[p. 161]
N. PREVENTATIVE CARE PAGE
N1
Refer to age.
1[] 40 and over, available (1)
2[] 17 and over, callback required (NP)
3[] Other (NP)
1. About how long has it been since you had an electrocardiogram, or EKG, which involves placing wires on the chest and arms?
98[] Less than 1 year
Years ____
2. About how long has it been since you had a test for glaucoma, sometimes referred to as an eye pressure test?
98[] Less than 1 year
Years ____
3. About how long has it been since you had a chest x-ray?
98[] Less than 1 year
Years ____
4. About how long has it been since you had your blood pressure taken?
98[] Less than 1 year
Years ____
5a Have you ever been told by a doctor that you had high blood pressure?
2[] No
b. Have you ever been told by a doctor that you had hypertension?
2[] No (N2)
6. Are you NOW taking any medicine prescribed by a doctor for your [high blood pressure/hypertension]?
2[] No
7a. Do you still have [high blood pressure/hypertension]?
[] No
[] DK
b. Is this condition completely cured or is it under control?
3[] Under control
N2
Refer to sex.
3[] Male (10)
8. About how long has it been since you had a Pap smear test?
98[] Less than 1 year
Years ____
9. About how long has it been since you had a breast examination by a medical doctor or assistant?
98[] Less than 1 year
Years ____
10. Do you have eyeglasses or contact lenses?
2[] No
b. About how long has it been since you had your eyes examined to see if you needed glasses (or new glasses)?
Read if age 17: Include any eye exams given in school.
98[] Less than 1 year
Years ____
RS1
2[] Proxy (Reason)
____
N. PREVENTATIVE CARE PAGE, Continued
N3
Refer to age
1[] 3-16 (11)
2[] Other (NP)
11a. Does -- have eyeglasses or contact lenses?
2[] No
b. About how long has it been since -- had -- eyes examined to see if -- needed glasses (or new glasses)?
Read if age 5-16: Include any eye exams given in school.
98[] Less than 1 year
Years ____
12a. During the past 12 months, (that is, since (12 month date) a year ago) was -- taken to a doctor for a routine physical examination, that is, not for a particular illness but for a general checkup?
Read if age 5-16: Include routine physical examinations given in school.
2[] No
b. About how long has it been since -- was taken to a doctor for a routine physical examination or general checkup?
Read if age 5-16: Include routine physical examinations given in school.
98[] Less than 1 year
Years ____
13. About how old was -- when -- first went to a dentist?
____ Years old