AHS2
> Hospitalization and History Forms
> HHF5
Biennial Hospitalization Form (V)/(V)a
Also known as HHQ5.
Notes
5/5A Difference: Date added to Q6
Pages
| Page 1 |
Page 2 |
Page 3 |
Page 4 | |
|---|---|---|---|
 |
 |
 |
 |
Notes
In this questionnaire, we asked the participants about the followings:
* Page One:
* Recent hospitalization, if there is any
* Page Two:
* Recent cancer incidence, if there is any
* Recent heart diseases, if there is any
* Whether visited the primary care doctor in the last two years
* Whether visited a specialist in the last two years
* Whether visited an alternative medicine provider in the last two years
* Whether having had a surgical procedure in the last two years
* Whether having visited urgent care or ED in the last two years
* Whether having had X-ray, MRI, or CAT scan in the last two years
* Page Three:
* Religious believes and approach to life
* Church attendance
* Health insurance status
* Presence of some chronic conditions
* Page Four:
* Present body weight
* Dietary patterns
* Cancer treatment preferences if applicable
* Discussing personal matters with someone