SHARE:
le_hrs001a_previous
General information
| Question text: | PREVIOUS MONTH
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: | previous which illnesses |
| Empty allowed: | One-time warning |
| Error allowed: | Not allowed |
| Multiple instances: | No |