I. Physical Measures

I. Physical Measures module of HRS 2012

item label type description
NV979 Question
NV978 Question
NV944 Question Why No Consent Blood_Specify
NV829STWALKTYPEOFAID Question walking aid type -specify
NV903 Question HEIGHT wearing shoes
NV953 Question BLOOD Did R sign - reason
NV818 Question HAND STRENGTH TEST R POSITION
NV819 Question HAND STRENGTH rest arm
NV955 Question Why No Consent PHYSICAL MEASURES _Specify
NV954 Question Why No Consent PHYSICAL MEASURES
NV812 Question HAND STRENGTH COMPLETE AT LEAST ONE TRIAL
NV813 Question HAND STRENGTH TEST REASON NOT COMPLETE
NV810 Question R BREATHING TEST effort
NV816 Question Left first (kg)
NV817 Question GRIP R EFFORT
NV814 Question HAND STRENGTH TEST REASON NOT COMPLETE -Specify
NV815 Question grip dominant hand
NV881 Question BALANCE TEST SEMI-TANDEM Compensatory
NV880 Question BALANCE TEST SEMI-TANDEM Time
NV883 Question BALANCE TEST S-B-S Complete
NV885 Question BALANCE TEST S-B-S REASON NOT COMPLETE -Specify
NV884 Question BALANCE TEST S-B-S STAND REASON NOT COMPLETE
NV887 Question BALANCE TEST SIDE-BY-SIDE Time
NV886 Question BALANCE TEST S-B-S Hold Full Time
NV889 Question BALANCE TEST S-B-S Floor Surface
NV844 Question WEIGHT wearing shoes
NV842 Question WEIGHT floor surface
NV974 Question
NV878 Question BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE -Specify
NV973 Question
NV972 Question
NV875 Question BLOODPRESSURE Smoke Etc
NV876 Question BALANCE TEST - SEMI-TANDEM STAND
NV869 Question BLOODPRESSURE 3 Systolic (mmHg)
NV877 Question BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE
NV870 Question BLOODPRESSURE 3 DIASTOLIC (mmHg)
NV871 Question BLOODPRESSURE 3 Pulse (bpm)
NV872 Question BLOODPRESSURE ARM
NV873 Question BLOODPRESSURE Compliance
NV861 Question BLOODPRESSURE 1 Pulse (bpm)
NV860 Question BLOODPRESSURE 1 DIASTOLIC (mmHg)
NV867 Question BLOODPRESSURE 3 TIME
NV866 Question BLOODPRESSURE 2 Pulse (bpm)
NV865 Question BLOODPRESSURE 2 DIASTOLIC (mmHg)
NV864 Question BLOODPRESSURE 2 SYSTOLIC (mmHg)
NV949 Question PHYSICAL MEASURES Did R sign - reason
NV917 Question Saliva Not Complete _Specify
NV916 Question Saliva Why Not Complete
NV915 Question Saliva Complete
NV833 Question HEIGHT REASON NOT COMPLETE -specify
NV913 Question Saliva Consent
NV912 Question Waist Bulky Clothes
NV911 Question Waist Who Measured
NV910 Question Waist Compliance
NV834 Question HEIGHT MEASURMENT (inches)
NV918 Question Saliva Fill Vial
NV947 Question WEIGHT Compliance
NV836 Question HEIGHT floor surface -Specify
NV940 Question Saliva BarCode 1
NV837 Question HEIGHT wearing shoes
NV942 Question Why No Consent Saliva _Specify
NV901 Question BALANCE TEST FULL TANDEM Floor Surface -Specify
NV905 Question Waist Why Not Complete
NV907 Question Waist Measurment (inches)
NV890 Question BALANCE TEST S-B-S Floor Surface -Specify
NV948 Question PHYSICAL MEASURES Did R sign the consent form
NV902 Question BALANCE TEST FULL TANDEM Compliance
NV945 Question Blood Fill Spots
NV941 Question Why No Consent Saliva
NV943 Question Why No Consent Blood
NV893 Question BALANCE TEST Full Tandem Complete
NV857 Question BLOODPRESSURE TIME
NV891 Question BALANCE TEST S-B-S Compliance
NV896 Question BALANCE TEST FULL TANDEM Hold Full Time
NV897 Question BALANCE TEST FULL TANDEM Time
NV894 Question BALANCE TEST Full Tandem STAND REASON NOT COMPLETE
NV895 Question BALANCE TEST Full Tandem REASON NOT COMPLETE -Specify
NV898 Question BALANCE TEST FULL TANDEM Compensatory
NV899 Question BALANCE TEST FULL TANDEM Floor Surface
NV826 Question T walk floor surface -Specify
NV825 Question T walk floor surface
NV824 Question T walk 2nd trial time (seconds)
NV823 Question T walk 1st trial time (seconds)
NV822 Question WALKING TEST REASON NOT COMPLETE -Specify
NV821 Question WALKING TEST REASON NOT COMPLETE
NV820 Question WALKING TEST COMPLETE AT LEAST ONE TRIAL
NV852 Question left second (kg)
NV906 Question Waist Not Complete_Specify
NV828 Question walking aid type
NV835HEIGHTFLOORING Question HEIGHT floor surface
NV862 Question BLOODPRESSURE2 TIME
NV830 Question walk R effort
NV991 Question
NV990 Question
NV975 Question
NV971 Question
NV967 Question
NV904 Question WAIST Complete
NV908 Question Waist Difficulties
NV909 Question Waist Difficulties_Specify
NV952 Question BLOOD Did R sign the consent form
NV951 Question SALIVA Did R sign - reason
NV950 Question SALIVA Did R sign the consent form
NV831 Question MEASURE R HEIGHT
NV811 Question BREATHING TEST R position
NV859 Question BLOODPRESSURE 1 SYSTOLIC (mmHg)
NV922 Question BLOOD Consent
NV914 Question Saliva Eat Drank Etc
NV939 Question Saliva BarCode 1
NV832 Question HEIGHT REASON NOT COMPLETE
NV931 Question Blood Compliance
NV930 Question Blood Pricks
NV933 Question SalivaBarCode
NV935 Question Blood BarCode 2
NV934 Question Blood BarCode 1
NV937 Question Blood Pressure Complete
NV936 Question finish phy measures
NV845 Question finish phy measures
NV919 Question Saliva Problems
NV888 Question BALANCE TEST SIDE-BY-SIDE Compensatory
NV846 Question PHYSICAL MEASURES INTRO
NV840 Question WEIGHT REASON NOT COMPLETE -Specify
NV843 Question WEIGHT floor surface -Specify
NV838 Question WEIGHT ABLE TO MEASURE
NV839 Question WEIGHT REASON NOT COMPLETE
NV988 Question
NV989 Question
NV985 Question
NV987 Question
NV981 Question
NV982 Question
NV809 Question Puff Test 3 (L/min)
NV856 Question BLOOD PRESSURE NOT COMPLETE_SPECIFY
NV964 Question
NV965 Question
NV960 Question
NV961 Question
NV802 Question PHYSICAL MEASURES CONSENT
NV805 Question Breath Test REASON NOT COMPLETE
NV854 Question Blood Pressure Complete
NV807 Question Puff Test 1 (L/min)
NV806 Question Breath Test REASON NOT COMPLETE -Specify
NV855 Question Reason Blood Pressure Not Complete
NV853 Question RIGHT Second (kg)
NV851 Question RIGHT first (kg)
NV879 Question BALANCE TEST SEMI-TANDEM Hold Full Time
NV983 Question
NV984 Question
NV980 Question
NV977 Question
NV966 Question
NV976 Question
NV808 Question Puff Test 2 (L/min)
NV841 Question Weight Measurment (lbs)
NV874 Question BLOODPRESSURE Position
NV962 Question
NV986 Question
NV963 Question
NV800 Question MODE OF INTERVIEW FOR PHYSICAL MEASURES
NV970 Question
NV804 Question Breath COMPLETE AT LEAST ONE TRIAL
NV968 Question
NV969 Question
NV928 Question Blood Who Measured
NV929 Question Blood Fill Spots
NV923 Question Blood Complete
NV920 Question Saliva Problem _ Specify
NV921 Question Saliva Compliance
NV926 Question Blood What Problems
NV927 Question Blood Problem _ Specify
NV924 Question Blood Why Not Complete
NV925 Question Blood NotComplete_Specify
Start of I. Physical Measures
 
NV800

MODE OF INTERVIEW FOR PHYSICAL MEASURES

» ENTER CURRENT MODE OF INTERVIEW
expand
 
If NX090_R = ENHANCEDFTF »
 
   
 
If MODE OF INTERVIEW FOR PHYSICAL MEASURES = 2 F-t-f and R IN NURSING HOME = NO and LANGUAGE = SPANISH or ENGNVSH »
 
     
   
NV802

PHYSICAL MEASURES CONSENT

» DID R SIGN THE PHYSICAL MEASURES CONSENT FORM?
expand
     
   
If PHYSICAL MEASURES CONSENT = 1 Yes »
 
       
     
NV854

Blood Pressure Complete

BLOOD PRESSURE» DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
expand
       
     
If Blood Pressure Complete = 5 No »
 
         
       
NV855

Reason Blood Pressure Not Complete

BLOOD PRESSURE
» WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT?
» (SELECT ALL THAT APPLY)

expand
         
     
ElseIf Blood Pressure Complete = 1 Yes »
 
         
       
NV857

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.

         
       
NV859

BLOODPRESSURE 1 SYSTOLIC (mmHg)

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.

expand
         
       
If BLOODPRESSURE 1 SYSTOLIC (mmHg) != 9993 and BLOODPRESSURE 1 SYSTOLIC (mmHg) != 999 »
 
           
         
NV860

BLOODPRESSURE 1 DIASTOLIC (mmHg)

BLOOD PRESSURE - 1ST DIASTOLIC
»FIRST READING DIASTOLIC
expand
           
         
NV861

BLOODPRESSURE 1 Pulse (bpm)

BLOOD PRESSURE - 1ST PULSE
»FIRST READING PULSE
expand
           
         
NV862

BLOODPRESSURE2 TIME

BLOOD PRESSURE - 2ND TIME
»SECOND 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.

           
         
NV864

BLOODPRESSURE 2 SYSTOLIC (mmHg)

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.

expand
           
         
If BLOODPRESSURE 2 SYSTOLIC (mmHg) != 9993 and BLOODPRESSURE 2 SYSTOLIC (mmHg) != 999 »
 
             
           
NV865

BLOODPRESSURE 2 DIASTOLIC (mmHg)

BLOOD PRESSURE - 2ND DIASTOLIC
»SECOND READING DIASTOLIC
expand
             
           
NV866

BLOODPRESSURE 2 Pulse (bpm)

BLOOD PRESSURE - 2ND PULSE
»SECOND READING PULSE
expand
             
           
NV867

BLOODPRESSURE 3 TIME

BLOOD PRESSURE - 3RD TIME
»THIRD 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.

             
           
NV869

BLOODPRESSURE 3 Systolic (mmHg)

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.

expand
             
           
If BLOODPRESSURE 3 Systolic (mmHg) != 9993 and BLOODPRESSURE 3 Systolic (mmHg) != 999 »
 
               
             
NV870

BLOODPRESSURE 3 DIASTOLIC (mmHg)

BLOOD PRESSURE - 3RD DIASTOLIC
»THIRD READING DIASTOLIC
expand
               
             
NV871

BLOODPRESSURE 3 Pulse (bpm)

BLOOD PRESSURE - 3RD PULSE
»THIRD READING PULSE
expand
               
         
NV872

BLOODPRESSURE ARM

BLOOD PRESSURE - ARM
»WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
expand
           
         
NV873

BLOODPRESSURE Compliance

BLOOD PRESSURE - COMPLIANCE
»HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
NV874

BLOODPRESSURE Position

BLOOD PRESSURE - POSITION
»WHAT WAS R'S POSITION FOR THIS TEST?
expand
           
         
NV875

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?

expand
           
     
NV804

Breath COMPLETE AT LEAST ONE TRIAL

BREATHING TEST
» DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?
expand
       
     
If Breath COMPLETE AT LEAST ONE TRIAL != 1 Yes »
 
         
       
NV805

Breath Test REASON NOT COMPLETE

BREATHING TEST
» WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)
expand
         
     
If Breath COMPLETE AT LEAST ONE TRIAL = 1 Yes »
 
         
       
NV807

Puff Test 1 (L/min)

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.

expand
         
       
NV808

Puff Test 2 (L/min)

BREATHING TEST
FIRST READING: Puff Test 1 (L/min)
SECOND READING:
THIRD READING:
» ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
» ENTER 999 IF R CHOSE NOT TO DO IT.

expand
         
       
NV809

Puff Test 3 (L/min)

BREATHING TEST
FIRST READING: Puff Test 1 (L/min)
SECOND READING: Puff Test 2 (L/min)
THIRD READING:
» ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
» ENTER 999 IF R CHOSE NOT TO DO IT.

expand
         
       
NV810

R BREATHING TEST effort

BREATHING TEST
» HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
NV811

BREATHING TEST R position

BREATHING TEST
» WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
     
NV812

HAND STRENGTH COMPLETE AT LEAST ONE TRIAL

HAND STRENGTH TEST
» DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
expand
       
     
If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL != 1 Yes »
 
         
       
NV813

HAND STRENGTH TEST REASON NOT COMPLETE

HAND STRENGTH TEST
» WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)
expand
         
     
Else If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL = 1 Yes »
 
         
       
NV815

grip dominant hand

HAND STRENGTH TEST
» RECORD R'S DOMINANT HAND.
expand
         
       
NV816

Left first (kg)

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 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
NV851

RIGHT first (kg)

HAND STRENGTH TEST
» RIGHT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
RIGHT HAND, FIRST MEASUREMENT:
LEFT HAND, SECOND MEASUREMENT:
RIGHT HAND, SECOND MEASUREMENT:
» ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
» ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
NV852

left second (kg)

HAND STRENGTH TEST
» LEFT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
RIGHT HAND, FIRST MEASUREMENT: RIGHT first (kg)
LEFT HAND, SECOND MEASUREMENT:
RIGHT HAND, SECOND MEASUREMENT:
» ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
NV853

RIGHT Second (kg)

HAND STRENGTH TEST
» RIGHT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
RIGHT HAND, FIRST MEASUREMENT: RIGHT first (kg)
LEFT HAND, SECOND MEASUREMENT: left second(kg)
RIGHT HAND, SECOND MEASUREMENT:
» ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
NV817

GRIP R EFFORT

HAND STRENGTH TEST
» HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
NV818

HAND STRENGTH TEST R POSITION

HAND STRENGTH TEST
» WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
       
NV819

HAND STRENGTH rest arm

HAND STRENGTH TEST
» DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
expand
         
     
NV876

BALANCE TEST - SEMI-TANDEM STAND

BALANCE TEST - SEMI-TANDEM STAND
» DID R COMPLETE THE SEMI-TANDEM STAND?
expand
       
     
If BALANCE TEST - SEMI-TANDEM STAND != 1 Yes »
 
         
       
NV877

BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE

BALANCE TEST - SEMI-TANDEM STAND
» WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND?
» SELECT ALL THAT APPLY

expand
         
     
ElseIf BALANCE TEST - SEMI-TANDEM STAND = 1 Yes »
 
         
       
NV879

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?
expand
         
       
If BALANCE TEST SEMI-TANDEM Hold Full Time = 1 Yes »
 
           
         
NV880

BALANCE TEST SEMI-TANDEM Time

BALANCE TEST - SEMI-TANDEM STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
           
       
If BALANCE TEST SEMI-TANDEM Hold Full Time != 999 R chose not to do it and BALANCE TEST SEMI-TANDEM Hold Full Time != 993 R tried but was unable »
 
           
         
NV881

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?
expand
           
     
If BALANCE TEST - SEMI-TANDEM STAND = 5 No or BALANCE TEST SEMI-TANDEM Hold Full Time != 1 Yes »
 
         
       
NV883

BALANCE TEST S-B-S Complete

BALANCE TEST - SIDE-BY-SIDE STAND
» DID R COMPLETE THE SIDE-BY-SIDE STAND?
expand
         
       
If BALANCE TEST S-B-S Complete != 1 Yes »
 
           
         
NV884

BALANCE TEST S-B-S STAND REASON NOT COMPLETE

BALANCE TEST - SIDE-BY-SIDE STAND
» WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND?
» SELECT ALL THAT APPLY

expand
           
       
ElseIf BALANCE TEST S-B-S Complete = 1 Yes »
 
           
         
NV886

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?
expand
           
         
If BALANCE TEST S-B-S Hold Full Time = 1 Yes »
 
             
           
NV887

BALANCE TEST SIDE-BY-SIDE Time

BALANCE TEST - SIDE-BY-SIDE STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
             
         
If BALANCE TEST S-B-S Hold Full Time != 993 R tried but was unable and BALANCE TEST S-B-S Hold Full Time != 999 R chose not to do it »
 
             
           
NV888

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?
expand
             
           
NV889

BALANCE TEST S-B-S Floor Surface

BALANCE TEST - SIDE-BY-SIDE STAND
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
NV891

BALANCE TEST S-B-S Compliance

BALANCE TEST - SIDE-BY-SIDE STAND
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
Else
 
         
       
NV893

BALANCE TEST Full Tandem Complete

BALANCE TEST - FULL TANDEM STAND
» DID R COMPLETE THE FULL TANDEM STAND?
expand
         
       
If BALANCE TEST Full Tandem Complete != 1 Yes »
 
           
         
NV894

BALANCE TEST Full Tandem STAND REASON NOT COMPLETE

BALANCE TEST - FULL TANDEM STAND
» WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND?
» SELECT ALL THAT APPLY

expand
           
       
Else
 
           
         
NV896

BALANCE TEST FULL TANDEM Hold Full Time

BALANCE TEST - FULL TANDEM STAND
» DID R HOLD FULL TANDEM STAND FOR FULL 30.0 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
expand
           
         
If BALANCE TEST FULL TANDEM Hold Full Time = 1 Yes and R CURRENT AGE CALCULATION > 70 »
 
             
           
NV897

BALANCE TEST FULL TANDEM Time

BALANCE TEST - FULL TANDEM STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
             
         
If BALANCE TEST FULL TANDEM Hold Full Time != 993 R tried but was unable and BALANCE TEST FULL TANDEM Hold Full Time != 999 R chose not to do it »
 
             
           
NV898

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?
expand
             
           
NV899

BALANCE TEST FULL TANDEM Floor Surface

BALANCE TEST - FULL TANDEM
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
NV902

BALANCE TEST FULL TANDEM Compliance

BALANCE TEST - FULL TANDEM STAND
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
If R CURRENT AGE CALCULATION > 64 »
 
         
       
NV820

WALKING TEST COMPLETE AT LEAST ONE TRIAL

WALKING TEST
» DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?
expand
         
       
If WALKING TEST COMPLETE AT LEAST ONE TRIAL != 1 Yes »
 
           
         
NV821

WALKING TEST REASON NOT COMPLETE

WALKING TEST
» WHY DIDN`T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
NV823

T walk 1st trial time (seconds)

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

expand
           
         
If T walk 1st trial time (seconds) != 993 and T walk 1st trial time (seconds) != 999 »
 
             
           
NV824

T walk 2nd trial time (seconds)

WALKING TEST - TIME FROM SECOND TRIAL
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL: T walk 1st trial time (seconds)
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT
ENTER 999 IF R CHOSE NOT TO DO IT

expand
             
           
NV825

T walk floor surface

WALKING TEST
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
NV828

walking aid type

WALKING TEST
» RECORD TYPE OF AID USED
expand
             
           
NV830

walk R effort

WALKING TEST
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT
expand
             
     
NV831

MEASURE R HEIGHT

HEIGHT
» WERE YOU ABLE TO MEASURE R`S HEIGHT?
expand
       
     
If MEASURE R HEIGHT != 1 Yes »
 
         
       
NV832

HEIGHT REASON NOT COMPLETE

HEIGHT
» WHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
NV834

HEIGHT MEASURMENT (inches)

HEIGHT
» ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.
expand
         
       
NV835HEIGHTFLOORING

HEIGHT floor surface

HEIGHT
» RECORD TYPE OF FLOOR SURFACE
expand
         
       
NV837

HEIGHT wearing shoes

HEIGHT
» WAS R WEARING SHOES DURING MEASUREMENT?
expand
         
       
NV903

HEIGHT wearing shoes

HEIGHT
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
     
If WEIGHT IN POUNDS < 300 »
 
         
       
NV838

WEIGHT ABLE TO MEASURE

WEIGHT
» WERE YOU ABLE TO MEASURE R`S WEIGHT?
expand
         
       
If WEIGHT ABLE TO MEASURE != 1 Yes »
 
           
         
NV839

WEIGHT REASON NOT COMPLETE

WEIGHT
» WHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
NV841

Weight Measurment (lbs)

WEIGHT
» ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST
expand
           
         
NV842

WEIGHT floor surface

WEIGHT
» RECORD TYPE OF FLOOR SURFACE
expand
           
         
NV844

WEIGHT wearing shoes

WEIGHT
» WAS R WEARING SHOES DURING MEASUREMENT?
expand
           
         
NV947

WEIGHT Compliance

WEIGHT
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
     
NV904

WAIST Complete

WAIST CIRCUMFERENCE
» WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
expand
       
     
If WAIST Complete != 1 Yes »
 
         
       
NV905

Waist Why Not Complete

WAIST CIRCUMFERENCE
» WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
NV907

Waist Measurment (inches)

WAIST CIRCUMFERENCE -MEASUREMENT
» ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.
» ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
» ENTER 999 IF R CHOSE NOT TO DO IT.

expand
         
       
If Waist Measurment (inches) != 993 and Waist Measurment (inches) != 999 »
 
           
         
NV908

Waist Difficulties

WAIST CIRCUMFERENCE -MEASUREMENT
» WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?
» SELECT ALL THAT APPLY
expand
           
         
NV910

Waist Compliance

WAIST CIRCUMFERENCE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
NV911

Waist Who Measured

WAIST CIRCUMFERENCE
» WHO COMPLETED THE MEASUREMENT?
expand
           
         
NV912

Waist Bulky Clothes

WAIST CIRCUMFERENCE
» WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
expand
           
   
NV913

Saliva Consent

SALIVA SAMPLE
» DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
expand
     
   
If Saliva Consent = 5 No »
 
       
     
NV941

Why No Consent Saliva

SALIVA SAMPLE
» WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
NV915

Saliva Complete

SALIVA SAMPLE
» DID R COMPLETE THE SALIVA SAMPLE?
expand
       
     
If Saliva Complete != 1 Yes »
 
         
       
NV916

Saliva Why Not Complete

SALIVA SAMPLE
» WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
NV918

Saliva Fill Vial

SALIVA SAMPLE
» DID R FILL THE VIAL TO THE DESIRED LEVEL?
expand
         
       
NV919

Saliva Problems

SALIVA SAMPLE
» WHAT, IF ANY, PROBLEMS OCCURED?
(SELECT ALL THAT APPLY)

expand
         
       
NV921

Saliva Compliance

SALIVA SAMPLE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
   
NV922

BLOOD Consent

BLOOD SAMPLE
» DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
expand
     
   
If BLOOD Consent = 5 No »
 
       
     
NV943

Why No Consent Blood

BLOOD SAMPLE
» WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
NV923

Blood Complete

BLOOD SAMPLE
» DID R COMPLETE THE BLOOD SAMPLE?
expand
       
     
If Blood Complete != 1 Yes »
 
         
       
NV924

Blood Why Not Complete

BLOOD SAMPLE
» WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
NV926

Blood What Problems

BLOOD SAMPLE
» WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE?
(SELECT ALL THAT APPLY)

expand
         
       
NV928

Blood Who Measured

BLOOD SAMPLE
» WHO PRICKED THE R'S FINGER(S)?
expand
         
       
NV929

Blood Fill Spots

BLOOD SAMPLE
» HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
expand
         
       
NV945

Blood Fill Spots

BLOOD SAMPLE
» HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
expand
         
       
NV930

Blood Pricks

BLOOD SAMPLE
» HOW MANY TIMES DID THE R'S FINGER HAVE TO BE PRICKED IN ORDER TO FILL THE CARDS?
expand
         
       
NV931

Blood Compliance

BLOOD SAMPLE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
End of I. Physical Measures
Start of I. Physical Measures

========================================================================
NV800
MODE OF INTERVIEW FOR PHYSICAL MEASURES

@/@S@WW@W ENTER CURRENT MODE OF INTERVIEW@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Phone
2 F-t-f


If NX090_R = ENHANCEDFTF »

If MODE OF INTERVIEW FOR PHYSICAL MEASURES (NV800) = 2 F-t-f and R IN NURSING HOME (NA028) = NO and LANGUAGE = SPANISH or ENGNVSH »

| |  ========================================================================
| | 
NV802
PHYSICAL MEASURES CONSENT

@/@S@WW@W DID R SIGN THE PHYSICAL MEASURES CONSENT FORM?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  If PHYSICAL MEASURES CONSENT (NV802) = 1 Yes »

| | |  ========================================================================
| | | 
NV854
Blood Pressure Complete

@/BLOOD PRESSURE@/@/@S@WW@W DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If Blood Pressure Complete (NV854) = 5 No »

| | | |  ========================================================================
| | | | 
NV855
Reason Blood Pressure Not Complete

@/BLOOD PRESSURE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT?
@/@WW@W (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  ElseIf Blood Pressure Complete (NV854) = 1 Yes »

| | | |  ========================================================================
| | | | 
NV857
BLOODPRESSURE TIME

@/BLOOD PRESSURE - 1ST TIME
@/@/@WW@W@SFIRST READING TIME OF READING
@/@/@WW@W 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.@S

| | | |  ========================================================================
| | | | 
NV859
BLOODPRESSURE 1 SYSTOLIC (mmHg)

@/BLOOD PRESSURE - 1ST SYSTOLIC
@/@/@WW@W@SFIRST READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | |  If BLOODPRESSURE 1 SYSTOLIC (mmHg) (NV859) != 9993 and BLOODPRESSURE 1 SYSTOLIC (mmHg) (NV859) != 999 »

| | | | |  ========================================================================
| | | | | 
NV860
BLOODPRESSURE 1 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 1ST DIASTOLIC
@/@/@WW@W@SFIRST READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | |  ========================================================================
| | | | | 
NV861
BLOODPRESSURE 1 Pulse (bpm)

@/BLOOD PRESSURE - 1ST PULSE
@/@/@WW@W@SFIRST READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | |  ========================================================================
| | | | | 
NV862
BLOODPRESSURE2 TIME

@/BLOOD PRESSURE - 2ND TIME
@/@/@WW@W@SSECOND READING TIME OF READING
@/@/@WW@W 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.@S

| | | | |  ========================================================================
| | | | | 
NV864
BLOODPRESSURE 2 SYSTOLIC (mmHg)

@/BLOOD PRESSURE - 2ND SYSTOLIC
@/@/@WW@W@SSECOND READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | |  If BLOODPRESSURE 2 SYSTOLIC (mmHg) (NV864) != 9993 and BLOODPRESSURE 2 SYSTOLIC (mmHg) (NV864) != 999 »

| | | | | |  ========================================================================
| | | | | | 
NV865
BLOODPRESSURE 2 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 2ND DIASTOLIC
@/@/@WW@W@SSECOND READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | |  ========================================================================
| | | | | | 
NV866
BLOODPRESSURE 2 Pulse (bpm)

@/BLOOD PRESSURE - 2ND PULSE
@/@/@WW@W@SSECOND READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | |  ========================================================================
| | | | | | 
NV867
BLOODPRESSURE 3 TIME

@/BLOOD PRESSURE - 3RD TIME
@/@/@WW@W@STHIRD READING TIME OF READING
@/@/@WW@W 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.@S

| | | | | |  ========================================================================
| | | | | | 
NV869
BLOODPRESSURE 3 Systolic (mmHg)

@/BLOOD PRESSURE - 3RD SYSTOLIC
@/@/@WW@W@STHIRD READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | |  If BLOODPRESSURE 3 Systolic (mmHg) (NV869) != 9993 and BLOODPRESSURE 3 Systolic (mmHg) (NV869) != 999 »

| | | | | | |  ========================================================================
| | | | | | | 
NV870
BLOODPRESSURE 3 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 3RD DIASTOLIC
@/@/@WW@W@STHIRD READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | | |  ========================================================================
| | | | | | | 
NV871
BLOODPRESSURE 3 Pulse (bpm)

@/BLOOD PRESSURE - 3RD PULSE
@/@/@WW@W@STHIRD READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | |  ========================================================================
| | | | | 
NV872
BLOODPRESSURE ARM

@/BLOOD PRESSURE - ARM
@/@/@WW@W@SWHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Left arm
2 Right arm


| | | | |  ========================================================================
| | | | | 
NV873
BLOODPRESSURE Compliance

@/BLOOD PRESSURE - COMPLIANCE
@/@/@WW@W@SHOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | | |  ========================================================================
| | | | | 
NV874
BLOODPRESSURE Position

@/BLOOD PRESSURE - POSITION
@/@/@WW@W@SWHAT WAS R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down


| | | | |  ========================================================================
| | | | | 
NV875
BLOODPRESSURE Smoke Etc

@/BLOOD PRESSURE - SMOKE ETC.
@/@/@WW@W@SDID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30
MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  ========================================================================
| | | 
NV804
Breath COMPLETE AT LEAST ONE TRIAL

@/BREATHING TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If Breath COMPLETE AT LEAST ONE TRIAL (NV804) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV805
Breath Test REASON NOT COMPLETE

@/BREATHING TEST
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  If Breath COMPLETE AT LEAST ONE TRIAL (NV804) = 1 Yes »

| | | |  ========================================================================
| | | | 
NV807
Puff Test 1 (L/min)

@/BREATHING TEST
@/@/FIRST READING:
@/@/SECOND READING:
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV808
Puff Test 2 (L/min)

@/BREATHING TEST
@/@/FIRST READING: Puff Test 1 (L/min)
@/@/SECOND READING:
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV809
Puff Test 3 (L/min)

@/BREATHING TEST
@/@/FIRST READING: Puff Test 1 (L/min)
@/@/SECOND READING: Puff Test 2 (L/min)
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV810
R BREATHING TEST effort

@/BREATHING TEST
@/@/@S@WW@W HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | |  ========================================================================
| | | | 
NV811
BREATHING TEST R position

@/BREATHING TEST
@/@/@S@WW@W WHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down


| | |  ========================================================================
| | | 
NV812
HAND STRENGTH COMPLETE AT LEAST ONE TRIAL

@/HAND STRENGTH TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (NV812) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV813
HAND STRENGTH TEST REASON NOT COMPLETE

@/HAND STRENGTH TEST
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  Else If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (NV812) = 1 Yes »

| | | |  ========================================================================
| | | | 
NV815
grip dominant hand

@/HAND STRENGTH TEST
@/@/@S@WW@W RECORD R'S DOMINANT HAND.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Right hand
2 Left hand
3 Both hands equally dominant


| | | |  ========================================================================
| | | | 
NV816
Left first (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @ULEFT@U HAND, FIRST MEASUREMENT@S.
@/@/@S@ULEFT HAND, FIRST MEASUREMENT:@U@S
@/@SRIGHT HAND, FIRST MEASUREMENT:@S
@/@SLEFT HAND, SECOND MEASUREMENT:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.
@/@/@WW@W ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV851
RIGHT first (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @URIGHT@U HAND, FIRST MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@S@URIGHT HAND, FIRST MEASUREMENT:@U@S
@/@SLEFT HAND, SECOND MEASUREMENT:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
@/@/@WW@W ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV852
left second (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @ULEFT@U HAND, @USECOND@U MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@SRIGHT HAND, FIRST MEASUREMENT:@S RIGHT first (kg)
@/@S@ULEFT HAND, SECOND MEASUREMENT@U:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
@/@/ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV853
RIGHT Second (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @URIGHT@U HAND, @USECOND@U MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@SRIGHT HAND, FIRST MEASUREMENT:@S RIGHT first (kg)
@/@SLEFT HAND, SECOND MEASUREMENT:@S left second(kg)
@/@S@URIGHT HAND, SECOND MEASUREMENT@U:@S
@/@/@WW@W ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
@/@/ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  ========================================================================
| | | | 
NV817
GRIP R EFFORT

@/HAND STRENGTH TEST
@/@/@S@WW@W HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | |  ========================================================================
| | | | 
NV818
HAND STRENGTH TEST R POSITION

@/HAND STRENGTH TEST
@/@/@S@WW@W WHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down


| | | |  ========================================================================
| | | | 
NV819
HAND STRENGTH rest arm

@/HAND STRENGTH TEST
@/@/@S@WW@W DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  ========================================================================
| | | 
NV876
BALANCE TEST - SEMI-TANDEM STAND

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R COMPLETE THE SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If BALANCE TEST - SEMI-TANDEM STAND (NV876) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV877
BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  ElseIf BALANCE TEST - SEMI-TANDEM STAND (NV876) = 1 Yes »

| | | |  ========================================================================
| | | | 
NV879
BALANCE TEST SEMI-TANDEM Hold Full Time

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | |  If BALANCE TEST SEMI-TANDEM Hold Full Time (NV879) = 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV880
BALANCE TEST SEMI-TANDEM Time

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | |  If BALANCE TEST SEMI-TANDEM Hold Full Time (NV879) != 999 R chose not to do it and BALANCE TEST SEMI-TANDEM Hold Full Time (NV879) != 993 R tried but was unable »

| | | | |  ========================================================================
| | | | | 
NV881
BALANCE TEST SEMI-TANDEM Compensatory

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If BALANCE TEST - SEMI-TANDEM STAND (NV876) = 5 No or BALANCE TEST SEMI-TANDEM Hold Full Time (NV879) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV883
BALANCE TEST S-B-S Complete

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R COMPLETE THE SIDE-BY-SIDE STAND? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  If BALANCE TEST S-B-S Complete (NV883) != 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV884
BALANCE TEST S-B-S STAND REASON NOT COMPLETE

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  ElseIf BALANCE TEST S-B-S Complete (NV883) = 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV886
BALANCE TEST S-B-S Hold Full Time

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | | |  If BALANCE TEST S-B-S Hold Full Time (NV886) = 1 Yes »

| | | | | |  ========================================================================
| | | | | | 
NV887
BALANCE TEST SIDE-BY-SIDE Time

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | | |  If BALANCE TEST S-B-S Hold Full Time (NV886) != 993 R tried but was unable and BALANCE TEST S-B-S Hold Full Time (NV886) != 999 R chose not to do it »

| | | | | |  ========================================================================
| | | | | | 
NV888
BALANCE TEST SIDE-BY-SIDE Compensatory

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | | |  ========================================================================
| | | | | | 
NV889
BALANCE TEST S-B-S Floor Surface

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | |  ========================================================================
| | | | | | 
NV891
BALANCE TEST S-B-S Compliance

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | |  Else

| | | |  ========================================================================
| | | | 
NV893
BALANCE TEST Full Tandem Complete

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R COMPLETE THE FULL TANDEM STAND? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  If BALANCE TEST Full Tandem Complete (NV893) != 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV894
BALANCE TEST Full Tandem STAND REASON NOT COMPLETE

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  Else

| | | | |  ========================================================================
| | | | | 
NV896
BALANCE TEST FULL TANDEM Hold Full Time

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R HOLD FULL TANDEM STAND FOR FULL 30.0 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | | |  If BALANCE TEST FULL TANDEM Hold Full Time (NV896) = 1 Yes and R CURRENT AGE CALCULATION (NA019) > 70 »

| | | | | |  ========================================================================
| | | | | | 
NV897
BALANCE TEST FULL TANDEM Time

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | | |  If BALANCE TEST FULL TANDEM Hold Full Time (NV896) != 993 R tried but was unable and BALANCE TEST FULL TANDEM Hold Full Time (NV896) != 999 R chose not to do it »

| | | | | |  ========================================================================
| | | | | | 
NV898
BALANCE TEST FULL TANDEM Compensatory

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | | |  ========================================================================
| | | | | | 
NV899
BALANCE TEST FULL TANDEM Floor Surface

@/BALANCE TEST - FULL TANDEM
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | |  ========================================================================
| | | | | | 
NV902
BALANCE TEST FULL TANDEM Compliance

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | |  If R CURRENT AGE CALCULATION (NA019) > 64 »

| | | |  ========================================================================
| | | | 
NV820
WALKING TEST COMPLETE AT LEAST ONE TRIAL

@/WALKING TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  If WALKING TEST COMPLETE AT LEAST ONE TRIAL (NV820) != 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV821
WALKING TEST REASON NOT COMPLETE

@/WALKING TEST
@/@/@S@WW@W WHY DIDN`T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  Else

| | | | |  ========================================================================
| | | | | 
NV823
T walk 1st trial time (seconds)

@/WALKING TEST - TIME FROM FIRST TRIAL
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
@/@/@UFIRST TRIAL:@U
@/@/SECOND TRIAL:
@/@/ENTER 993 IF R WAS UNABLE TO DO IT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | | |  If T walk 1st trial time (seconds) (NV823) != 993 and T walk 1st trial time (seconds) (NV823) != 999 »

| | | | | |  ========================================================================
| | | | | | 
NV824
T walk 2nd trial time (seconds)

@/WALKING TEST - TIME FROM SECOND TRIAL
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
@/@/FIRST TRIAL: T walk 1st trial time (seconds)
@/@/@USECOND TRIAL:@U
@/@/ENTER 993 IF R WAS UNABLE TO DO IT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | | | |  ========================================================================
| | | | | | 
NV825
T walk floor surface

@/WALKING TEST
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | |  ========================================================================
| | | | | | 
NV828
walking aid type

@/WALKING TEST
@/@/@S@WW@W RECORD TYPE OF AID USED@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 NONE
2 Walking stick or cane
3 Elbow crutches
4 Walking frame
7 Other (specify)


| | | | | |  ========================================================================
| | | | | | 
NV830
walk R effort

@/WALKING TEST
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | |  ========================================================================
| | | 
NV831
MEASURE R HEIGHT

@/HEIGHT
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R`S HEIGHT? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If MEASURE R HEIGHT (NV831) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV832
HEIGHT REASON NOT COMPLETE

@/HEIGHT
@/@/@S@WW@W WHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  Else

| | | |  ========================================================================
| | | | 
NV834
HEIGHT MEASURMENT (inches)

@/HEIGHT
@/@/@S@WW@W ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..99

| | | |  ========================================================================
| | | | 
NV835HEIGHTFLOORING
HEIGHT floor surface

@/HEIGHT
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | |  ========================================================================
| | | | 
NV837
HEIGHT wearing shoes

@/HEIGHT
@/@/@S@WW@W WAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  ========================================================================
| | | | 
NV903
HEIGHT wearing shoes

@/HEIGHT
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | |  If WEIGHT IN POUNDS (NC139) < 300 »

| | | |  ========================================================================
| | | | 
NV838
WEIGHT ABLE TO MEASURE

@/WEIGHT
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R`S WEIGHT? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  If WEIGHT ABLE TO MEASURE (NV838) != 1 Yes »

| | | | |  ========================================================================
| | | | | 
NV839
WEIGHT REASON NOT COMPLETE

@/WEIGHT
@/@/@S@WW@W WHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  Else

| | | | |  ========================================================================
| | | | | 
NV841
Weight Measurment (lbs)

@/WEIGHT
@/@/@S@WW@W ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

| | | | |  ========================================================================
| | | | | 
NV842
WEIGHT floor surface

@/WEIGHT
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | |  ========================================================================
| | | | | 
NV844
WEIGHT wearing shoes

@/WEIGHT
@/@/@S@WW@W WAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | |  ========================================================================
| | | | | 
NV947
WEIGHT Compliance

@/WEIGHT
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | |  ========================================================================
| | | 
NV904
WAIST Complete

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If WAIST Complete (NV904) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV905
Waist Why Not Complete

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  Else

| | | |  ========================================================================
| | | | 
NV907
Waist Measurment (inches)

@/WAIST CIRCUMFERENCE -MEASUREMENT
@/@/@S@WW@W ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.
@/@/@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..999

| | | |  If Waist Measurment (inches) (NV907) != 993 and Waist Measurment (inches) (NV907) != 999 »

| | | | |  ========================================================================
| | | | | 
NV908
Waist Difficulties

@/WAIST CIRCUMFERENCE -MEASUREMENT
@/@/@S@WW@W WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?@S
@/@S@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | | |  ========================================================================
| | | | | 
NV910
Waist Compliance

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | | |  ========================================================================
| | | | | 
NV911
Waist Who Measured

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WHO COMPLETED THE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R completed the measurement
2 IWER completed the measurement


| | | | |  ========================================================================
| | | | | 
NV912
Waist Bulky Clothes

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  ========================================================================
| | 
NV913
Saliva Consent

@/@SSALIVA SAMPLE@S
@/@/@S@WW@W DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  If Saliva Consent (NV913) = 5 No »

| | |  ========================================================================
| | | 
NV941
Why No Consent Saliva

@/@SSALIVA SAMPLE @S
@/@/@S@WW@W WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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
97 Other (specify)


| |  Else

| | |  ========================================================================
| | | 
NV915
Saliva Complete

@/SALIVA SAMPLE
@/@/@S@WW@W DID R COMPLETE THE SALIVA SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If Saliva Complete (NV915) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV916
Saliva Why Not Complete

@/SALIVA SAMPLE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  Else

| | | |  ========================================================================
| | | | 
NV918
Saliva Fill Vial

@/SALIVA SAMPLE
@/@/@S@WW@W DID R FILL THE VIAL TO THE DESIRED LEVEL?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | |  ========================================================================
| | | | 
NV919
Saliva Problems

@/SALIVA SAMPLE
@/@/@S@WW@W WHAT, IF ANY, PROBLEMS OCCURED?
@/(SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  ========================================================================
| | | | 
NV921
Saliva Compliance

@/SALIVA SAMPLE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| |  ========================================================================
| | 
NV922
BLOOD Consent

@/@SBLOOD SAMPLE@S
@/@/@S@WW@W DID R SIGN THE BLOOD SAMPLE CONSENT FORM?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| |  If BLOOD Consent (NV922) = 5 No »

| | |  ========================================================================
| | | 
NV943
Why No Consent Blood

@/@SBLOOD SAMPLE@S
@/@/@S@WW@W WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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
97 Other (specify)


| |  Else

| | |  ========================================================================
| | | 
NV923
Blood Complete

@/BLOOD SAMPLE
@/@/@S@WW@W DID R COMPLETE THE BLOOD SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | |  If Blood Complete (NV923) != 1 Yes »

| | | |  ========================================================================
| | | | 
NV924
Blood Why Not Complete

@/BLOOD SAMPLE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | |  Else

| | | |  ========================================================================
| | | | 
NV926
Blood What Problems

@/BLOOD SAMPLE
@/@/@S@WW@W WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE?
@/(SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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)


| | | |  ========================================================================
| | | | 
NV928
Blood Who Measured

@/BLOOD SAMPLE
@/@/@S@WW@W WHO PRICKED THE R'S FINGER(S)?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R pricked own finger(s)
2 IWER pricked R's finger(s)
3 Both R and Iwer pricked R

| | | |  ========================================================================
| | | | 
NV929
Blood Fill Spots

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three


| | | |  ========================================================================
| | | | 
NV945
Blood Fill Spots

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three


| | | |  ========================================================================
| | | | 
NV930
Blood Pricks

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY TIMES DID THE R'S FINGER HAVE TO BE PRICKED IN ORDER TO FILL THE CARDS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 One time
2 Two times
3 Two times but the R was unable to fill all of the collection areas


| | | |  ========================================================================
| | | | 
NV931
Blood Compliance

@/BLOOD SAMPLE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


End of I. Physical Measures