HC1
Refer to item C2 to determine if a condition page was completed for the main condition in 4. Enter condition number, or mark box.
HC1
____ Cond. number (NP)
[] No condition page
5. When did -- first notice his (main condition in 4)?
1 [] Last week
2 [] Week before
3 [] Past 2 weeks, DK which
4 [] 2 weeks - 3 months
5 [] Over 3-12 months
6 [] More than 12 months ago