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[p. 1]


CHILD CORE
Section I -- IDENTIFICATION AND VERIFICATION
Check item CHILD BEGIN: If no sample child or sample child section is completed, go to Immunization Questionnaire; Else if KNOWSC (person who knows sample child) equals blank, go to CID.015/KNOAVAIL, Else go to CID.001.
CID.001

FR: ENTER THE NUMBER OF THE PERSON TO WHOM YOU ARE SPEAKING.
CURRES__________(1-30) Person number
[If the same person in CID.001 is identified as a person knowledgeable about child's health (FID.650/KNOWSC) go to CID.005; Else go to CSPEDIT.]

CID.005

The next questions are about {Sample Child name}. Are you able to answer questions about {his/her} health at this time?
CSRESP
(1) Yes (CID.030)
(2) No (Check item CSPEDIT)
(7) Refused (Check item CSPEDIT)
(9) DK (Check item CSPEDIT)
Check item CSPEDIT: Check the content from FID.630, First section of Family Core: Plug names in CID.010 {KNOWSC name} for persons identified as knowledgeable about the child's health (FID.630/KNOWSC marked 'X') and go to CSDPEDIT2. If KNOWSC for CID.010 equals 7 or 9 (Refused or DK) go to Check Item CSPEDIT2.
Check item CSPEDIT2: Check the first person identified as knowledgeable about the child's health (FID.630/KNOWSC marked 'X'); if not available, check next person with KNOWSC marked 'X'; If all the KNOWSC are not available, go to CID.015/KNOAVAIL; if no one else in the family is available, go to CSPEDIT3.
Check item CSPEDIT3: Arrange a callback; go to next questionnaire.
CID.010

Is {KNOWSC name} available to answer some questions about {sample child name}'s health?
CSPAVAIL
(1) Available (CID.030)
(2) Not available (Check Item CSPEDIT)
(7) Refused (Check Item CSPEDIT)
(9) DK (Check Item CSPEDIT)

CID.015

Is there any family member available who can answer questions about {sample child name}'s health?
KNOAVAIL
(1) Yes (CID.020)
(2) No (Immunization Questionnaire)

CID.020

Enter the person number of the respondent.
CSRESPNO _________(1-30) Person number

[p. 2]


CID.030

FR: SHOW CARD C1.ENTER ONLY 1.
What is {CSRESPNO name}'s relationship to {sample child name}?
Card Cl
1. Parent (Biological, Adoptive or Step)
2.Grandparent
3.Aunt/Uncle
4.Brother/Sister
5.Other relative
6.Legal guardian
7.Foster parent
8.Other non-relative
CSRELTIV
(1) Parent (Biological adoptive, or step)
(2) Grandparent
(3) Aunt/Uncle
(4) Brother/Sister
(5) Other relative
(6) Legal guardian
(7) Foster parent
(8) Other non-relative
(97) Refused
(99) DK

Check item CIDCCI1: If CSRESPNO is the Family Respondent, go to next section -- Conditions, Limitations, Health Status; Else go to CID.040.
CID.040

FR: PLEASE VERIFY THE FOLLOWING INFORMATION ABOUT THE SAMPLE CHILD BEFORE PROCEEDING:

(1) Yes
(2) No
CSPVERF1 Gender = {male/female} Is it correct?
CSPVERF2 Age = {3 digit format}Is it correct?
CSPVERF3 Birthday = {spoken word format}Is it correct?

Check item CIDCCI1A: If CSPVERF1 equals 2 then go to CID.042; If CSPVERF2 equals 2 then go to CID.044; If SPVERF3 equals 2 then go to CID.046; If any changes in age or birth date have been made in CID.040, go to CAGECHK; If age is 18+, skip the rest of the Child questionnaire and Immunization questionnaire; If no changes or when changes complete go to next section -- Child Condition, Limitation, Health Status.

CID.042

Is {sample child name} Male or Female?
NEWSEX
(1) Male
(2) Female

(Go to Check item CIDCCI1A)

[Update revised sex - NEWSEX in SEX]

CID.044

How old is {sample child name}?
NEWAGE
(0-96)years old
(97) Refused
(99) DK(Go to Check item CIDCCI1A)

[Update revised age - NEWAGE in AGE]

[p. 3]

CID.046

What is {sample child name} birthday?
NEWDOB_M
MONTH: _______
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
NEWDOB_D
DAY: ________
(01-31) 1-31
(97)Refused
(99)DK
NEWDOB_Y
YEAR: ____________
(1979-1999)1979-1999
(9997) Refused
(9999) DK

[Update Birthdates in DOB_M, DOB_BDAY, and DOB_Y]
Check item CAGECHK: Verify that the age and birthdate are consistent. If not, go to CID.040, re-enter age or birth date.
(Go to next section--Conditions, Limitations, Health Status)
[p. 4]


Section II - CONDITIONS, LIMITATION, HEALTH STATUS

Part A -- Conditions, Limitation of Activity and Health Status


CHS.010

What was {S.C.name}'s birth weight?

FR: ALLOW THE RESPONSES IN METRIC IF VOLUNTEERED.
BWGTLB
Pounds _________
(01-15) 0-15 pounds
(997) Refused
(999) DK
BWGTOZ
Ounces ________
(00-15) ounces
(97) Refused
(99) DK
BWGTMGR
Grams ______________
(0500) 500 grams or less
(0501-5484) 501-5484 grams
(9997) Refused
(9999) DK

CHS.020

About how tall is {S.C.name} now?
FR: ALLOW ALL RESPONSES TO BE IN METRIC IF VOLUNTEERED.
CHGHTF
Feet _________
(00-07) 0-7 feet
(97)Refused
(99)DK
CHGHTI
Inches __________
(00-36) 0-36 inches
(97) Refused
(99) DK
CHGHTM
Meters _____________
(00-02) 0-2 meters
(7) Refused
(9) DK
CHGHTCM
Centimeters ____________
(00-241) 0-241 centimeters
(997) Refused
(999) DK

[p. 5]

CHS.021

About how much does {S.C.name} weigh now? (without shoes)
FR: ALLOW RESPONSES IN METRIC IF VOLUNTEERED.
CWT_LB
Pounds _______________
(001-500) 1-500 pounds
(997) Refused
(999) DK
CWT_KG
Kilograms ___________
(0002-0226) 2-226 kilograms
(9997) Refused
(9999) DK


Check Item CHSCCI1:[If age is greater than or equal to 2 go to CHS.032; If the age is less than 2 then go to CHS.031]


CHS.031

Has a doctor or health professional ever told you that {S.C.name} had:

(1) Yes
(2) No
(7) Refused
(9) DK
AMR1 Mental Retardation?
AODD1 Any other developmental delay?

[Update Birthdates in DOB_M, DOB_BDAY, and DOB_Y]

CHS.032

Has a doctor or health professional ever told you that {S.C.name} had:

(1) Yes
(2) No
(7) Refused
(9) DK
ADD2 Attention Deficit Disorder?
AMR2 Mental Retardation?
AODD2 Any other developmental delay?


CHS.060

FR: SHOW CARD C2.

Looking at this list, has a doctor or health professional ever told you that {S.C.name} had any of these conditions?
Card C2
1. Down's Syndrome
2. Cerebral Palsy
3. Muscular Dystrophy
4. Cystic Fibrosis
5. Sickle Cell Anemia
6. Autism
7. Diabetes
8. Arthritis
9. Congenital Heart Disease
10. Other Heart Condition
CONDL
(0) None
(1) Down's syndrome
(2) Cerebral Palsy
(3) Muscular Dystrophy
(4) Cystic Fibrosis
(5) Sickle cell anemia
(6) Autism
(7) Diabetes
(8) Arthritis
(9) Congenital heart disease
(10) Other heart condition
(97) Refused
(99) DK
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

[p. 6]


CHS.070

Has {S.C.name} EVER had chickenpox?
CPOX
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.080

Has a doctor or other health professional EVER told you that {S.C.name} had asthma?
CASHMEV
(1) Yes (CHS.090)
(2) No (Check Item CHSCCI2)
(7) Refused (Check Item CHSCCI2)
(9) DK (Check Item CHSCCI2)


Check Item CHSCCI2:[If CHS.080 = 1 go to CHS.090. If CHS.080 equals 2, 7, or 9, and the age is greater than 2 then go to CHS.115; If CHS.080 equals 2, 7, 9 and the age is less than or equal to 2 then go to CHS.111]

CHS.090

During the past 12 months, has {S.C.name} had an episode of asthma or an asthma attack?
CASHYR
(1) Yes (CHS.100)
(2) No (Check item CHSCCI3)
(7) Refused (Check item CHSCCI3)
(9) DK (Check item CHSCCI3)


Check Item CHSCCI3: [If CHS.090 = 1 go to CHS.100. If CHS.090 equals 2, 7, or 9, and the age is greater than 2 then go to CHS.115; If CHS.080 equals 2, 7, 9 and the age is less than or equal to 2 then go to CHS.111]

CHS.100

During the past 12 months, did {S.C.name} have to visit an emergency room or urgent care center because of asthma?
CASMERYR
(1) Yes
(2) No
(7) Refused
(9) DK


Check Item CHSCCI4: [If the age is greater than to 2 then go to CHS.115; If the age is less than or equal to 2 then go to CHS.111]

CHS.111

During the past 12 months, has {S.C.name} had any of the following conditions?

(1) Yes
(2) No
(7) Refused
(9) DK
HAYF1 Hay fever?
RALLG1 Any kind of respiratory allergy?
DALLG1 Any kind of food or digestive allergy?
SALLG1 Eczema or any kind of skin allergy?
DIARH1 Frequent or repeated diarrhea or colitis?
ANEMIA1 Anemia?
EARINF1 Three or more ear infections?
SEIZE1 Seizures?

(Go to CHS.210)
[p. 7]


CHS.115

During the past 12 months, has {S.C.name} had any of the following conditions?

(1) Yes
(2) No
(7) Refused
(9) DK
HAYF2 Hay fever?
RALLG2 Any kind of respiratory allergy?
DALLG2 Any kind of food or digestive allergy?
SALLG2 Eczema or any kind of skin allergy?
DIARH2 Frequent or repeated diarrhea or colitis?
ANEMIA2 Anemia?
FHEAD Frequent or severe headaches, including migraines?
EARINF2 Three or more ear infections?
SEIZE2 Seizures?
STUTTER Stuttering or stammering?


CHS.210

Compared with 12 months ago, would you say {S.C.name}'s health is now BETTER, WORSE, or ABOUT THE SAME?
CHSTATYR
(1)Better
(2)Worse
(3)About the same
(7)Refused
(9)DK


Check Item CHSCCI5:[If the age is greater than 4 go to CHS.220; If age is less than or equal to 4 go to CHS.230]

CHS.220

During the past 12 months, that is, since {12-month ref. date}, about how many days did{S.C. name} miss school because of illness or injury?
SCHDAYR1
(000) none
(001-240) 1-240 Days
(996) Did not go to school
(997) Refused
(999) DK

CHS.230

These next questions are about {S.C.name}'s recent health during the 2 weeks outlined on that calendar.


Did {S.C.name} have a head cold or chest cold that started during those two weeks?
CCOLD2W
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.240

Did {S.C.name} have a stomach or intestinal illness with vomiting or diarrhea that started during those two weeks?
CINTIL2W
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.250

Which statement best describes {S.C.name}'s hearing (without a hearing aid): GOOD, A LITTLE TROUBLE, A LOT OF TROUBLE, or DEAF?
CHEARST
(1) Good
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused
(9) DK

[p. 8]


CHS.260

Does {S.C.name} have any trouble seeing?

[If child's age is 2 or more add:]
Even when wearing glasses or contact lenses?
CVISION
(1) Yes (CHS.270)
(2) No (CHS.290)
(7) Refused (CHS.290)
(9) DK (CHS.290)


CHS.270

Is {S.C.name} blind or unable to see at all?
CBLIND
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.290

Does {S.C.name} have any impairment or health problem that requires {him/her} to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?
IHSPEQ
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.300

Does {S.C.name} have an impairment or health problem that limits {his/her} ability to (crawl), walk, run, or play?
IHMOB
(1) Yes (CHS.310)
(2) No (CHS.311)
(7) Refused (CHS.311)
(9) DK (CHS.311)

CHS.310

Is this an impairment or health problem that has lasted, or is expected to last 12 months or longer?
IHMOBYR
(1) Yes
(2) No
(7) Refused
(9) DK


CHS.311

Does {S.C.name}NOW have a problem for which {he/she} has regularly taken prescription medication for at least three months?
PROBRX
(1) Yes
(2) No
(7) Refused
(9) DK


Check Item CHSCCI6:[If age is less than or equal to 1 go to next section -- Health Care Access and Utilization. CAU.020; If the age is equal to 2 go to CHSCCI7; If the age is greater than or equal to 3 go to CHS.312]

CHS.312

Has a representative from a school or a health professional ever told you that {S.C.name} had a learning disability?
LEARND
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 9]

Part B - Child Behavior


Check item CHSCCI7:If AGE = 2-3 and RPSEX is male, then go to CHS.321;
If AGE = 2-3 and RPSEX is female, then, go to CHS.361;
If AGE = 4-11 and RPSEX is male, then go to CHS.401;
If AGE = 4-11 and RPSEX is female, then go to CHS.441;
If AGE = 12-17 and RPSEX is male, then go to CHS.481;
If AGE = 12-17 and RPSEX is female, then go to CHS.521.


CHS.321

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of {S.C.name} during the past 2 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

HE:
CMHAGM12 Has been uncooperative?
CMHAGM13 Has trouble getting to sleep?
CMHAGM14 Has speech problems?
CMHAGM15 Has been unhappy, sad, or depressed?

(Go to CAU.020)

CHS.361

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of {S.C. name} during the past 2 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

SHE:
Card C3
0. Not true
1. Sometimes true
2. Often true
CMHAGF12 Has temper tantrums or a hot temper?
CMHAGF13 Has speech problems?
CMHAGF14 Has been nervous or high-strung?
CMHAGF15 Has been unhappy, sad, or depressed?

(Go to next section -- Health Care Access and Utilization)
[p. 10]


CHS.401

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of {S.C.name} during the past 6 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

HE:
Card C3
0. Not true
1. Sometimes true
2. Often true
CMHAGM22 Doesn't get along with other kids?
CMHAGM23 Can't concentrate or pay attention long?
CMHAGM24 Feels worthless or inferior?
CMHAGM25 Has been unhappy, sad, or depressed?

(Go to next section -- Health Care Access and Utilization)

CHS.441

I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE of {S.C.name} during the past 6 months.

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

SHE:
Card C3
0. Not true
1. Sometimes true
2. Often true
CMHAGF22 Can't concentrate or pay attention long?
CMHAGF23 Has been nervous, high strung or tense?
CMHAGF24 Acts too young for her age?
CMHAGF25 Has been unhappy, sad, or depressed?

(Go to next section -- Health Care Access and Utilization)

CHS.481

I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, that during the past 6 months, {S.C.name}:

FR: SHOW CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

HE:
Card C3
0. Not true
1. Sometimes true
2. Often true
CMHAGM32 Can't concentrate or pay attention long?
CMHAGM33 Lies or cheats?
CMHAGM34 Doesn't get along with other kids?
CMHAGM35 Has been unhappy, sad, or depressed?

(Go to next section -- Health Care Access and Utilization)
[p. 11]


CHS.521

I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, that during the past 6 months, {S.C.name}:

FR: HAND CARD C3.

(0) Not True
(1) Sometimes True
(2) Often True
(7) Refused
(9) DK

SHE:
Card C3
0. Not true
1. Sometimes true
2. Often true
CMHAGF32 Lies or cheats?
CMHAGF33 Does poorly at school work?
CMHAGF34 Has trouble sleeping?
CMHAGF35 Has been unhappy, sad, or depressed?

(Go to next section-Health Care Access and Utilization)
[p. 12]


Section III -- HEALTH CARE ACCESS AND UTILIZATION

Part A -- Access To Care


CAU.020

The next questions are about Health Care.
Is there a place that {S.C.name} USUALLY goes when {he/she} is sick or you need advice about {his/her} health?
CUSUALPL
(1) Yes (CAU.030)
(2) There is NO place (CAU.037)
(3) There is MORE THAN ONE place (CAU.030)
(7) Refused (CAU.037)
(9) DK (CAU.037)


CAU.030

[If CAU.020 equal 1, then read:]
What kind of place is it ...

[Else CAU.020 equal 3, then read:]
What kind of place does {S.C.name} go to most often .. A clinic, doctor's office, emergency room, or some other place?
CPLKIND
(1) Clinic or health center (CAU.035)
(2) Doctor's office or HMO (CAU.035)
(3) Hospital emergency room (CAU.035)
(4) Hospital outpatient department (CAU.035)
(5) Some other place (CAU.035)
(7) Refused (CAU.037)
(9) DK (CAU.037)


CAU.035

Is that {place selected in CAU.030} the same place {S.C.name} usually goes when {he/she} needs routine or preventive care, such as a physical examination or well baby/child check-up?
CHCPLROU
(1) Yes (CAU.040)
(2) No (CAU.037)
(7) Refused (CAU.037)
(9) DK (CAU.037)


CAU.037

What kind of place does {S.C.name} go to when {he/she} needs routine preventive care, such as a physical examination or well baby/child check-up?
CHCPLKND
(0) Doesn't get preventive care anywhere
(1) Clinic or health center
(2) Doctor's office or HMO
(3) Hospital emergency room
(4) Hospital outpatient department
(5) Some other place
(7) Refused
(9) DK


Check item CAUCCI1: If CAU.020 equals 2, 7, or 9, then go to CAU.080; Else go to CAU.040.

CAU.040

At any time in the past 12 months did you CHANGE the place(s) to which {S.C.name} USUALLY goes for health care?
CHCCHGYR
(1) Yes (CAU.050)
(2) No (CAU.080)
(7) Refused (CAU.080)
(9) DK (CAU.080)

CAU.050

Was this change for a reason related to health insurance?
CHCCHGHI
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 13]


CAU.080

There are many reasons people delay getting medical care. Have you delayed getting care for {S.C.name} for any of the following reasons in the past 12 months?

(1) Yes
(2) No
(7) Refused
(9) DK
CHCDLYR1 You couldn't get through on the telephone.
CHCDLYR2 You couldn't get an appointment for {S.C.name} soon enough.
CHCDLYR3 Once you get there, {S.C.name} has to wait too long to see the doctor.
CHCDLYR4 The clinic/doctor's office wasn't open when you could get there.
CHCDLYR5 You didn't have transportation


Check Item CAUCCI2:[If age is greater than or equal to 2 go to CAU.135; Else go to CAU.130]

CAU.130

During the past 12 months, was there any time when {S.C.name} needed any of the following, but didn't get it because you couldn't afford it? Prescription medicines?
CHCAFYR
(1) Yes
(2) No
(7) Refused
(9) DK

(Go to CAU.170)


CAU.135

During the past 12 months, was there any time when {S.C.name} needed any of the following, but didn't get it because you couldn't afford it:

(1) Yes
(2) No
(3) Refused
(9) DK
CHCAFYR1 Prescription medicines?
CHCAFYR2 Mental health care or counseling?
CHCAFYR3 Dental care (including check-ups)?

[p. 14]


Part B -- Dental Care

CAU.160

FR: SHOW CARD C4.

About how long has it been since {S.C.name} last saw or talked to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
Card C4
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 3 years ago
4. More than 3 years
5. Never
CDENLONG
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 3 years ago
(4) More than 3 years
(5) Never
(7) Refused
(9) DK

Check Item CAUCCI3:[If age is greater than or equal to 2 go to CAU.175; Else go to CAU.170.]
[p. 15]

Part C -- Health Care Provider Contacts


CAU.170

During the past 12 months, that is since {12-month ref. date}, has anyone in the family seen or talked to any of the following health care providers about {S.C.name}'s health?

(1) Yes
(2) No
(3) Refused
(9) DK
CHCSYR11 An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)?
CHCSYR12 A foot doctor?
CHCSYR13 A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
CHCSYR14 A nurse practitioner, physician assistant or midwife?(Go to Check Item CAUCCI4)

CAU.175

During the past 12 months, that is since {12-month ref. date}, have you seen or talked to any of the following health care providers about {S.C.name}'s health?

(1) Yes
(2) No
(3) Refused
(9) DK
CHCSYR1 A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
CHCSYR2 An optometrist, optician, or eye doctor (someone who prescribes eyeglasses)?
CHCSYR3 A foot doctor?
CHCSYR4 A chiropractor?
CHCSYR5 A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
CHCSYR6 A nurse practitioner, physician assistant or midwife?


Check Item CAUCCI4: [If female and age is greater than 14 then go to CAU.230; Else go to CAU.240]

CAU.230

During the past 12 months, have you seen or talked to a doctor who specializes in women's health (an obstetrician/gynecologist) about {S.C.name}'s health?
CHCSYR7
(1) Yes
(2) No
(7) Refused
(9) DK


CAU.240

During the past 12 months, have you seen or talked to the following about {S.C.name}'s health?

(1) Yes
(2) No
(7) Refused
(9) DK
CHCSYR81 A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist or ophthalmologist)?
CHCSYR82 A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal medicine)?

Check Item CAUCCI5: [If CHCSYR82 = 1 go to CAU.260; Else go to CAU.270]

CAU.260

Does that doctor treat children and adults (a doctor in general practice or family medicine)?
CHCSYR10
(1) Yes
(2) No
(7) Refused
(9) DK

[p. 16]


CAU.270

During the past 12 months did {S.C.name} receive a physical examination or well baby/child check-up?
CHPEXYR
(1) Yes
(2) No
(7) Refused
(9) DK


CAU.280

During the past 12 months, HOW MANY TIMES has {S.C.name} gone to a HOSPITAL EMERGENCY ROOM about {his/her} health? (This includes emergency room visits that resulted in a hospital admission.)

FR: SHOW CARD C5.
Card C5
0. None
1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more
CHERNOYR
(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK


CAU.290

During the past 12 months, did {S.C.name} receive care AT HOME from a nurse or other health care professional?
CHCHYR
(1) Yes (CAU.300)
(2) No (CAU.320)
(7) Refused (CAU.320)
(9) DK (CAU.320)


CAU.300

During how many of the past 12 months did {S.C.name} receive care at home from a health care professional?
CHCHMOYR
(01-12) 1-12 months
(97) Refused
(99) DK


CAU.310

What was the total number of home visits received for {S.C.name} during that/those months?

FR: SHOW CARD C6
Card C6
1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more
CHCHNOYR
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK


CAU.320

During the past 12 months, HOW MANY TIMES has {S.C.name} seen a doctor or other health care professional about {his/her} health at A DOCTOR's OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times {S.C.name} was hospitalized overnight, visits to hospital emergency rooms, home visits, or telephone calls.

FR: SHOW CARD C5
Card C5
0. None
1. 1
2. 2-3
3. 4-9
4. 10-12
5. 13 or more
CHCNOYR
(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) DK

[p. 17]


CAU.330

During the past 12 months has {S.C.name} had SURGERY or other surgical procedures either as an inpatient or outpatient?
CSRGYR
(1) Yes (CAU.340)
(2) No (Check item CAUCCI6)
(7) Refused (Check item CAUCCI6)
(9) DK (Check item CAUCCI6)


CAU.340

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has {S.C. name} had surgery done as an outpatient during the past 12 months?
CSRGNOYR
(00-94) 0-94 times
(95) 95+ times
(97) Refused
(99) DK


Check item CAUCCI6: If sample child had a doctor visit in the last 2 weeks as indicated in the family core, that is: If FAU.180 equals 1 and sample child's person number is in FAU.190, then CAU.345 equals 1 and go to next questionnaire--Immunization; Else go to CAU.345.

CAU.345

About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about {S.C.name}'s health? Include doctors seen while {he/she} was a patient in a hospital.
CMDLONG
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 3 years ago
(4) More than 3 years
(5) Never
(7) Refused
(9) DK

(Go to next questionnaire -- Immunization)