[p. 151]
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
[] 14 and over (1a)
Number of times ____ (NP)
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.)
Number of times ____ (NP)
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.)
[] No (3a)
b. Who received this care? Mark "DR Visit" box in person's column.
c. Anyone else?
[] No
Ask for each person with "DR Visit" in 2b:
d. How many times did -- receive this care during that period?
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?
[] No (E2)
b. Who was the phone call about? Mark "Phone call" box in person's column.
c. Were there any calls about anyone else?
[] No
Ask for each person with "DR Visit" in 3b:
d. How many telephone calls were made about --?
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. 152]
F. 2-WEEK DOCTOR VISITS PAGE
Refer to C1, "2-WK. DV" box.
Person number ____
F1
Refer to age
[] 14 and over (1a)
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 --?
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 during that period? Make necessary corrections to 2-Wk. DV box in C1.
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)
Not in hospital:
03[] Doctor's office
04[] Co.or Ind Clinic
05[] Other clinic
06[] Lab
07[] Other specify ____
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?
2[] No (3c)
8[] DK if M.D (3c)
9[] DK who was see (3f)
b. Did anyone actually talk to a medical doctor about --?
2[] No (3c)
8[] DK if M.D (3c)
9[] DK who was see (3f)
c. What type of medical person or assistant was talked to?
99[] DK
d. Does the (entry in 3c) work with or for one doctor or than one doctor?
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?
2[] Specialist (3g)
9[] DK (4)
f. Is that doctor a general practitioner or a specialist?
2[] Specialist (3g)
9[] DK (4)
g. What 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.
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.
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]?
[] No
d. Was this [test/examination] because of a specific condition -- had?
[] No (4g)
e. During the past 2 weeks was -- sick because of her pregnancy?
[] No (4g)
f. What was the matter?
g. During this [visit/call] was the doctor/(entry in 3c)] talked to about any (other) condition?
[] No (5)
h. What was the condition?
Condition ____ (Item in 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?
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.
[2] ____
c. Was there any other surgery or operation during this visit?
[] No