Section H: Medical History and Conditions

Section H: Medical History and Conditions Module of 2003 Mail Survey On Diabetes

Label Type Description
H1A Question During the past 4 weeks, how often have you felt short of breath: (Circle one answer for each line.) When lying down flat
H1B Question When sitting, resting
H1C Question When walking less than one block
H1D Question When climbing one flight of stairs
H1E Question When climbing several flights of stairs
H2A Question In the past 12 months, have you been told by a doctor that you have any of the following problems related to your heart or circulation: (Circle one answer for each line.) Heart attack or previous heart attack
H2B Question Congestive heart failure
H2C Question Angina
H2D Question Stroke or previous stroke
H2E Question Transient ischemic attacks (TIA or "mini-strokes")
H3A Question In the past 12 months, have you had any of the following operations or procedures related to your heart: (Circle one answer for each line.) Coronary artery bypass surgery (open heart surgery) (qxh3a)
H3B Question Coronary angioplasty
H3C Question Heart catherization (angiogram)
H3D Question Exercise test (stress test)
H3E Question Pacemaker insertion
H4A Question In the past 12 months, how many times have you had any of the following problems related to your heart or circulation: (Circle one answer for each line.) Chest pain or pressure when you exercise
H4B Question Chest pain or pressure when resting
H4C Question Ankles or legs that swell as the day goes on
H4D Question Fainting or dizziness when you stand up
H5 Question Have you been told by a doctor to take aspirin on a daily basis? (Mark one.)
H6 Question Do you usually take aspirin each day?
H7A Question Have you ever been told by a doctor that you have any of the following: (Circle one answer for each line.) Kidney failure
H7B Question Protein in your urine
H8A Question Have you ever had: (Circle one answer for each line.) Kidney dialysis
H8B Question Kidney transplant
H9A Question During the past 12 months, how often have you had any of the following problems with your legs and feet: (Circle one answer for each line.) Numbness or loss of feeling in your feet
H9B Question Tingling or burning sensation in your feet, especially at night
H9C Question Decreased ability to feel hot or cold with your hands or feet
H9D Question Sores, infections or ulcers on your feet that did not heal
H10A Question Have you ever had an amputation of a toe, foot, part, or all of a leg for a poorly healing sore or poor circulation? (Circle one answer for each line.) Toe(s)
H10B Question Part of a foot (or feet)
H10C Question Leg, below the knee
H10D Question Leg, above the knee
H11 Question Have you ever had diabetic eye disease or laser surgery on your eyes (for your diabetes)?
H12 Question How would you rate your vision (using your glasses or contacts, if you wear them)? (Mark one.)
H13 Question Has a doctor or nurse ever told you that you have high blood pressure?
H14 Question How many years ago were you first told that you have high blood pressure?
H15 Question Do you now take medication for your high blood pressure?
H16 Question When was your last blood pressure reading? .D Uncertain, can't say
H17 Question At that time, what was your blood pressure? (Example: 130/85: 130 is systolic, 85 is diastolic) .D Uncertain, can't say
H18 Question Do you have a goal or target for what you would like your blood pressure to be at or below?
H19 Question What is your goal for your blood pressure? (Example: 130/85: 130 is systolic, 85 is diastolic)
H20 Question Has a doctor or nurse ever told you that you have high cholesterol?
H21 Question How many years ago were you first told that you have high cholesterol?
H22 Question Do you now take medication for your high cholesterol?
H23 Question When was your last cholesterol reading?