEST - FULL TANDEM STAND
DID R HOLD FULL TANDEM STAND FOR FULL SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
BALANCE TEST - FULL TANDEM STAND
DID R HOLD FULL TANDEM STAND FOR FULL SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview
| | | | |
If Balance test full tandem hold full time (LI896) = 1. Yes and R current age calculation (LA019) > 70 »
| | | | | | ========================================================================
| | | | | |
LI897
Balance test full tandem time
BALANCE TEST - FULL TANDEM STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
BALANCE TEST - FULL TANDEM STAND
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
| | | | |
If Balance test full tandem hold full time (LI896) != 993. R tried but was unable and Balance test full tandem hold full time (LI896) != 999. R chose not to do it »
| | | | | | ========================================================================
| | | | | |
LI898
Balance test full tandem compensatory
BALANCE TEST - FULL TANDEM STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable
BALANCE TEST - FULL TANDEM STAND
DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable
| | | | | | ========================================================================
| | | | | |
LI899
Balance test full tandem floor surface
BALANCE TEST - FULL TANDEM
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BALANCE TEST - FULL TANDEM
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | | | ========================================================================
| | | | | |
LI902
Balance test full tandem compliance
BALANCE TEST - FULL TANDEM STAND
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BALANCE TEST - FULL TANDEM STAND
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | |
If R current age calculation (LA019) > 64 »
| | | | ========================================================================
| | | |
LI820
Walking test complete at least one trial
WALKING TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
WALKING TEST
DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | |
If Walking test complete at least one trial (LI820) != 1. Yes »
| | | | | ========================================================================
| | | | |
LI821
Walking test reason not complete
WALKING TEST
WHY DIDN'T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from walking
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
WALKING TEST
WHY DIDN'T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete test
5. R did not understand the instructions
6. R had surgery, injury, or other health condition that prevented r from walking
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | | |
Else
| | | | | ========================================================================
| | | | |
LI823
Walking test 1st trial time
WALKING TEST - TIME FROM FIRST TRIAL
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL:
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R unable to do it
99998. Don't know; not ascertained
99999. R chose not to do it
WALKING TEST - TIME FROM FIRST TRIAL
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL:
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R unable to do it
99998. Don't know; not ascertained
99999. R chose not to do it
| | | | |
If Walking test 1st trial time (LI823) != 993 and Walking test 1st trial time (LI823) != 999 »
| | | | | | ========================================================================
| | | | | |
LI824
Walking test 2nd trial time
WALKING TEST - TIME FROM SECOND TRIAL
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL: [T WALK 1ST TRIAL TIME]
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R was unable to do it
99998. Don't know; not ascertained
99999. R chose not to do it
WALKING TEST - TIME FROM SECOND TRIAL
RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL: [T WALK 1ST TRIAL TIME]
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R was unable to do it
99998. Don't know; not ascertained
99999. R chose not to do it
| | | | | | ========================================================================
| | | | | |
LI825
T walk floor surface
WALKING TEST
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
WALKING TEST
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
| | | | | | ========================================================================
| | | | | |
LI828
Walking aid type
WALKING TEST
RECORD TYPE OF AID USED
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Walking stick or cane
3. Elbow crutches
4. Walking frame
7. Other (specify)
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
WALKING TEST
RECORD TYPE OF AID USED
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Walking stick or cane
3. Elbow crutches
4. Walking frame
7. Other (specify)
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | | | ========================================================================
| | | | | |
LI830
Walking test r effort
WALKING TEST
HOW COMPLIANT WAS R DURING THIS MEASUREMENT
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant.
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
WALKING TEST
HOW COMPLIANT WAS R DURING THIS MEASUREMENT
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant.
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | | ========================================================================
| | |
LI831
Measure r height
HEIGHT
WERE YOU ABLE TO MEASURE R'S HEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
HEIGHT
WERE YOU ABLE TO MEASURE R'S HEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Measure r height (LI831) != 1. Yes »
| | | | ========================================================================
| | | |
LI832
Height reason not complete
HEIGHT
WHY WEREN'T YOU ABLE TO MEASURE R'S HEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R is not able to stand; other health reason
7. No suitable space available
8. Problem with equipment or supplies
9. R too tall, interviewer could not reach
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
HEIGHT
WHY WEREN'T YOU ABLE TO MEASURE R'S HEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R is not able to stand; other health reason
7. No suitable space available
8. Problem with equipment or supplies
9. R too tall, interviewer could not reach
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
Else
| | | | ========================================================================
| | | |
LI834
| | | | ========================================================================
| | | |
LI835
Height floor surface
HEIGHT
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
HEIGHT
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI837
Height wearing shoes
HEIGHT
WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
HEIGHT
WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI903
Height compliance
HEIGHT
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
HEIGHT
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | |
If Weight in pounds (LC139) < 300 »
| | | | ========================================================================
| | | |
LI838
Weight able to measure
WEIGHT
WERE YOU ABLE TO MEASURE R'S WEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
WEIGHT
WERE YOU ABLE TO MEASURE R'S WEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | |
If Weight able to measure (LI838) != 1. Yes »
| | | | | ========================================================================
| | | | |
LI839
Weight reason not complete
WEIGHT
WHY WEREN'T YOU ABLE TO MEASURE R'S WEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R is not able to stand or balance on scale; other health reason
7. No suitable space available
8. Scale did not work; other problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
WEIGHT
WHY WEREN'T YOU ABLE TO MEASURE R'S WEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R is not able to stand or balance on scale; other health reason
7. No suitable space available
8. Scale did not work; other problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | | |
Else
| | | | | ========================================================================
| | | | |
LI841
Weight pounds measurment
WEIGHT
ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 1/2 POUND). ENTER 99993 IF R TRIED BUT RECEIVED AN ERROR MESSAGE. ENTER 99999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R tried but received an error message
99999. R chose not to do it
WEIGHT
ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 1/2 POUND). ENTER 99993 IF R TRIED BUT RECEIVED AN ERROR MESSAGE. ENTER 99999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R tried but received an error message
99999. R chose not to do it
| | | | | ========================================================================
| | | | |
LI842
Weight floor surface
WEIGHT
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
WEIGHT
RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete/brick
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview
| | | | | ========================================================================
| | | | |
LI844
Weight wearing shoes
WEIGHT
WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
WEIGHT
WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | | | | ========================================================================
| | | | |
LI947
Weight compliance
WEIGHT
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
WEIGHT
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | | ========================================================================
| | |
LI904
Waist complete
WAIST CIRCUMFERENCE
WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE
WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Waist complete (LI904) != 1. Yes »
| | | | ========================================================================
| | | |
LI905
Waist why not complete
WAIST CIRCUMFERENCE
WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R is not able to stand; other health reason
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE
WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R is not able to stand; other health reason
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
Else
| | | | ========================================================================
| | | |
LI907
Waist measurment
WAIST CIRCUMFERENCE -MEASUREMENT
ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.
ENTER 99993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 99999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R tried but was unable to complete the test
99999. R chose not to do it
WAIST CIRCUMFERENCE -MEASUREMENT
ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.
ENTER 99993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 99999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
99993. R tried but was unable to complete the test
99999. R chose not to do it
| | | |
If Waist measurment (LI907) != 993 and Waist measurment (LI907) != 999 »
| | | | | ========================================================================
| | | | |
LI908
Waist difficulties
WAIST CIRCUMFERENCE -MEASUREMENT
WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R had breathing difficulties
3. R was unable to hold breath at end of exhale
4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
5. R did not appear to give full effort, but no obvious reason for this.
6. Had difficulty or unable to locate navel
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE -MEASUREMENT
WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R had breathing difficulties
3. R was unable to hold breath at end of exhale
4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
5. R did not appear to give full effort, but no obvious reason for this.
6. Had difficulty or unable to locate navel
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | | | | ========================================================================
| | | | |
LI910
Waist compliance
WAIST CIRCUMFERENCE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | | | | ========================================================================
| | | | |
LI911
Waist who measured
WAIST CIRCUMFERENCE
WHO COMPLETED THE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R completed the measurement
2. Iwer completed the measurement
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE
WHO COMPLETED THE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R completed the measurement
2. Iwer completed the measurement
8. Don't know; not ascertained
Blank. Inapplicable; partial interview
| | | | | ========================================================================
| | | | |
LI912
Waist bulky clothes
WAIST CIRCUMFERENCE
WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
WAIST CIRCUMFERENCE
WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | ========================================================================
| |
LI913
Saliva consent
SALIVA SAMPLE
DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
SALIVA SAMPLE
DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| |
If Saliva consent (LI913) = 5. No »
| | | ========================================================================
| | |
LI941
Why no consent saliva
SALIVA SAMPLE
WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R could not complete the measurement due to health reasons
7. No suitable space
8. R ate, drank, smoked, or brushed teeth in last 30 minutes
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
SALIVA SAMPLE
WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R could not complete the measurement due to health reasons
7. No suitable space
8. R ate, drank, smoked, or brushed teeth in last 30 minutes
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| |
Else
| | | ========================================================================
| | |
LI915
Saliva sample complete
SALIVA SAMPLE
DID R COMPLETE THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
SALIVA SAMPLE
DID R COMPLETE THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Saliva sample complete (LI915) != 1. Yes »
| | | | ========================================================================
| | | |
LI916
Saliva why not complete
SALIVA SAMPLE
WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R could not complete the measurement due to health problems
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
SALIVA SAMPLE
WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R could not complete the measurement due to health problems
7. No suitable space available
8. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| | |
Else
| | | | ========================================================================
| | | |
LI918
Saliva fill vial
SALIVA SAMPLE
DID R FILL THE VIAL TO THE DESIRED LEVEL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
SALIVA SAMPLE
DID R FILL THE VIAL TO THE DESIRED LEVEL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI919
Saliva problems
SALIVA SAMPLE
WHAT, IF ANY, PROBLEMS OCCURED? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Solution in cover leaked before vial was sealed
3. Saliva spilled
4. R was unable to produce enough saliva
5. Collection container leaked; other problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
SALIVA SAMPLE
WHAT, IF ANY, PROBLEMS OCCURED? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Solution in cover leaked before vial was sealed
3. Saliva spilled
4. R was unable to produce enough saliva
5. Collection container leaked; other problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI921
Saliva compliance
SALIVA SAMPLE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
SALIVA SAMPLE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
| | ========================================================================
| |
LI922
Blood sample consent
BLOOD SAMPLE
DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BLOOD SAMPLE
DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| |
If Blood sample consent (LI922) = 5. No »
| | | ========================================================================
| | |
LI943
Why no consent blood
BLOOD SAMPLE
WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7. No suitable space
8. R ate, drank, smoked, or brushed teeth in last 30 minutes
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
BLOOD SAMPLE
WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7. No suitable space
8. R ate, drank, smoked, or brushed teeth in last 30 minutes
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview
| |
Else
| | | ========================================================================
| | |
LI923
Blood sample complete
BLOOD SAMPLE
DID R COMPLETE THE BLOOD SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
BLOOD SAMPLE
DID R COMPLETE THE BLOOD SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview
| | |
If Blood sample complete (LI923) != 1. Yes »
| | | | ========================================================================
| | | |
LI924
Why blood sample not complete
BLOOD SAMPLE
WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
BLOOD SAMPLE
WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7. No suitable space
8. Problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
| | |
Else
| | | | ========================================================================
| | | |
LI926
Blood sample what problems
BLOOD SAMPLE
WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R became lightheaded, fainted, or became nauseous
3. R had difficulty getting finger to stop bleeding
4. Unable to obtain enough blood
5. Problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
BLOOD SAMPLE
WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R became lightheaded, fainted, or became nauseous
3. R had difficulty getting finger to stop bleeding
4. Unable to obtain enough blood
5. Problem with equipment or supplies
97. Other (specify)
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI928
Blood who measured
BLOOD SAMPLE
WHO PRICKED THE R'S FINGER(S)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R pricked own finger(s)
2. Iwer pricked r's finger(s)
3. Both r and iwer pricked r's finger(s)
4. Someone else pricked r's finger(s)
Blank. Inapplicable; partial interview
BLOOD SAMPLE
WHO PRICKED THE R'S FINGER(S)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R pricked own finger(s)
2. Iwer pricked r's finger(s)
3. Both r and iwer pricked r's finger(s)
4. Someone else pricked r's finger(s)
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI929
Amount of blood on first card
BLOOD SAMPLE
HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD SAMPLE
HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI945
Amount of blood on storage card
BLOOD SAMPLE
HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
BLOOD SAMPLE
HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI930
How many blood pricks
BLOOD SAMPLE
HOW MANY TIMES DID THE R'S FINGER NEED TO BE PRICKED IN ORDER TO FILL THE CIRCLES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. One time
2. Two times
3. Two times, but r was unable to fill all four circles with blood
Blank. Inapplicable; partial interview
BLOOD SAMPLE
HOW MANY TIMES DID THE R'S FINGER NEED TO BE PRICKED IN ORDER TO FILL THE CIRCLES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. One time
2. Two times
3. Two times, but r was unable to fill all four circles with blood
Blank. Inapplicable; partial interview
| | | | ========================================================================
| | | |
LI931
Blood sample compliance
BLOOD SAMPLE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
BLOOD SAMPLE
HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview
End of I. Physical Measures (respondent)