Survey Text

2017 2013 2009 2005
2016 2012 2008 2004
2015 2011 2007
2014 2010 2006
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2017
Survey form view entire document:  text  image

Question ID:FIJ.052_00.000

Instrument Variable Name: IPDATEMT
Question Text:

(book) F3 ? [F1] Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill: ^IPDATEM (text)]?
1 Beginning
2 Middle
3 End
7 Refused
9 Don't know
Universe Text All injury/poisoning episodes where don't know was entered for day of episode
Skip Instructions:
go to IPHOW

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2016

No questionnaire text is available for this sample.


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2015

No questionnaire text is available for this sample.


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2014

No questionnaire text is available for this sample.


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2013

No questionnaire text is available for this sample.


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2012

No questionnaire text is available for this sample.


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2011

No questionnaire text is available for this sample.


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2010

No questionnaire text is available for this sample.


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2009

No questionnaire text is available for this sample.


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2008

No questionnaire text is available for this sample.


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2007

No questionnaire text is available for this sample.


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2006

No questionnaire text is available for this sample.


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2005

No questionnaire text is available for this sample.


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2004
Survey form view entire document:  text  image

FIJ.050_01.000

Instrument Variable Name: IPDATEM
Question Text:
1 of 3
*Please hand the calendar card to the respondent.
{if only 1 injury/poisoning episode for the person}
When did [fill1: your/ALIAS's] [fill2: injury/poisoning] happen for which a medical professional was consulted?
{first of multiple injury/poisoning episodes for the person}
Now I'm going to ask a few questions about the [fill3: ^MTFINJ3M/^MTFPOI3M] times [fill4: you were/ALIAS was] [fill5: injured/poisoned] for which a medical professional was consulted. Starting with the most recent time, when did this [fill2: injury/poisoning] happen?
{second plus of multiple injury/poisoning episodes for the person}
You just told me about [fill1: your/ALIAS's] [fill6: (month, day of previous event)][fill7:most recent/second most recent/third most recent/fourth most recent [fill2: injury/poisoning]. What was the date of the [fill2: injury/poisoning] before that for which a medical professional was consulted?
*Enter month.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1-12) [goto IPDATED]
(R) [goto IPHOW]
(D) [goto IPDATENO]

FIJ.050_02.000

Instrument Variable Name: IPDATED
Question Text:
2 of 3
*Enter day.
01-31 1-31
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes where a valid month of episode was entered
Skip Instructions:
(1-31) [goto IPDATEY]
(R) [goto IPHOW]
(D) [goto IPDATEMT]

FIJ.050_03.000

Instrument Variable Name: IPDATEY
Question Text:
3 of 3
*Enter year.
2003 2003
2004 2004
9997 Refused
9999 Don't know
Universe Text: All injury/poisoning episodes where a valid day of episode was enetered
Skip Instructions:
if IPDATEM, IPDATED and IPDATEY result in a future date; goto ERR_IPDATEY; else, if IPDATEM, IPDATED and IPDATEY result in a date prior to the start date of the 91 day reference period, goto ERR1_IPDATEY; else, goto IPHOW

FIJ.051_01.000

Instrument Variable Name: IPDATENO
Question Text:
1 of 2
Can you tell me approximately how long ago [fill1: your/ALIAS's] [fill2: injury/poisoning] happened?
*Enter number for time since event.
01-91 1-91
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes where don't know was entered for month of episode
Skip Instructions:
(1-91) [goto IPDATETP]
(R,D) [goto IPHOW]

FIJ.051_02.000

Instrument Variable Name: IPDATETP
Question Text:
2 of 2
*Enter number for time period since event.
^IPDATENO...
1 Days
2 Weeks
3 Months
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes where don't know was entered for month of episode and 1-91 was entered for the "number" part of this two-part question
Skip Instructions:
goto IPHOW

FIJ.052_00.000

Instrument Variable Name: IPDATEMT
Question Text:
(book) F3? [F1]
Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill:^IPDATEM (text)]?
1 Beginning
2 Middle
3 End
7 Refused
9 Don't know

[Flashcard F3 shows numbers 1-31 displayed in a grid, simulating a calendar. The boxes numbers 1-20 are displayed in are white; the boxes numbers 21-31 are displayed in are gray.]
Card F3
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20

21
22 23 24 25 26 27 28
29 30 31

Universe Text: All injury/poisoning episodes where don't know was entered for day of episode
Skip Instructions:
gotoIPHOW