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General information

Question text: PREVIOUS MONTH

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

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