By cnwest - May 23, 2016
AHS2
> Hospitalization and History Forms
> HHF1
HHF1: Page 2
Notes
* Variable names are not yet converted: currently listed variable names are non-existent placeholders.
Image
Questions
Question 2 (Second Hospitalization)
| Variable name | Description | Notes |
|---|---|---|
| HOSPNAME2 |
HOSPITAL NAME | |
| HOSPADR2 |
ADDRESS | |
| HOSPCITY2 |
CITY | |
| HOSPSTATE2 |
STATE | |
| HOSPZIP2 |
ZIPCODE | |
| HOSPMOYR2 |
MONTH AND YEAR | |
| HOSPCAUSE2 |
REASON FOR HOSPITALIZATION |
Question 3 (Third Hospitalization)
| Variable name | Description | Notes |
|---|---|---|
| HOSPNAME3 |
HOSPITAL NAME | |
| HOSPADR3 |
ADDRESS | |
| HOSPCITY3 |
CITY | |
| HOSPSTATE3 |
STATE | |
| HOSPZIP3 |
ZIPCODE | |
| HOSPMOYR3 |
MONTH AND YEAR | |
| HOSPCAUSE3 |
REASON FOR HOSPITALIZATION | |
| HOSPNAME3 |
HOSPITAL NAME |
Question 4 (Four or More Hospitalization)
| Variable name | Description | Notes |
|---|---|---|
| MORE4HOSP |
IF YOU HAVE FOUR OR MORE HOSPITAL STAY |
Question 5 (Any Cancer/Tumors Diagnosed During Hospitalizations)
| Variable name | Description | Notes |
|---|---|---|
| HOSPCANDX |
DIAGNOSED WITH CANCER DURING HOSPITALIZATION | |
| HOSPCANDX1 |
DIAGNOSED IN 1ST HOSP | |
| HOSPCANDX2 |
DIAGNOSED IN 2ND HOSP | |
| HOSPCANDX3 |
DIAGNOSED IN 3RD HOSP |