dv
[p. 148]

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

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.)

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.)

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.)

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

c. Anyone else?

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?

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

c. Were there any calls about anyone else?

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. 149]

F. 2-WEEK DOCTOR VISITS PAGE

DR VISIT 1
Refer to C1, "2-WK. DV" box.

F1
Refer to age

1a. On what (other) date(s) during those 2 weeks did -- see or talk to a medical doctor, nurse or doctor's assistant?

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 --?

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)

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

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

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

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

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

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

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.

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

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

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

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

f. What was the matter?

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

h. What was the condition?

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

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?

Go to next DV if "Home" in 2.
6. In what city (town), county, and State is the (place in 2) located?