C1. Health Status
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Module C1. Health Status of survey KLoSAW5
Start of C1. Health Status
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C001
Next I have some questions about your health. Would you say your health is excellent, very good, good, fair, or poor?
NEXT I HAVE SOME QUESTIONS ABOUT YOUR HEALTH. WOULD YOU SAY YOUR HEALTH IS EXCELLENT, VERY GOOD, GOOD, FAIR, OR POOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
NEXT I HAVE SOME QUESTIONS ABOUT YOUR HEALTH. WOULD YOU SAY YOUR HEALTH IS EXCELLENT, VERY GOOD, GOOD, FAIR, OR POOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
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C159
I have some questions about your health. How do you appreciate your health?
I HAVE SOME QUESTIONS ABOUT YOUR HEALTH. HOW DO YOU APPRECIATE YOUR HEALTH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Excellent
2 Very good
3 Good
4 Average
5 Bad
I HAVE SOME QUESTIONS ABOUT YOUR HEALTH. HOW DO YOU APPRECIATE YOUR HEALTH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Excellent
2 Very good
3 Good
4 Average
5 Bad
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C002
How has your health status changed since the previous interview (____year__month__date)?
HOW HAS YOUR HEALTH STATUS CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Greatly improved
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAS YOUR HEALTH STATUS CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Greatly improved
2 Improved
3 Same
4 Worsened
5 Greatly worsened
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C003
Have you ever received a disability diagnosis from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DISABILITY DIAGNOSIS FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes, received a disability diagnosis
5 No, haven't received a disability diagnosis
HAVE YOU EVER RECEIVED A DISABILITY DIAGNOSIS FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes, received a disability diagnosis
5 No, haven't received a disability diagnosis
If Have you ever received a disability diagnosis from a doctor since the previous interview (____year__month__date)? (C003) = 1 Yes, received a disability diagnosis
5 No, haven't received a disability diagnosis
»
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C004
What was your type of disability? Please choose all that apply.
WHAT WAS YOUR TYPE OF DISABILITY? PLEASE CHOOSE ALL THAT APPLY.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Physical disability
2 Disability of brain lesion
3 Visual disability
4 Hearing disability
5 Speech disability
6 Kidney dysfunction
7 Cardiac dysfunction
8 Mental disorder
9 Others
WHAT WAS YOUR TYPE OF DISABILITY? PLEASE CHOOSE ALL THAT APPLY.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Physical disability
2 Disability of brain lesion
3 Visual disability
4 Hearing disability
5 Speech disability
6 Kidney dysfunction
7 Cardiac dysfunction
8 Mental disorder
9 Others
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C005
Does your health condition hamper you doing work?
DOES YOUR HEALTH CONDITION HAMPER YOU DOING WORK?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes, very much so
2 Yes, to some degree
3 No, not much
4 No, not at all
DOES YOUR HEALTH CONDITION HAMPER YOU DOING WORK?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes, very much so
2 Yes, to some degree
3 No, not much
4 No, not at all
If R DID NOT RECEIVE HIGH BP ON PREV INTERVIEW or DK or RF »
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C006
Have you ever received a diagnosis of high blood pressure from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF HIGH BLOOD PRESSURE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF HIGH BLOOD PRESSURE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of high blood pressure from a doctor since the previous interview (____year__month__date)? (C006) = 1 Yes
5 No
»
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C007
When were you first diagnosed with hypertension? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH HYPERTENSION? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH HYPERTENSION? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
Else
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C008
How have your symptoms of high blood pressure changed since the previous inrerview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF HIGH BLOOD PRESSURE CHANGED SINCE THE PREVIOUS INRERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF HIGH BLOOD PRESSURE CHANGED SINCE THE PREVIOUS INRERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
If Have you ever received a diagnosis of high blood pressure from a doctor since the previous interview (____year__month__date)? (C006) != 5 »
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C009
Are you currently taking any medication or receiving treatment to lower your blood pressure?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT TO LOWER YOUR BLOOD PRESSURE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT TO LOWER YOUR BLOOD PRESSURE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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C010
Does your high blood pressure limit your daily activities?
DOES YOUR HIGH BLOOD PRESSURE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR HIGH BLOOD PRESSURE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
Else
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C011
Have you ever received a diagnosis of diabetes or high blood sugar from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF DIABETES OR HIGH BLOOD SUGAR FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF DIABETES OR HIGH BLOOD SUGAR FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of diabetes or high blood sugar from a doctor since the previous interview (____year__month__date)? (C011) = 1 Yes
5 No
»
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C012
When were you first diagnosed with diabetes or high blood sugar? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH DIABETES OR HIGH BLOOD SUGAR? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH DIABETES OR HIGH BLOOD SUGAR? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of diabetes or high blood sugar from a doctor since the previous interview (____year__month__date)? (C011) != 5 »
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C013
How have your symptoms of diabetes or high blood sugar changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF DIABETES OR HIGH BLOOD SUGAR CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF DIABETES OR HIGH BLOOD SUGAR CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
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C014
Are you currently taking any medication or receiving treatment to treat your diabetes or stabilize your blood sugar level?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT TO TREAT YOUR DIABETES OR STABILIZE YOUR BLOOD SUGAR LEVEL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT TO TREAT YOUR DIABETES OR STABILIZE YOUR BLOOD SUGAR LEVEL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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C015
Does your diabetes limit your daily activities?
DOES YOUR DIABETES LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR DIABETES LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DID NOT RECEIVE HIGH BP or DK or RF ON PREV INTERVIEW »
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C016
Have you ever received a diagnosis of cancer or a malignant tumor (excluding minor skin cancer) from a doctor since the previous interview (____year__month__day)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CANCER OR A MALIGNANT TUMOR (EXCLUDING MINOR SKIN CANCER) FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CANCER OR A MALIGNANT TUMOR (EXCLUDING MINOR SKIN CANCER) FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of cancer or a malignant tumor (excluding minor skin cancer) from a doctor since the previous interview (____year__month__day)? (C016) = 1 Yes
5 No
»
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C017
When were you first diagnosed with cancer or a malignant tumor, excluding minor skin cancer? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH CANCER OR A MALIGNANT TUMOR, EXCLUDING MINOR SKIN CANCER? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH CANCER OR A MALIGNANT TUMOR, EXCLUDING MINOR SKIN CANCER? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
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C018
In which organ or part of your body do you have cancer?
IN WHICH ORGAN OR PART OF YOUR BODY DO YOU HAVE CANCER?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Liver
2 Stomach
3 Lung
4 Colon
5 Thyroid
6 Breast
7 Cervix
8 Ovary
9 Prostate
10 Others
IN WHICH ORGAN OR PART OF YOUR BODY DO YOU HAVE CANCER?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Liver
2 Stomach
3 Lung
4 Colon
5 Thyroid
6 Breast
7 Cervix
8 Ovary
9 Prostate
10 Others
| |
If In which organ or part of your body do you have cancer? (C018) = 9 »
| | | ========================================================================
Else
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C020
How have your symptoms of cancer or malignant tumor (excluding minor skin cancer) changed since the previous interview (____year__month__day)?
HOW HAVE YOUR SYMPTOMS OF CANCER OR MALIGNANT TUMOR (EXCLUDING MINOR SKIN CANCER) CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF CANCER OR MALIGNANT TUMOR (EXCLUDING MINOR SKIN CANCER) CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
If Have you ever received a diagnosis of cancer or a malignant tumor (excluding minor skin cancer) from a doctor since the previous interview (____year__month__day)? (C016) != 5 »
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C021
Are you currently taking any medication to alleviate your symptoms (pain, nausea, rash, etc.) or receiving cancer treatment such as chemotherapy?
ARE YOU CURRENTLY TAKING ANY MEDICATION TO ALLEVIATE YOUR SYMPTOMS (PAIN, NAUSEA, RASH, ETC.) OR RECEIVING CANCER TREATMENT SUCH AS CHEMOTHERAPY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION TO ALLEVIATE YOUR SYMPTOMS (PAIN, NAUSEA, RASH, ETC.) OR RECEIVING CANCER TREATMENT SUCH AS CHEMOTHERAPY?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
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C022
Does your cancer limit your daily activities?
DOES YOUR CANCER LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR CANCER LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DID NOT RECEIVE DIAGNOSIS OF CHRONIC LUNG DISEASE or DK or RF = PREV INTERVIEW »
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C023
Have you ever received a diagnosis of chronic lung disease, such as bronchitis or emphysema, from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA, FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA, FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of chronic lung disease, such as bronchitis or emphysema, from a doctor since the previous interview (____year__month__date)? (C023) = 1 Yes
5 No
»
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C024
When were you first diagnosed with chronic lung disease, such as bronchitis or emphysema? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of chronic lung disease, such as bronchitis or emphysema, from a doctor since the previous interview (____year__month__date)? (C023) != 5 and When were you first diagnosed with chronic lung disease, such as bronchitis or emphysema? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.] (C024) !was answered »
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|
C025
How have your symptoms of chronic lung disease, such as bronchitis or emphysema, changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA, CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF CHRONIC LUNG DISEASE, SUCH AS BRONCHITIS OR EMPHYSEMA, CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C026
Are you currently taking any medication or receiving treatment in relation to your lung disease?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT IN RELATION TO YOUR LUNG DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT IN RELATION TO YOUR LUNG DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C027
Does your lung condition limit your daily activities?
DOES YOUR LUNG CONDITION LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR LUNG CONDITION LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DID NOT RECEIVE DIAGNOSIS OF LIVER DISEASE or DK or RF = PREV INTERVIEW »
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|
C028
you ever received a diagnosis of liver disease from a doctor since the previous interview (____year__month__day)? (All types of liver disease except fatty liver)
YOU EVER RECEIVED A DIAGNOSIS OF LIVER DISEASE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)? (ALL TYPES OF LIVER DISEASE EXCEPT FATTY LIVER)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
YOU EVER RECEIVED A DIAGNOSIS OF LIVER DISEASE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)? (ALL TYPES OF LIVER DISEASE EXCEPT FATTY LIVER)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If you ever received a diagnosis of liver disease from a doctor since the previous interview (____year__month__day)? (All types of liver disease except fatty liver) (C028) = 1 Yes
5 No
»
| | ========================================================================
| |
C029
When were you first diagnosed with liver disease? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH LIVER DISEASE? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH LIVER DISEASE? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If you ever received a diagnosis of liver disease from a doctor since the previous interview (____year__month__day)? (All types of liver disease except fatty liver) (C028) != 5 and When were you first diagnosed with liver disease? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.] (C029) !was answered »
| ========================================================================
|
C030
How have your symptoms of liver disease (All types of liver disease except fatty liver) changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF LIVER DISEASE (ALL TYPES OF LIVER DISEASE EXCEPT FATTY LIVER) CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF LIVER DISEASE (ALL TYPES OF LIVER DISEASE EXCEPT FATTY LIVER) CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C031
Are you currently taking any medication or receiving treatment due to your liver disease?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR LIVER DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR LIVER DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C032
Does your liver disease limit your daily activities?
DOES YOUR LIVER DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR LIVER DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DID NOT RECEIVE A DIAGNOSIS OF A HEART DISEASE or DK or RF = PREV INTERVIEW »
| ========================================================================
|
C033
Have you ever received a diagnosis of a heart attack, angina pectoris, myocardial infarction, congestive heart failure or other heart disease from a doctor since the previous interview (____year__month__day)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF A HEART ATTACK, ANGINA PECTORIS, MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE OR OTHER HEART DISEASE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF A HEART ATTACK, ANGINA PECTORIS, MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE OR OTHER HEART DISEASE FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DAY)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of a heart attack, angina pectoris, myocardial infarction, congestive heart failure or other heart disease from a doctor since the previous interview (____year__month__day)? (C033) = 1 Yes
5 No
»
| | ========================================================================
| |
C034
were you first diagnosed with such heart disease? (unit: year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WERE YOU FIRST DIAGNOSED WITH SUCH HEART DISEASE? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WERE YOU FIRST DIAGNOSED WITH SUCH HEART DISEASE? (UNIT: YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of a heart attack, angina pectoris, myocardial infarction, congestive heart failure or other heart disease from a doctor since the previous interview (____year__month__day)? (C033) != 5 and Are you currently taking any medication or receiving treatment due to your heart disease? (C036) !was answered »
| ========================================================================
|
C035
How have your symptoms of a heart attack, angina pectoris, myocardial infarction, congestive heart failure or any other heart disease changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF A HEART ATTACK, ANGINA PECTORIS, MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE OR ANY OTHER HEART DISEASE CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF A HEART ATTACK, ANGINA PECTORIS, MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE OR ANY OTHER HEART DISEASE CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C036
Are you currently taking any medication or receiving treatment due to your heart disease?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR HEART DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR HEART DISEASE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C037
Does your heart disease limit your daily activities?
DOES YOUR HEART DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR HEART DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DID NOT RECEIVE A DIAGNOSIS OF CEREBROVASCULAR DISEASE or DK or RF = PREV INTERVIEW »
| ========================================================================
|
C038
Have you ever received a diagnosis of cerebrovascular disease (cerebral apoplexy, cerebral hemorrhage, cerebral infarction, etc.) from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CEREBROVASCULAR DISEASE (CEREBRAL APOPLEXY, CEREBRAL HEMORRHAGE, CEREBRAL INFARCTION, ETC.) FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
3 Possible stroke or transient ischemic attack
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF CEREBROVASCULAR DISEASE (CEREBRAL APOPLEXY, CEREBRAL HEMORRHAGE, CEREBRAL INFARCTION, ETC.) FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
3 Possible stroke or transient ischemic attack
5 No
|
If Have you ever received a diagnosis of cerebrovascular disease (cerebral apoplexy, cerebral hemorrhage, cerebral infarction, etc.) from a doctor since the previous interview (____year__month__date)? (C038) = 1 Yes
3 Possible stroke or transient ischemic attack
5 No
or Have you ever received a diagnosis of cerebrovascular disease (cerebral apoplexy, cerebral hemorrhage, cerebral infarction, etc.) from a doctor since the previous interview (____year__month__date)? (C038) = 3 »
| | ========================================================================
| |
C039
were you first diagnosed with cerebrovascular disease? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WERE YOU FIRST DIAGNOSED WITH CEREBROVASCULAR DISEASE? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WERE YOU FIRST DIAGNOSED WITH CEREBROVASCULAR DISEASE? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of cerebrovascular disease (cerebral apoplexy, cerebral hemorrhage, cerebral infarction, etc.) from a doctor since the previous interview (____year__month__date)? (C038) != 5 and were you first diagnosed with cerebrovascular disease? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.] (C039) !was answered »
| ========================================================================
|
C040
How have your symptoms of cerebrovascular disease changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF CEREBROVASCULAR DISEASE CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF CEREBROVASCULAR DISEASE CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C041
Are you currently taking any medication or receiving treatment due to your cerebrovascular disease or its complications?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR CEREBROVASCULAR DISEASE OR ITS COMPLICATIONS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT DUE TO YOUR CEREBROVASCULAR DISEASE OR ITS COMPLICATIONS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C042
Does your cerebrovascular disease limit your daily activities?
DOES YOUR CEREBROVASCULAR DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR CEREBROVASCULAR DISEASE LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R NO PSYCHIATRIC / EMOTIONAL / NERVOUS or RF or DK »
| ========================================================================
|
C043
Have you ever received a diagnosis of any emotional (depression, anxiety disorder, etc.), nervous (insomnia, too much stress, etc.), or psychiatric (mental disorder, difficulties in maintaining interpersonal relationships, etc.) problems from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF ANY EMOTIONAL (DEPRESSION, ANXIETY DISORDER, ETC.), NERVOUS (INSOMNIA, TOO MUCH STRESS, ETC.), OR PSYCHIATRIC (MENTAL DISORDER, DIFFICULTIES IN MAINTAINING INTERPERSONAL RELATIONSHIPS, ETC.) PROBLEMS FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF ANY EMOTIONAL (DEPRESSION, ANXIETY DISORDER, ETC.), NERVOUS (INSOMNIA, TOO MUCH STRESS, ETC.), OR PSYCHIATRIC (MENTAL DISORDER, DIFFICULTIES IN MAINTAINING INTERPERSONAL RELATIONSHIPS, ETC.) PROBLEMS FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of any emotional (depression, anxiety disorder, etc.), nervous (insomnia, too much stress, etc.), or psychiatric (mental disorder, difficulties in maintaining interpersonal relationships, etc.) problems from a doctor since the previous interview (____year__month__date)? (C043) = 1 Yes
5 No
»
| | ========================================================================
| |
C044
When were you first diagnosed with such problems? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH SUCH PROBLEMS? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH SUCH PROBLEMS? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of any emotional (depression, anxiety disorder, etc.), nervous (insomnia, too much stress, etc.), or psychiatric (mental disorder, difficulties in maintaining interpersonal relationships, etc.) problems from a doctor since the previous interview (____year__month__date)? (C043) != 5 and When were you first diagnosed with such problems? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.] (C044) !was answered »
| ========================================================================
|
C045
How have your symptoms of emotional, nervous, or psychiatric problems changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF EMOTIONAL, NERVOUS, OR PSYCHIATRIC PROBLEMS CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF EMOTIONAL, NERVOUS, OR PSYCHIATRIC PROBLEMS CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C046
Are you currently taking tranquilizers, antidepressants, sedatives or sleeping pills or receiving psychiatric or psychological treatment?
ARE YOU CURRENTLY TAKING TRANQUILIZERS, ANTIDEPRESSANTS, SEDATIVES OR SLEEPING PILLS OR RECEIVING PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING TRANQUILIZERS, ANTIDEPRESSANTS, SEDATIVES OR SLEEPING PILLS OR RECEIVING PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C047
Do your emotional, nervous or psychiatric problems limit your daily activities?
DO YOUR EMOTIONAL, NERVOUS OR PSYCHIATRIC PROBLEMS LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DO YOUR EMOTIONAL, NERVOUS OR PSYCHIATRIC PROBLEMS LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If R DIDNT RECEIVE ARTHRITIS or RHEUMATISM or DK or RF »
| ========================================================================
|
C048
Have you ever received a diagnosis of arthritis or rheumatism from a doctor since the previous interview (____year__month__date)?
HAVE YOU EVER RECEIVED A DIAGNOSIS OF ARTHRITIS OR RHEUMATISM FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER RECEIVED A DIAGNOSIS OF ARTHRITIS OR RHEUMATISM FROM A DOCTOR SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
|
If Have you ever received a diagnosis of arthritis or rheumatism from a doctor since the previous interview (____year__month__date)? (C048) = 1 Yes
5 No
»
| | ========================================================================
| |
C049
When were you first diagnosed with arthritis or rheumatism? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.]
WHEN WERE YOU FIRST DIAGNOSED WITH ARTHRITIS OR RHEUMATISM? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN WERE YOU FIRST DIAGNOSED WITH ARTHRITIS OR RHEUMATISM? (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 2014. IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
If Have you ever received a diagnosis of arthritis or rheumatism from a doctor since the previous interview (____year__month__date)? (C048) != 5 and When were you first diagnosed with arthritis or rheumatism? (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 2014. If the month is not clear, enter 201400.] (C049) !was answered »
| ========================================================================
|
C050
How have your symptoms of arthritis or rheumatism changed since the previous interview (____year__month__date)?
HOW HAVE YOUR SYMPTOMS OF ARTHRITIS OR RHEUMATISM CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
HOW HAVE YOUR SYMPTOMS OF ARTHRITIS OR RHEUMATISM CHANGED SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Completely recovered
2 Improved
3 Same
4 Worsened
5 Greatly worsened
========================================================================
C051
Are you currently taking any medication or receiving treatment for your arthritis or rheumatism?
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT FOR YOUR ARTHRITIS OR RHEUMATISM?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
ARE YOU CURRENTLY TAKING ANY MEDICATION OR RECEIVING TREATMENT FOR YOUR ARTHRITIS OR RHEUMATISM?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C052
Does your arthritis or rheumatism limit your daily activities?
DOES YOUR ARTHRITIS OR RHEUMATISM LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR ARTHRITIS OR RHEUMATISM LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C053
Have you ever been in a traffic accident and received medical treatment since the previous interview (____year__month__date)?
HAVE YOU EVER BEEN IN A TRAFFIC ACCIDENT AND RECEIVED MEDICAL TREATMENT SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER BEEN IN A TRAFFIC ACCIDENT AND RECEIVED MEDICAL TREATMENT SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If Have you ever been in a traffic accident and received medical treatment since the previous interview (____year__month__date)? (C053) = 1 Yes
5 No
»
| ========================================================================
|
C054
When did you have the traffic accident? If you had more than two accidents, please answer about the most recent one. (unit : year and month combined into 6 digits)[IWER: Enter the year and month using 6 digits. For example, mark 201401 for January 20114 If the month is not clear, enter 201400.]
WHEN DID YOU HAVE THE TRAFFIC ACCIDENT? IF YOU HAD MORE THAN TWO ACCIDENTS, PLEASE ANSWER ABOUT THE MOST RECENT ONE. (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 20114 IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
WHEN DID YOU HAVE THE TRAFFIC ACCIDENT? IF YOU HAD MORE THAN TWO ACCIDENTS, PLEASE ANSWER ABOUT THE MOST RECENT ONE. (UNIT : YEAR AND MONTH COMBINED INTO 6 DIGITS)[IWER: ENTER THE YEAR AND MONTH USING 6 DIGITS. FOR EXAMPLE, MARK 201401 FOR JANUARY 20114 IF THE MONTH IS NOT CLEAR, ENTER 201400.]
- - - - - - - - - - - - - - - - - - - - - - - - -
200600..201411
| ========================================================================
|
C055
Does your injury caused by the traffic accident limit your daily activities?
DOES YOUR INJURY CAUSED BY THE TRAFFIC ACCIDENT LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR INJURY CAUSED BY THE TRAFFIC ACCIDENT LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C056
Have you ever fallen down since the previous interview (____year__month__date)?
HAVE YOU EVER FALLEN DOWN SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER FALLEN DOWN SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
If Have you ever fallen down since the previous interview (____year__month__date)? (C056) = 1 Yes
5 No
»
| ========================================================================
|
C057
How many times have you had a fall accident since the previous interview (____year__month__date)? (unit : a time)_____ times
HOW MANY TIMES HAVE YOU HAD A FALL ACCIDENT SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)? (UNIT : A TIME)_____ TIMES
- - - - - - - - - - - - - - - - - - - - - - - - -
1..100
HOW MANY TIMES HAVE YOU HAD A FALL ACCIDENT SINCE THE PREVIOUS INTERVIEW (____YEAR__MONTH__DATE)? (UNIT : A TIME)_____ TIMES
- - - - - - - - - - - - - - - - - - - - - - - - -
1..100
| ========================================================================
|
C058
In your most recent fall, did you injure yourself seriously enough to need medical treatment?
IN YOUR MOST RECENT FALL, DID YOU INJURE YOURSELF SERIOUSLY ENOUGH TO NEED MEDICAL TREATMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
IN YOUR MOST RECENT FALL, DID YOU INJURE YOURSELF SERIOUSLY ENOUGH TO NEED MEDICAL TREATMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| ========================================================================
|
C059
Have you ever fractured your hip due to a fall accident?
HAVE YOU EVER FRACTURED YOUR HIP DUE TO A FALL ACCIDENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
HAVE YOU EVER FRACTURED YOUR HIP DUE TO A FALL ACCIDENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
| ========================================================================
|
C060
Does your injury or fracture due to the fall limit your daily activities?
DOES YOUR INJURY OR FRACTURE DUE TO THE FALL LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
DOES YOUR INJURY OR FRACTURE DUE TO THE FALL LIMIT YOUR DAILY ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
========================================================================
C061
How much do you usually worry about falling down?
HOW MUCH DO YOU USUALLY WORRY ABOUT FALLING DOWN?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Not at all
3 A little bit
5 A lot
HOW MUCH DO YOU USUALLY WORRY ABOUT FALLING DOWN?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Not at all
3 A little bit
5 A lot
========================================================================
C062
Are there any activities that you refrain from doing due to the fear of falling down?
ARE THERE ANY ACTIVITIES THAT YOU REFRAIN FROM DOING DUE TO THE FEAR OF FALLING DOWN?
ARE THERE ANY ACTIVITIES THAT YOU REFRAIN FROM DOING DUE TO THE FEAR OF FALLING DOWN?