Site
ID
What is your current marital status
Currently working at paying job
Full time or part-time
Are you (currently) seeking work
Household composition
Need help - walk in doors
Walk help - from person or equipment
Need help - bathing
Bathing help - from person or equipment
Need help - personal grooming
Grooming help - from person or equipment
Need help - dressing
Dressing help - from person or equipment
Need help - eating
Eating help - from person or equipment
Need help - getting from bed to chair
From bed to chair - from person or equip
Need help - using the toilet
Toilet help - from person or equipment
Able to do heavy work around the house
Able to walk up and down stairs to 2nd f
Able to walk 1/2 mile w/o help
Difficulty pulling/pushing large objects
Difficulty stooping/crouching/kneeling
Difficulty reaching/extending arms above
Difficulty writing or handling small obj
W/wo hear aid-understand speech w/o seei
Do you ear eyeglasses/contact lenses
When wearing glass/len can see friend ac
When wearing glass/len can read ordinary
DUMMY
Dr ever told you had heart attack
One or more heart attacks
Ever in hospital for heart attack
Dr ever told you had stroke
Ever in hospital for stroke
Dr ever told you had cancer
Where was it - lung
Where was it - breast
Where was it - colon,bowel,rectal
Where was it - other
Ever in hospital for cancer
Dr ever told you had diabetes
Dr tell to take insulin for diabetes
Currently taking insulin
Dr ever told you had hip fracture
Ever in hospital for hip fracture
Dr ever told you had any other fractures
Where was fracture - wrist
Where was fracture - arm
Where was fracture - back or spine
Where was fracture - any other bones
Ever in hospital for other fractures
Since last spoke-gained/lost > 10 pounds
Was (is) this due to a special diet
Now taking digitalis,Digoxin,Lanoxin,or
Have you ever been (a patient) in a nurs
DUMMY2