I. Physical Measures
I. Physical Measures module of HRS 2014
Start of I. Physical Measures
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OI800
MODE OF INTERVIEW FOR PHYSICAL MEASURES
@/@S ENTER CURRENT MODE OF INTERVIEW@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Phone
2 F-t-f
@/@S ENTER CURRENT MODE OF INTERVIEW@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Phone
2 F-t-f
If OX090_R = ENHANCEDFTF »
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If MODE OF INTERVIEW FOR PHYSICAL MEASURES (OI800) = 2 F-t-f and R IN NURSING HOME (OA028) = NO and LANGUAGE = SPANISH or ENGLISH »
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OI802
Physical Measures Consent
@/@SDID R SIGN THE PHYSICAL MEASURES CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SDID R SIGN THE PHYSICAL MEASURES CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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If Physical Measures Consent (OI802) = 1 Yes »
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OI854
Blood Pressure Complete
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NO@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NO@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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If Blood Pressure Complete (OI854) = 5 No »
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OI855
Reason Blood Pressure Not Complete
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NO@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT?@S
@/@/@|@S@WW@W ENTER 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, a cast, edema, open sores or wounds, or significant bruise where the blood cuff would contact R's arm
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NO@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT?@S
@/@/@|@S@WW@W ENTER 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, a cast, edema, open sores or wounds, or significant bruise where the blood cuff would contact R's arm
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
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ElseIf Blood Pressure Complete (OI854) = 1 Yes »
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OI857
Blood Pressure 1 Time
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NJ@N OF @NM@N@D -- OBS@S
@/@/@|@S@WW@W INSTRUCT THE R TO REMAIN STILL.@S
@/@/@|@S@WW@W PRESS THE START/STOP BUTTON AND RECORD MEASUREMENTS@S
@/@/@S@DFIRST@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NJ@N OF @NM@N@D -- OBS@S
@/@/@|@S@WW@W INSTRUCT THE R TO REMAIN STILL.@S
@/@/@|@S@WW@W PRESS THE START/STOP BUTTON AND RECORD MEASUREMENTS@S
@/@/@S@DFIRST@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
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OI859
Blood Pressure 1 Systolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
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If Blood Pressure 1 Systolic (mmHg) (OI859) != 9993 and Blood Pressure 1 Systolic (mmHg) (OI859) != 999 »
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OI860
Blood Pressure 1 Diastolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DDIASTOLIC@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DDIASTOLIC@D@S
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OI861
Blood Pressure 1 Pulse (bpm)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DPULSE@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 1: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DFIRST@D READING - @DPULSE@D@S
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OI862
Blood Pressure 2 Time
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NJ@N OF @NM@N@D -- OBS@S
@/@/@SENSURE THAT YOU'VE ALLOWED 45 SECONDS TO ELAPSE SINCE FIRST MEASUREMENT.@S
@/@/@S@DSECOND@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NJ@N OF @NM@N@D -- OBS@S
@/@/@SENSURE THAT YOU'VE ALLOWED 45 SECONDS TO ELAPSE SINCE FIRST MEASUREMENT.@S
@/@/@S@DSECOND@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
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OI864
Blood Pressure 2 Systolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
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If Blood Pressure 2 Systolic (mmHg) (OI864) != 9993 and Blood Pressure 2 Systolic (mmHg) (OI864) != 999 »
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OI865
Blood Pressure 2 Diastolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DDIASTOLIC@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DDIASTOLIC@D@S
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OI866
Blood Pressure 2 Pulse (bpm)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DPULSE@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 2: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DSECOND@D READING - @DPULSE@D@S
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OI867
Blood Pressure 3 Time
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NJ@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NJ@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DTIME@D OF READING@S
@/@/@|@S@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'.@S
@/@/@|@S@WW@W PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
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OI869
Blood Pressure 3 Systolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DSYSTOLIC@D@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT OR IF AN UNRESOLVABLE EQUIPMENT PROBLEM OCCURS.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
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If Blood Pressure 3 Systolic (mmHg) (OI869) != 9993 and Blood Pressure 3 Systolic (mmHg) (OI869) != 999 »
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OI870
Blood Pressure 3 Diastolic (mmHg)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DDIASTOLIC@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NL@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DDIASTOLIC@D@S
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OI871
Blood Pressure 3 Pulse (bpm)
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DPULSE@D@S
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE 3: @NM@N OF @NM@N@D -- OBS@S
@/@/@S@DTHIRD@D READING - @DPULSE@D@S
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OI872
Blood Pressure Arm
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NO@N@D@S
@/@/@SWHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Left arm
2 Right arm
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NO@N@D@S
@/@/@SWHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Left arm
2 Right arm
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OI874
Blood Pressure Position
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NO@N@D@S
@/@/@SWHAT WAS R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
@/@SBLOOD PRESSURE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NO@N@D@S
@/@/@SWHAT WAS R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
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OI804
Breath Complete at east One Trial
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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If Breath Complete at east One Trial (OI804) != 1 Yes »
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OI805
Breath Test Reason Not Complete
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BREATHING TEST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BREATHING TEST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
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If Breath Complete at east One Trial (OI804) = 1 Yes »
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OI807
Puff Test 1 (L/min)
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NN@N@D -- OBS@S
@/@/@|@S@DFIRST@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IF READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IF READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NN@N@D -- OBS@S
@/@/@|@S@DFIRST@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IF READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IF READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
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OI808
Puff Test 2 (L/min)
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NN@N@D -- OBS@S
@/@/@|@S@DSECOND@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IS READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IS READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NN@N@D -- OBS@S
@/@/@|@S@DSECOND@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IS READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IS READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
| | | | ========================================================================
| | | |
OI809
Puff Test 3 (L/min)
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NN@N OF @NN@N@D -- OBS@S
@/@/@|@S@DTHIRD@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IS READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IS READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
@/@SBREATHING TEST@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NN@N OF @NN@N@D -- OBS@S
@/@/@|@S@DTHIRD@D READING - RECORD TO THE NEAREST 10 L/MIN@S
@/@/@|@S@WW@W ENTER [30] IS READING IS LESS THAN 60.@S
@/@/@|@S@WW@W ENTER [890] IS READING IS PAST LAST TICK MARK.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
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| | | |
OI810
R Breathing Test Effort
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SHOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R gave full effort
2 R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3 R did not appear to give full effort, but no obvious reason for this
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SHOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R gave full effort
2 R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3 R did not appear to give full effort, but no obvious reason for this
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| | | |
OI811
Breathing Test R position
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SWHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
@/@SBREATHING TEST@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SWHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
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| | |
OI812
HAND STRENGTH COMPLETE AT LEAST ONE TRIAL
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (OI812) != 1 Yes »
| | | | ========================================================================
| | | |
OI813
Hand Strength TEST REASON NOT COMPLETE
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE HAND STRENGTH TEST?@S
@/@/@|@S@WW@W ENTER 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, swelling, etc. on both hands
97 Other (specify)
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE HAND STRENGTH TEST?@S
@/@/@|@S@WW@W ENTER 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, swelling, etc. on both hands
97 Other (specify)
| | |
Else If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (OI812) = 1 Yes »
| | | | ========================================================================
| | | |
OI815
Grip dominant hand
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- @DSETUP @NJ@N OF @NK@N@D -- MEASURE -- OBS@S
@/@/WHICH IS YOUR DOMINANT HAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Right hand
2 Left hand
3 Both hands equally dominant
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- @DSETUP @NJ@N OF @NK@N@D -- MEASURE -- OBS@S
@/@/WHICH IS YOUR DOMINANT HAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Right hand
2 Left hand
3 Both hands equally dominant
| | | | ========================================================================
| | | |
OI816
left first (kg)
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DREMEMBER:@D RESET THE GAUGE BETWEEN MEASURES.@S
@/@/@|@S@D LEFT HAND, FIRST MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DREMEMBER:@D RESET THE GAUGE BETWEEN MEASURES.@S
@/@/@|@S@D LEFT HAND, FIRST MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | ========================================================================
| | | |
OI851
right first (kg)
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DREMEMBER:@D RESET THE GAUGE BETWEEN MEASURES.@S
@/@/@|@S@D RIGHT HAND, FIRST MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NM@N@D -- OBS@S
@/@/@S@DREMEMBER:@D RESET THE GAUGE BETWEEN MEASURES.@S
@/@/@|@S@D RIGHT HAND, FIRST MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | ========================================================================
| | | |
OI852
left second(kg)
@/@SHAND STRENGTH@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NM@N@D -- OBS@S
@/@/@|@S@D LEFT HAND, SECOND MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SHAND STRENGTH@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NM@N@D -- OBS@S
@/@/@|@S@D LEFT HAND, SECOND MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | ========================================================================
| | | |
OI853
right second (kg)
@/@SHAND STRENGTH@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NM@N OF @NM@N@D -- OBS@S
@/@/@|@S@D RIGHT HAND, SECOND MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SHAND STRENGTH@S
@/@SINTRODUCTION -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NM@N OF @NM@N@D -- OBS@S
@/@/@|@S@D RIGHT HAND, SECOND MEASUREMENT:@D@S
@/@/@|@S@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO PERFORM THIS MEASUREMENT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | ========================================================================
| | | |
OI817
Grip R Effort
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NN@N@D@S
@/@/@SHOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R gave full effort
2 R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3 R did not appear to give full effort, but no obvious reason for this
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NN@N@D@S
@/@/@SHOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R gave full effort
2 R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3 R did not appear to give full effort, but no obvious reason for this
| | | | ========================================================================
| | | |
OI818
Hand Strength TEST R POSITION
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SWHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SWHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
| | | | ========================================================================
| | | |
OI819
Hand Strength rest arm
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SDID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Both hands
2 Left hand only
3 Right hand only
5 No
@/@SHAND STRENGTH@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SDID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Both hands
2 Left hand only
3 Right hand only
5 No
| | | ========================================================================
| | |
OI876
Balance Test Semi-Tandem Stand
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If Balance Test Semi-Tandem Stand (OI876) != 1 Yes »
| | | | ========================================================================
| | | |
OI877
Balance Test Semi-Tandem Reason Not Complete
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE SEMI-TANDEM STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE SEMI-TANDEM STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
| | |
ElseIf Balance Test Semi-Tandem Stand (OI876) = 1 Yes »
| | | | ========================================================================
| | | |
OI879
Balance Test Semi-Tandem Hold Full Time
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | |
If Balance Test Semi-Tandem Hold Full Time (OI879) = 1 Yes »
| | | | | ========================================================================
| | | | |
OI880
Balance Test Semi-Tandem Time
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@SRECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@SRECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | |
If Balance Test Semi-Tandem Hold Full Time (OI879) != 999 and Balance Test Semi-Tandem Hold Full Time (OI879) != 993 »
| | | | | ========================================================================
| | | | |
OI881
Balance Test Semi-Tandem Compensatory
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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
@/@SBALANCE TEST: SEMI-TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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 (OI876) = 5 No or Balance Test Semi-Tandem Hold Full Time (OI879) != 1 Yes »
| | | | ========================================================================
| | | |
OI883
BALANCE TEST S-B-S Complete
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE SIDE-BY-SIDE STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE SIDE-BY-SIDE STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | |
If BALANCE TEST S-B-S Complete (OI883) != 1 Yes »
| | | | | ========================================================================
| | | | |
OI884
BALANCE TEST S-B-S STAND REASON NOT COMPLETE
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE SIDE-BY-SIDE STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE SIDE-BY-SIDE STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
| | | |
ElseIf BALANCE TEST S-B-S Complete (OI883) = 1 Yes »
| | | | | ========================================================================
| | | | |
OI886
BALANCE TEST S-B-S Hold Full Time
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID 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
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID 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
| | | | |
If BALANCE TEST S-B-S Hold Full Time (OI886) = 1 Yes »
| | | | | | ========================================================================
| | | | | |
OI887
BALANCE TEST SIDE-BY-SIDE Time
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | |
If BALANCE TEST S-B-S Hold Full Time (OI886) != 993 and BALANCE TEST S-B-S Hold Full Time (OI886) != 999 »
| | | | | | ========================================================================
| | | | | |
OI888
BALANCE TEST SIDE-BY-SIDE Compensatory
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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
@/@SBALANCE TEST: SIDE-BY-SIDE STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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
| | |
Else
| | | | ========================================================================
| | | |
OI893
BALANCE TEST FULL TANDEM STAND Complete
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE FULL TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@SDID R ATTEMPT TO COMPLETE THE FULL TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | |
If BALANCE TEST FULL TANDEM STAND Complete (OI893) != 1 Yes »
| | | | | ========================================================================
| | | | |
OI894
BALANCE TEST FULL TANDEM STAND REASON NOT Complete
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE FULL-TANDEM STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NL@N@D@S
@/@/@SWHY DIDN'T R ATTEMPT TO COMPLETE THE FULL-TANDEM STAND?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has surgery, injury, or other health condition that prevented R from standing
97 Other (specify)
| | | |
Else
| | | | | ========================================================================
| | | | |
OI896
BALANCE TEST FULL TANDEM STAND Hold Full Time
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID R HOLD FULL TANDEM STAND FOR FULL @D30@D SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NJ@N OF @NL@N@D -- OBS@S
@/@/@SDID R HOLD FULL TANDEM STAND FOR FULL @D30@D SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | | |
If BALANCE TEST FULL TANDEM STAND Hold Full Time (OI896) = 1 Yes and R CURRENT AGE CALCULATION (OA019) > 70 »
| | | | | | ========================================================================
| | | | | |
OI897
BALANCE TEST FULL TANDEM STAND Time
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | |
If BALANCE TEST FULL TANDEM STAND Hold Full Time (OI896) != 993 and BALANCE TEST FULL TANDEM STAND Hold Full Time (OI896) != 999 »
| | | | | | ========================================================================
| | | | | |
OI898
BALANCE TEST FULL TANDEM STAND Compensatory
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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
@/@SBALANCE TEST: FULL TANDEM STAND@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NL@N@D@S
@/@/@SDID 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
| | |
If R CURRENT AGE CALCULATION (OA019) > 64 »
| | | | ========================================================================
| | | |
OI820
Walking Speed Complete at Least One Trial
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NP@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NP@N@D@S
@/@/@SDID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | |
If Walking Speed Complete at Least One Trial (OI820) != 1 Yes »
| | | | | ========================================================================
| | | | |
OI821
Walking Speed Reason Not Complete
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NP@N@D@S
@/@/@SWHY DIDN`T R COMPLETE THE WALKING TEST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NP@N@D@S
@/@/@SWHY DIDN`T R COMPLETE THE WALKING TEST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
| | | |
Else
| | | | | ========================================================================
| | | | |
OI823
T walk trial time (seconds)
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@S@DTIME@D FROM @DFIRST@D TRIAL@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO DO IT@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NK@N OF @NL@N@D -- OBS@S
@/@/@S@DTIME@D FROM @DFIRST@D TRIAL@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO DO IT@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | |
If T walk trial time (seconds) (OI823) != 993 and T walk trial time (seconds) (OI823) != 999 »
| | | | | | ========================================================================
| | | | | |
OI824
T walk trial time (seconds)
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@S@DTIME@D FROM @DSECOND@D TRIAL@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO DO IT@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- @DMEASURE @NL@N OF @NL@N@D -- OBS@S
@/@/@S@DTIME@D FROM @DSECOND@D TRIAL@S
@/@/@|@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
@/@/@|@S@WW@W ENTER [993] IF R WAS UNABLE TO DO IT@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | | | ========================================================================
| | | | | |
OI828
Walking Aid Type
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NP@N@D@S
@/@/@SWHAT TYPE OF AID WAS USED?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 Walking stick or cane
3 Elbow crutches
4 Walking frame
7 Other (specify)
@/@SWALKING SPEED@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NP@N@D@S
@/@/@SWHAT TYPE OF AID WAS USED?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 Walking stick or cane
3 Elbow crutches
4 Walking frame
7 Other (specify)
| | | ========================================================================
| | |
OI831
Measure R Height
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R`S HEIGHT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NN@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R`S HEIGHT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If Measure R Height (OI831) != 1 Yes »
| | | | ========================================================================
| | | |
OI832
Height Reason Not Complete
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT?@S
@/@/@|@S@WW@W ENTER 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 Respondent too tall, interviewer could not reach
7 No suitable space available
97 Other (specify)
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NN@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT?@S
@/@/@|@S@WW@W ENTER 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 Respondent too tall, interviewer could not reach
7 No suitable space available
97 Other (specify)
| | |
Else
| | | | ========================================================================
| | | |
OI834
Height Measurement (inches)
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..99
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NN@N@D@S
@/@/@SENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..99
| | | | ========================================================================
| | | |
OI837
Height wearing shoes
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SWAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SHEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NN@N@D@S
@/@/@SWAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If WEIGHT IN POUNDS (OC139) < 300 »
| | | | ========================================================================
| | | |
OI838
Weight able to Measure
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NQ@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R`S WEIGHT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NQ@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R`S WEIGHT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | |
If Weight able to Measure (OI838) != 1 Yes »
| | | | | ========================================================================
| | | | |
OI839
Weight Reason Not Complete
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT?@S
@/@/@|@S@WW@W ENTER 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 Respondent was too heavy; did not attempt
7 No suitable space available
8 Scale did not work
97 Other (specify)
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT?@S
@/@/@|@S@WW@W ENTER 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 Respondent was too heavy; did not attempt
7 No suitable space available
8 Scale did not work
97 Other (specify)
| | | |
Else
| | | | | ========================================================================
| | | | |
OI841
Weight Measurement (lbs)
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NQ@N@D@S
@/@/@SENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 0.5 POUND). @S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT RECEIVED AN ERROR MESSAGE.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NQ@N@D@S
@/@/@SENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 0.5 POUND). @S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT RECEIVED AN ERROR MESSAGE.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
| | | | | ========================================================================
| | | | |
OI842
Weight floor surface
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NQ@N@D@S
@/@/@SRECORD TYPE OF FLOOR SURFACE@S
@/@/@|@S@WW@W IF YOU USED THE SUPPORT TILE, PLEASE RECORD THE SURFACE ON WHICH THE TILE WAS PLACED.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NQ@N@D@S
@/@/@SRECORD TYPE OF FLOOR SURFACE@S
@/@/@|@S@WW@W IF YOU USED THE SUPPORT TILE, PLEASE RECORD THE SURFACE ON WHICH THE TILE WAS PLACED.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)
| | | | | ========================================================================
| | | | |
OI844
Weight Wearing Shoes
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NQ@N@D@S
@/@/@SWAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SWEIGHT@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NQ@N@D@S
@/@/@SWAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | | ========================================================================
| | |
OI904
WAIST Complete
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NQ@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NQ@N@D@S
@/@/@SWERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If WAIST Complete (OI904) != 1 Yes »
| | | | ========================================================================
| | | |
OI905
Waist Why Not Complete
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R'S WAIST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY WEREN'T YOU ABLE TO MEASURE R'S WAIST?@S
@/@/@|@S@WW@W ENTER 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
97 Other (specify)
| | |
Else
| | | | ========================================================================
| | | |
OI907
Waist Measurement (inches)
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NQ@N@D@S
@/@/@SENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..999
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NQ@N@D@S
@/@/@SENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.@S
@/@/@|@S@WW@W ENTER [993] IF R TRIED BUT WAS UNABLE TO DO IT.@S
@/@/@|@S@WW@W ENTER [999] IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..999
| | | |
If Waist Measurement (inches) (OI907) != 993 and Waist Measurement (inches) (OI907) != 999 »
| | | | | ========================================================================
| | | | |
OI908
Waist Difficulties
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NQ@N@D@S
@/@/@SWHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?@S
@/@/@|@S@WW@W ENTER 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)
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NQ@N@D@S
@/@/@SWHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?@S
@/@/@|@S@WW@W ENTER 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)
| | | | | ========================================================================
| | | | |
OI911
Waist Who Measured
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NQ@N@D@S
@/@/@SWHO COMPLETED THE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R completed the measurement
2 IWER completed the measurement
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NQ@N@D@S
@/@/@SWHO COMPLETED THE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R completed the measurement
2 IWER completed the measurement
| | | | | ========================================================================
| | | | |
OI912
Waist Bulky Clothes
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NQ@N@D@S
@/@/@SWAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SWAIST CIRCUMFERENCE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NQ@N@D@S
@/@/@SWAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | ========================================================================
| |
OI913
Saliva Consent
@/@SSALIVA SAMPLE@S
@/@S@DINTRO @NK@N OF @NK@N@D -- DEMO -- SAFETY -- SETUP -- MEASURE -- OBS@S
@/@/@SDID R SIGN THE SALIVA CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SSALIVA SAMPLE@S
@/@S@DINTRO @NK@N OF @NK@N@D -- DEMO -- SAFETY -- SETUP -- MEASURE -- OBS@S
@/@/@SDID R SIGN THE SALIVA CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| |
If Saliva Consent (OI913) = 5 No »
| | | ========================================================================
| | |
OI941
Why No Consent Saliva
@/@SSALIVA SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY DIDN'T R SIGN THE SALIVA CONSENT FORM?@S
@/@/@|@S@WW@W ENTER 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
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
9 Problem with equipment or supplies
97 Other (specify)
@/@SSALIVA SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NP@N OF @NQ@N@D@S
@/@/@SWHY DIDN'T R SIGN THE SALIVA CONSENT FORM?@S
@/@/@|@S@WW@W ENTER 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
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
9 Problem with equipment or supplies
97 Other (specify)
| |
Else
| | | ========================================================================
| | |
If Saliva Complete (OI915) != 1 Yes »
| | | | ========================================================================
| | | |
OI916
Saliva Why Not Complete
@/@SSALIVA SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NQ@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE SALIVA SAMPLE?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
8 Problem with equipment or supplies
97 Other (specify)
@/@SSALIVA SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NN@N OF @NQ@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE SALIVA SAMPLE?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
8 Problem with equipment or supplies
97 Other (specify)
| | |
Else
| | | | ========================================================================
| | | | ========================================================================
| | | |
OI919
Saliva Problems
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 Solution in cover leaked before vial was sealed
3 Saliva spilled
4 R was unable to produce enough saliva
97 Other (specify)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 Solution in cover leaked before vial was sealed
3 Saliva spilled
4 R was unable to produce enough saliva
97 Other (specify)
| | ========================================================================
| |
OI922
BLOOD Consent
@/@SBLOOD SAMPLE@S
@/@S@DINTRO @NK@N OF @NL@N@D -- DEMO -- SAFETY -- SETUP -- MEASURE -- OBS@S
@/@/@SDID R SIGN THE BLOOD SPOT CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBLOOD SAMPLE@S
@/@S@DINTRO @NK@N OF @NL@N@D -- DEMO -- SAFETY -- SETUP -- MEASURE -- OBS@S
@/@/@SDID R SIGN THE BLOOD SPOT CONSENT FORM?@S
@/@/@SIF YES, THE CONSENT WAS NOT PROPERLY SAVED. TO RE-LAUNCH AND RE-SIGN:@S
@/@/@|@S 1) ENTER [1] YES@S
@/@|@S 2) CLICK THE
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| |
If BLOOD Consent (OI922) = 5 No »
| | | ========================================================================
| | |
OI943
Why No Consent Blood
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NR@N@D@S
@/@/@SWHY DIDN'T R SIGN THE BLOOD CONSENT FORM?@S
@/@/@|@S@WW@W ENTER 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
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
9 Problem with equipment or supplies
97 Other (specify)
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NO@N OF @NR@N@D@S
@/@/@SWHY DIDN'T R SIGN THE BLOOD CONSENT FORM?@S
@/@/@|@S@WW@W ENTER 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
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
9 Problem with equipment or supplies
97 Other (specify)
| |
Else
| | | ========================================================================
| | |
OI923
Blood Complete
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NR@N@D@S
@/@/@SDID R ATTEMPT TO COMPLETE THE BLOOD SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NL@N OF @NR@N@D@S
@/@/@SDID R ATTEMPT TO COMPLETE THE BLOOD SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| | |
If Blood Complete (OI923) != 1 Yes »
| | | | ========================================================================
| | | |
OI924
Blood Why Not Complete
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NQ@N OF @NR@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BLOOD SAMPLE?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
8 Problem with equipment or supplies
97 Other (specify)
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NQ@N OF @NR@N@D@S
@/@/@SWHY DIDN'T R COMPLETE THE BLOOD SAMPLE?@S
@/@/@|@S@WW@W ENTER 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
5 R did not understand the instructions
6 R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
8 Problem with equipment or supplies
97 Other (specify)
| | |
Else
| | | | ========================================================================
| | | |
OI926
Blood What Problems
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NR@N@D@S
@/@/@SWHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE?@S
@/@/@|@S@WW@W ENTER ALL THAT APPLY.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 R became lightheaded, fainted, or became nauseous
3 R had difficulty getting finger to stop bleeding
97 Other (specify)
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NM@N OF @NR@N@D@S
@/@/@SWHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE?@S
@/@/@|@S@WW@W ENTER ALL THAT APPLY.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 R became lightheaded, fainted, or became nauseous
3 R had difficulty getting finger to stop bleeding
97 Other (specify)
| | | | ========================================================================
| | | |
OI929
Blood Fill Spots Card 1
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NR@N@D@S
@/@/@SHOW MANY CIRCLES WERE FILLED ON THE @UFIRST@U CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
4 Four
5 Five
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NJ@N OF @NR@N@D@S
@/@/@SHOW MANY CIRCLES WERE FILLED ON THE @UFIRST@U CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
4 Four
5 Five
| | | | ========================================================================
| | | |
OI945
Blood Fill Spots Card 2
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NR@N@D@S
@/@/@SHOW MANY CIRCLES WERE FILLED ON THE @USTORAGE@U CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
4 Four
5 Five
@/@SBLOOD SAMPLE@S
@/@SINTRO -- DEMO -- SAFETY -- SETUP -- MEASURE -- @DOBS @NK@N OF @NR@N@D@S
@/@/@SHOW MANY CIRCLES WERE FILLED ON THE @USTORAGE@U CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
4 Four
5 Five
End of I. Physical Measures