General information

Question text: Please click the relevant box if any of the events below occurred to you in the last month (^FLMonth).
Answer type: Check boxes
Answer options: 1 I fell down
2 I was injured in an accident at home
3 I was injured in an accident at work
4 I was injured due to an accident elsewhere (not at home or work)
5 I was assaulted
6 I suffered a heart attack, or was diagnosed with coronary heart disease, angina, congestive heart failure, or other heart problems?
7 I was diagnosed with heart disease
8 I was diagnosed with cancer or a malignant tumor
9 I was diagnosed with dementia senility or any other serious memory impairment
10 I was diagnosed with diabetes
11 I contracted Influenza
12 I contracted pneumonia
13 I was diagnosed with kidney disease
14 I was diagnosed with a chronic lung disease such as chronic bronchitis or emphysema
15 I was diagnosed with arthritis or rheumatism
16 A doctor told me I have osteoporosis
17 I had surgery or any joint replacement because of arthritis
18 A doctor told me that I have high blood pressure or hypertension
19 I contracted shingles
20 A doctor told me that I have an emotional, nervous, or psychiatric problem
21 A doctor or other health professional told me that I have a sleep disorder
22 I was diagnosed with an illness not listed above
Label: which illnesses
Empty allowed: One-time warning
Error allowed: Not allowed
Multiple instances: No

Data information

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