Survey Text

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Some of the following conditions were asked about earlier, but tell me whether or not -- ever had any of these conditions even if they have been mentioned before.
If "Yes," enter condition and number in Item 1, Section J.
Did -- ever have --?

1. Hepatitis?
2. Yellow jaundice?
3. Any other liver trouble?**
4. Colitis?
5. Any other bowel trouble?**
6. An ulcer?
7. A hernia or rupture?
8. Any other condition of the digestive system? **
9. Asthma?
10. Hay fever or allergies?
11. Tonsillitis or enlargement of the tonsils or adenoids?*
12. Tuberculosis?
13. Pneumonia?
14. Any other respiratory, lung or pulmonary condition?**
15. Arthritis of any kind or rheumatism?
16. Curvature of the spine?
17. Clubfoot?
18. Any other condition affecting the bone, cartilage, muscle or tendon?**
19. Eczema or psoriasis (so-rye-uh-sis)?
20. Trouble with acne?
21. Any kind of skin allergy?
22. Any other kind of skin trouble?**
23. Repeated ear infections?
24. Deafness in one or both ears?
25. Any other trouble hearing with one or both ears?**
26. Blindness in one or both eyes?
27. Cataracts?
28. Any other trouble seeing with one or both eyes even when wearing glasses?**
29. A cleft palate or harelip?
30. Stammering or stuttering?
31. Any other speech defect?**
32. Autism or has -- ever been autistic?
33. Palsy or cerebral palsy?
34. Paralysis of any kind?
35. Mental retardation?
36. Epilepsy?
37. Repeated convulsions, seizures, or blackouts?
38. Migraine?
39. Frequent or severe headaches?
40. Meningitis?
41. Chorea (ko-ree-uh) or St. Vitus' dance?
42. Nephritis?
43. Urinary tract infection?
44. Any other kidney trouble?**
45. Diabetes?
46. Goiter or other thyroid trouble?
47. Cystic fibrosis?
48. Anemia or sickle cell anemia?
49. A heart murmur?
50. Cancer or any kind?
51. High blood pressure?
52. Rheumatic fever?
53. Rheumatic heart disease?
54. Congenital heart disease?
55. Any other heart trouble?**
56. Does -- now have - a missing finger, hand, or arm, toe, foot, or leg?
57. Permanent stiffness or any deformity in the back, foot, or leg? (Permanent stiffness - joints will not move at all)
58. Permanent stiffness or any deformity of the fingers, hands or arm?
59. Did -- ever have any other health problem which lasted for at least 3 months which you have not mentioned?
If "Yes," ask: What was the condition?

4a. When was (Condition) first noticed?
(Was it during the past 12 months or before that time?)
(Was it during the past 3 months or before that time?)

4[] 3 months or less (6)
5[] Over 3-12 months (6)
6[] More than 12 months ago

0 [] Condition from 56, 57, or 58 (NC)
6a. Does -- still have this condition?

1[] Y (NC)
2[] N

b. Is this condition completely cured or is it under control?

2[] Cured
3[] Under control
4[] Other - Specify ____