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[p. 146]

E. 2-WEEK DOCTOR VISITS PROBE PAGE

Read to respondent(s):
These next questions are about health care received during the 2 weeks outlined in red on that calendar.

E1
Refer to age

[] Under 14 (1b)
[] 14 and over (1a)
1a. During those 2 weeks, how many times did -- see or talk to a medical doctor? {Include all types of doctors, such as dermatologists, psychiatrists, and ophthalmologists, as well as general practitioners and osteopaths.} [Do not count times while an overnight patient in a hospital].

00[] None (NP)
____ Number of times

b. During those 2 weeks, how many times did anyone see or talk to a medical doctor about --? (Do not count times while an overnight patient in a hospital.)

00[] None (NP)
____ Number of times

2a. (Besides the time(s) you just told me about) During those 2 weeks, did anyone in the family receive health care at home or go to a doctor's office, clinic, hospital or some other place? Include care from a nurse or anyone working with or for a medical doctor. Do not count times while an overnight patient in a hospital.)

[] Yes
[] No (3a)

b. Who received this care? Mark "DR Visit" box in person's column.

[] DR Visit

c. Anyone else?

[] Yes (Reask 2b and c)
[] No

Ask for each person with "DR Visit" in 2b:
d. How many times did -- receive this care during that period?

____ Number of times

3a. (Besides the time(s) you already told me about) During those 2 weeks, did anyone in the family get any medical advice, prescriptions or test results over the phone from a doctor, nurse, or anyone working with or for a medical doctor?

[] Yes
[] No (E2)

b. Who was the phone call about? Mark "Phone call" box in person's column.

[] Phone call

c. Were there any calls about anyone else?

[] Yes (Reask 3b and c)
[] No

Ask for each person with "DR Visit" in 3b:
d. How many telephone calls were made about --?

[] Number of calls

E2
Add numbers in 1, 2d, and 3d for each person. Record total number of visits and calls in "2-WK. DV" box in Item C1.

[p.147]

F. 2-WEEK DOCTOR VISITS PAGE

Refer to C1, "2-WK. DV" box.

Person number ____
F1
Refer to age

[] Under 14 (1b)
[] 14 and over (1a)
1a. On what (other) date(s) during those 2 weeks did -- see or talk to a medical doctor, nurse or doctor's assistant?

____ Month
____ Date
OR
7777[] Last week
8888[] Week before

b. On what (other) date(s) during those 2 weeks did anyone see or talk to a medical doctor, nurse, or doctor's assistant about --?

____ Month
____ Date

OR

7777[] Last week
8888[] Week before

Ask after last DR visit column for this person:
c. Were there any other visits or calls for -- during that period?
Make necessary corrections to 2-Wk. DV box in C1.

1[] Yes (Reask 1a or b and c)
2[] No (Ask 2-5 for each visit)

2. Where did -- receive health care on (date in 1), at a doctor's office, clinic, hospital, some other place, or was this a telephone call?
If doctor's office: Was this office in a hospital?
If hospital: Was it the outpatient clinic or the emergency room?
If clinic: Was it at a hospital outpatient clinic, a company clinic, a public health clinic, or some other kind of clinic?
If lab: Was it this lab in a hospital?
What was done during this visit (Footnote)

01[] Telephone
Not in Hospital:
02[] Home
03[] Doctor's office
04[] Co. or Ind clinic
05[] Other clinic
06[] Lab
07[] Other (Specify) ____

Hospital:
08[] O.P clinic
09[] Emergency room
10[] Doctor's office
11[] Lab
12[] Overnight patient (Next DR visit)
88[] Other (Specify) ____

Ask 3b if under 14.
3a. Did -- actually talk to a medical doctor?

1[] Yes (3f)
2[] No (3c)
8[] DK if M.D (3c)
9[] DK who was seen (3f)

b. Did anyone actually talk to a medical doctor about --?

1[] Yes (3f)
2[] No (3c)
8[] DK if M.D (3c)
9[] DK who was seen (3f)

c. What type of medical person or assistant was talked to?

________ Type
99[] DK

d. Does the (entry in 3c) work with or for one doctor or more than one doctor?

1[] One (3f)
2[] More
3[] None (4)
9[] DK

e. For this [visit/call] what kind of doctor was the (entry in 3c) working with or for -- a general practitioner or a specialist?

1[] GP (4)
2[] Specialist (3g)
9[] DK (4)

f. Is that doctor a general practitioner or a specialist?

1[] GP
2[] Specialist (3g)
9[] DK (4)

g. What kind of specialist?

________ Kind of specialist

Ask 4b if under 14.
4a. For what condition did -- see or talk to the [doctor/(entry in 3c)] on (date in 1)?
Mark first appropriate box.

1[] Condition (Item C2, then 4g)
2[] Pregnancy (4e)
3[] Test(s) or examination (4c)
8[] Other (Specify) ____ (4g)

b. For what condition did anyone see or talk to the [doctor/(entry in 3c)] on (date in 1)? Mark first appropriate box.

1[] Condition (Item C2, then 4g)
2[] Pregnancy (4e)
3[] Test(s) or examination (4c)
8[] Other (Specify) ____ (4g)

c. Was a condition found as a result of the [test(s)/examination]?

[] Yes (4h)
[] No

d. Was this [test/examination] because of a specific condition -- had?

[] Yes (4h)
[] No (4g)

e. During the past 2 weeks was -- sick because of -- pregnancy?

[] Yes
[] No (4g)

f. What was the matter?

________ Condition (Item C2, then 4g)

g. During this [visit/call] was the doctor/(entry in 3c)] talked to about any (other) condition?

[] Yes
[] No (5)

h. What was the condition?

[] Pregnancy (4e)
________ Condition (Item C2, then 4g)

Mark box if "Telephone" in 2.
5a. Did -- have any kind of surgery or operation during this visit, including bone settings and stitches?

0[] Telephone in 2 (Next DR visit)
1[] Yes
2[] No (Next DR visit)

b. What was the name of the surgery or operation? If name of operation not known, describe what was done.

________
________

c. Was there any other surgery or operation during this visit?

[] Yes (Reask 5b and c)
[] No