By Anonymous - October 3, 2016
AHS2
> Hospitalization and History Forms
> HFF3
HHF3: Page 2
Notes
* Variable names are not yet converted: currently listed variable names are non-existent placeholders.
Image
| Page 2 | Page 2A | |
|---|---|
 |
 |
Questions
Question 3 (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 4 (THREE OR MORE HOSPITALIZATION)
| Variable name | Description | Notes |
|---|---|---|
| MORE3HOSP |
IF YOU HAVE THREE 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 |
Question 6 (Hospitalizations heart attack related?)
| Variable name | Description | Notes |
|---|---|---|
| MI |
DIAGNOSED WITH MIOCARDIAL/INFARCTION-RELATED DURING HOSP | |
| MIY1 |
DIAGNOSED IN 1ST HOSP | |
| MIY2 |
DIAGNOSED IN 2ND HOSP | |
| MIY3 |
DIAGNOSED IN 3RD HOSP |
Question 7 (First Cancer or Tumor Diagnosed NOT Requiring Hospitalization)
| Variable name | Description | Notes |
|---|---|---|
| DRCANDX |
TUMORS DIAGNOSED NOT REQUIRING HOSPITALIZATION | |
| DRCANLOC1 |
LOCATION OF TUMOR | |
| DXMOYR1 |
MONTH AND YEAR OF DIAGNOSIS | |
| DRNAME1 |
PHYSICIAN NAME | |
| DRADR1 |
ADDRESS | |
| DRCITY1 |
CITY | |
| DRSTATE1 |
STATE | |
| DRZIP1 |
ZIPCODE |
Question 8 (MORE THAN ONE CANCER NOT Requiring Hospitalization)
| Variable name | Description | Notes |
|---|---|---|
| MORECAN |
IF YOU HAVE ONE MORE CANCER NOT REQUIRING HOSPITALIZATION |