Survey Text

2017
2015
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2017
Survey form view entire document:  text  image

Question ID: ACN.199_00.030

Instrument Variable Name: EPILEP3
Questionnaire File Name: Sample Adult
Question Text:
Today is [fill: Current Date]. Think back to last year about the same time. About how many seizures of any type have you had in the past year?
*Read if necessary: Some people may call it “convulsion,” “fit,” “falling out spell,” “episode,” “attack,” “drop attack,” “staring spell,” or “out-of-touch.”
*If the respondent mentions and counts “auras” as seizures accept the response. If a respondent indicates that he/she has had nothing more than an aura and is unsure about counting the aura(s), do NOT count auras as seizures.
0 None
1 One
2 Two or three
3 Between four and ten
4 More than 10
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever been told they had epilepsy
Skip Instructions:
(0-4,R,D) [goto EPILEP4]

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2015
Survey form view entire document:  text  image

Question ID: ACN.192_00.030

Instrument Variable Name: EPILEP3
Questionnaire File Name: Sample Adult
Question Text:
Today is [fill: Current Date]. Think back to last year about the same time. About how many seizures of any type have you had in the past year?
*Read if necessary: Some people may call it “convulsion,” “fit,” “falling out spell,” “episode,” “attack,” “drop attack,” “staring spell,” or “out-of-touch.”
*If the respondent mentions and counts “auras” as seizures accept the response. If a respondent indicates that he/she has had nothing more than an aura and is unsure about counting the aura(s), do NOT count auras as seizures.
0 None
1 One
2 Two or three
3 Between four and ten
4 More than 10
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Skip Instructions:
(0-4,R,D) [go to EPILEP4]

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2013
Survey form view entire document:  text  image

Question ID: ACN.192_00.030

Instrument Variable Name: EPILEP3
Question Text:
Today is [fill: Current Date]. Think back to last year about the same time. About how many seizures of any type have you had in the past year?
*Read if necessary: Some people may call it "convulsion," "fit," "falling out spell," "episode," "attack," "drop attack," "staring spell," or "out-of-touch.".
*If the respondent mentions and counts "auras" as seizures accept the response. If a respondent indicates that he/she has had nothing more than an aura and is unsure about counting the aura(s), do NOT count auras as seizures.
0 None
1 One
2 Two or three
3 Between four and ten
4 More than 10
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:
(0-4,R,D) [goto EPILEP4]

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2010
Survey form view entire document:  text  image

Question ID:ACN.192_00.030

Instrument Variable Name:EPILEP3
QuestionText:
Today is [fill: Current Date]. Think back to last year about the same time. About how many seizures of any type have you
had in the past year?
*Read if necessary: Some people may call it "convulsion," "fit," "falling out spell," "episode," "attack," "drop attack,"
"staring spell," or "out-of-touch.".
*If the respondent mentions and counts "auras" as seizures accept the response. If a respondent indicates that he/she has
had nothing more than an aura and is unsure about counting the aura(s), do NOT count auras as seizures.
0None
1One
2Two or three
3Between four and ten
4More than 10
7Refused
9Don't know
UniverseText:Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:
(0-4,R,D) [goto EPILEP4]