Survey Text

1984
1977
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1984
Survey form view entire document:  text  image

top
1977
Survey form view entire document:  text  image
4a. (Besides) During the past 12 months did (adults 19+) have-

1. Diabetes or sugar diabetes? ____
2. High blood pressure or hypertension? ____
3. Heart disease or heart trouble? ____
4. Blood clots in arms, legs, or lungs? ____

If "Yes," ask:
b. Who was this? ____

Mark box in person's column and reask 4a and b

1 [] Diabetes
2 [] High Blood Pressure
3 [] Heart Disease
4 [] Blood Clots