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[p. 167]

Section B -- UNINTENTIONAL INJURIES

These questions are about injuries.


1a. During the past 12 months, did anyone in the family have a head injury where he or she lost consciousness or completely blacked out?

1[] Yes (1b)
2[] No (B1)
9[] DK (B1)

b. Who was this?
Mark "Head injury" box in appropriate person's column.

1[] Head injury

c. Did anyone else have such a head injury in the past 12 months?

1[] Yes (Reask 1b and c)
2[] No (B1)
9[] DK (B1)


Item B1
Refer to 1b

1[] Head injury in 1b (2)
8[] Other (B2)

2a. How many injuries did -- have in the past 12 months where -- lost consciousness or completely blacked out?

Head injuries ____


b. Did -- receive medical care for -- most recent head injury?

1[] Yes (2c)
2[] No (2e)
9[] DK (2e)


c. Where did -- first get medical care for this head injury, at a doctor's office, clinic, hospital, or some other place? (Do not count care in an ambulance).
If doctor's office: Was this office in a hospital?
If hospital: Was it the emergency room or an outpatient clinic?
If clinic: Was it a hospital outpatient clinic, a company clinic, or some other kind of clinic?

Non-hospital

:

01[] Doctor's office
02[] Company clinic
03[] Urgent care center
04[] Other clinic
05[] Other non-hospital (Specify) ____
Hospital:
06[] Outpatient clinic
07[] Emergency room
08[] Doctor's office
98[] Other hospital (specify) ____
99[] DK


d. Did -- stay in a hospital overnight or longer because of this head injury?

1[] Yes (2f)
2[] No (2e)
9[] DK (2e)


e. Did this head injury cause -- to cut down for more than half of the day on the things -- usually does?

1[] Yes (3a)
2[] No (3a)
9[] DK (3a)


f. Altogether, how many nights did -- stay in the hospital because of this head injury?

Nights ____
999[] DK


g. When -- was discharged form the hospital, was -- transferred to a rehabilitation center or extended care facility because of this head injury?

1[] Yes (3a)
2[] No (3a)
9[] DK (3a)

[p. 168]

Section B -- UNINTENTIONAL INJURIES -- Continued


3a. Where did -- head injury happen?

1[] At home (inside house or adjacent premises)
2[] Street or highway (includes roadway and public sidewalks)
3[] Industrial place (includes premises)
4[] School (includes premises)
5[] Place of recreation and sports, except at school
8[] Other
9[] DK


b. Was -- at work at -- job or business when this injury occurred?

1[] Yes
2[] No
9[] DK


c. What was the cause of this head injury?

1[] Motor vehicle accident
2[] Other accident (Specify) ____
3[] Assault (Item B2)
4[] Other non-accident (Specify) ____
9[] DK


Mark box or ask.
d. At the time of the head injury, was -- playing sports or engaged in some other physical activity or exercise?

1[] Playing sports
2[] Other physical activity (Specify) ____
3[] Not playing sports or other physical activity
9[] DK


Item B2
Refer to age

1[] Under 65 (Item B1 for NP)
2[] 65 and over (4)

4a. During the past 12 months, has -- fallen?

1[] Yes (4b)
2[] No (Item B1 for NP)
9[] DK (Item B1 for NP)

b. How many times?

Times ____
9[] DK


c. Did -- break -- hip as a result of (this/any of these) fall(s)?

1[] Yes (Item B1 for NP)
2[] No (4d)
9[] DK (4d)


d. (Did this fall result/how many of these falls resulted) in an injury where -- had to cut down for more than half of the day on the things -- usually does?

[] 0 No/None
Fall(s) ____
[] 9 DK


e. (For how many of these falls) Did -- receive medical care?

0[] No/None (Item B1 for NP)
Fall(s) ____ (Number) (Item B1 for NP)
9[] DK