English

SECTION 2: Initial Demographics

14 forms  
Section 2. INITIAL SCREENING
Description

Section 2. INITIAL SCREENING

Do any of your children’) currently need or use medicine prescribed by a doctor, other than vitamins?
Description

READ IF NECESSARY: This applies to ANY medications prescribed by a doctor. Do not include over-the-counter medications such as cold or headache medications, or any vitamins, minerals, or supplements that can be purchased without a prescription. THESE QUESTIONS REFER ONLY TO A CURRENT CONDITION. THE RESPONDENT SHOULD ONLY REPLY WITH "YES" IF THE CHILD CURRENTLY HAS A SPECIAL HEALTH CARE NEED.

Data type

integer

Alias
UMLS CUI [1]
C2347852
Is [his/her] need for prescription medicine because of ANY medical, behavioral or other health condition?
Description

CSHCN1_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0348080
Is this a condition that has lasted or is expected to last 12 months or longer?
Description

asked only for a YES response to CSHCN1_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0348080
UMLS CUI [1,4]
C2826184
Does [CHILD'S NAME] need or use more medical care, mental health or educational services than is usual for most children of the same age?
Description

READ IF NECESSARY: The child requires more medical care, the use of more mental health services, or the use of more educational services than most children the same age. THESE QUESTIONS REFER ONLY TO A CURRENT CONDITION. THE RESPONDENT SHOULD ONLY REPLY WITH "YES" IF THE CHILD CURRENTLY NEEDS OR USES SERVICES.

Data type

integer

Alias
UMLS CUI [1,1]
C0496675
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
Is [his/her] need for medical care, mental health, or educational services because of ANY medical, behavioral or other health condition?
Description

CSHCN2_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C0496675
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
UMLS CUI [1,4]
C0392360
UMLS CUI [1,5]
C0348080
Is this a condition that has lasted or is expected to last 12 months or longer?
Description

CSHCN2_B_X

Data type

integer

Alias
UMLS CUI [1,1]
C0496675
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
UMLS CUI [1,4]
C0392360
UMLS CUI [1,5]
C0348080
UMLS CUI [1,6]
C0392360
UMLS CUI [1,7]
C0348080
UMLS CUI [1,8]
C2826184
Is [CHILD'S NAME] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do?
Description

Read if necessary: A child is limited or prevented when there are things the child can't do as much or can't do at all that most children the same age can. THIS QUESTION REFERS ONLY TO CURRENT LIMITATIONS. THE RESPONDENT SHOULD REPLY WITH "YES" IF THE CHILD IS CURRENTLY LIMITED.

Data type

integer

Alias
UMLS CUI [1,1]
C0449295
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
Description

CSHCN3_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C0449295
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
UMLS CUI [1,4]
C0392360
UMLS CUI [1,5]
C0348080
Is this a condition that has lasted or is expected to last 12 months or longer?
Description

CSHCN3_B_X

Data type

integer

Alias
UMLS CUI [1,1]
C0449295
UMLS CUI [1,2]
C0439093
UMLS CUI [1,3]
C0030767
UMLS CUI [1,4]
C0392360
UMLS CUI [1,5]
C0348080
UMLS CUI [1,6]
C2826184
Does [CHILD'S NAME] need or get special therapy, such as physical, occupational, or speech therapy?
Description

READ IF NECESSARY: Special therapy includes physical, occupational, or speech therapy. This is centered on physical needs, and things like psychological therapy are not included here. THIS QUESTION REFERS ONLY TO A CURRENT SPECIAL THERAPY. THE RESPONDENT SHOULD ONLY REPLY WITH "YES" IF THE CHILD CURRENTLY NEEDS OR USES SPECIAL THERAPY.

Data type

integer

Alias
UMLS CUI [1]
C0949766
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
Description

CSHCN4_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C0949766
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0348080
Is this a condition that has lasted or is expected to last 12 months or longer?
Description

CSHCN4_B_X

Data type

integer

Alias
UMLS CUI [1,1]
C0949766
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0348080
UMLS CUI [1,4]
C2826184
Do any of your children have any kind of emotional, developmental, or behavioral problem for which they need treatment or counseling?
Description

READ IF NECESSARY: These are remedies, therapy, or guidance a child may receive for his/her emotional, developmental, or behavioral problem. THESE QUESTIONS REFER ONLY TO A CURRENT NEED FOR TREATMENT OR COUNSELING. THE RESPONDENT SHOULD ONLY REPLY WITH "YES" IF THE CHILD CURRENTLY NEEDS OR USES TREATMENT OR COUNSELING.

Data type

integer

Alias
UMLS CUI [1]
C0848067
Has [his/her]’s emotional, developmental, or behavioral problem lasted or expected to last for 12 months or longer?
Description

CSHCN5_A_X

Data type

integer

Alias
UMLS CUI [1,1]
C0848067
UMLS CUI [1,2]
C2826184
Back to the top of the page

Similar models

SECTION 2: Initial Demographics

14 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Section 2. INITIAL SCREENING
Item
Do any of your children’) currently need or use medicine prescribed by a doctor, other than vitamins?
integer
C2347852 (UMLS CUI [1])
C10Q02A
Code List
Do any of your children’) currently need or use medicine prescribed by a doctor, other than vitamins?
CL Item
BIOLOGICAL MOTHER (01)
CL Item
STEP MOTHER (02)
CL Item
FOSTER MOTHER (03)
CL Item
ADOPTIVE MOTHER (04)
CL Item
MOTHER, but TYPE REFUSED (05)
CL Item
BIOLOGICAL FATHER (06)
CL Item
STEP FATHER (07)
CL Item
FOSTER FATHER (08)
CL Item
ADOPTIVE FATHER (09)
CL Item
FATHER, but TYPE REFUSED (10)
CL Item
GRANDMOTHER (11)
CL Item
GRANDFATHER (12)
CL Item
AUNT (13)
CL Item
UNCLE (14)
CL Item
FEMALE GUARDIAN (15)
CL Item
MALE GUARDIAN (16)
CL Item
SISTER (BIOLOGICAL) (17)
CL Item
SISTER ( STEP) (18)
CL Item
SISTER ( FOSTER) (19)
CL Item
SISTER (HALF) (20)
CL Item
SISTER (ADOPTIVE) (21)
CL Item
BROTHER (BIOLOGICAL) (22)
CL Item
BROTHER (STEP) (23)
CL Item
BROTHER (FOSTER) (24)
CL Item
BROTHER ( HALF) (25)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
CL Item
BROTHER (ADOPTIVE) (26)
CL Item
COUSIN (27)
CL Item
IN-LAW OF ANY TYPE (28)
CL Item
OTHER RELATIVE/FAMILY MEMBER (29)
CL Item
PARENT'S BOYFRIEND/MALE PARTNER (30)
CL Item
PARENT'S GIRLFRIEND/FEMALE PARTNER (31)
CL Item
PARENT'S PARTNER, but SEX REFUSED (32)
CL Item
OTHER NON-RELATIVE OR FRIEND (33)
Item
Is [his/her] need for prescription medicine because of ANY medical, behavioral or other health condition?
integer
C2347852 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0348080 (UMLS CUI [1,3])
C10Q20
Code List
Is [his/her] need for prescription medicine because of ANY medical, behavioral or other health condition?
CL Item
8th GRADE OR LESS (01)
CL Item
9th-12th GRADE NO DIPLOMA (02)
CL Item
HIGH SCHOOL GRADUATE OR GED COMPLETED (03)
CL Item
COMPLETED A VOCATIONAL TRADE, OR BUSINESS SCHOOL PROGRAM (04)
CL Item
SOME COLLEGE CREDIT BUT NO DEGREE (05)
CL Item
ASSOCIATE DEGREE (AA, AS) (06)
CL Item
BACHELOR'S DEGREE (BA, BS, AB) (07)
CL Item
MASTER'S DEGREE (MA, MSW, MBA) (08)
CL Item
DOCTORATE (PhD, EdD) OR PROFESSIONAL DEGREE (MD, DDS, DVM, JD) (09)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Is this a condition that has lasted or is expected to last 12 months or longer?
integer
C2347852 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0348080 (UMLS CUI [1,3])
C2826184 (UMLS CUI [1,4])
C10Q20
Code List
Is this a condition that has lasted or is expected to last 12 months or longer?
CL Item
8th GRADE OR LESS (01)
CL Item
9th-12th GRADE NO DIPLOMA (02)
CL Item
HIGH SCHOOL GRADUATE OR GED COMPLETED (03)
CL Item
COMPLETED A VOCATIONAL TRADE, OR BUSINESS SCHOOL PROGRAM (04)
CL Item
SOME COLLEGE CREDIT BUT NO DEGREE (05)
CL Item
ASSOCIATE DEGREE (AA, AS) (06)
CL Item
BACHELOR'S DEGREE (BA, BS, AB) (07)
CL Item
MASTER'S DEGREE (MA, MSW, MBA) (08)
CL Item
DOCTORATE (PhD, EdD) OR PROFESSIONAL DEGREE (MD, DDS, DVM, JD) (09)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Does [CHILD'S NAME] need or use more medical care, mental health or educational services than is usual for most children of the same age?
integer
C0496675 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C10Q02A
Code List
Does [CHILD'S NAME] need or use more medical care, mental health or educational services than is usual for most children of the same age?
CL Item
BIOLOGICAL MOTHER (01)
CL Item
STEP MOTHER (02)
CL Item
FOSTER MOTHER (03)
CL Item
ADOPTIVE MOTHER (04)
CL Item
MOTHER, but TYPE REFUSED (05)
CL Item
BIOLOGICAL FATHER (06)
CL Item
STEP FATHER (07)
CL Item
FOSTER FATHER (08)
CL Item
ADOPTIVE FATHER (09)
CL Item
FATHER, but TYPE REFUSED (10)
CL Item
GRANDMOTHER (11)
CL Item
GRANDFATHER (12)
CL Item
AUNT (13)
CL Item
UNCLE (14)
CL Item
FEMALE GUARDIAN (15)
CL Item
MALE GUARDIAN (16)
CL Item
SISTER (BIOLOGICAL) (17)
CL Item
SISTER ( STEP) (18)
CL Item
SISTER ( FOSTER) (19)
CL Item
SISTER (HALF) (20)
CL Item
SISTER (ADOPTIVE) (21)
CL Item
BROTHER (BIOLOGICAL) (22)
CL Item
BROTHER (STEP) (23)
CL Item
BROTHER (FOSTER) (24)
CL Item
BROTHER ( HALF) (25)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
CL Item
BROTHER (ADOPTIVE) (26)
CL Item
COUSIN (27)
CL Item
IN-LAW OF ANY TYPE (28)
CL Item
OTHER RELATIVE/FAMILY MEMBER (29)
CL Item
PARENT'S BOYFRIEND/MALE PARTNER (30)
CL Item
PARENT'S GIRLFRIEND/FEMALE PARTNER (31)
CL Item
PARENT'S PARTNER, but SEX REFUSED (32)
CL Item
OTHER NON-RELATIVE OR FRIEND (33)
Item
Is [his/her] need for medical care, mental health, or educational services because of ANY medical, behavioral or other health condition?
integer
C0496675 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0348080 (UMLS CUI [1,5])
C10Q20
Code List
Is [his/her] need for medical care, mental health, or educational services because of ANY medical, behavioral or other health condition?
CL Item
8th GRADE OR LESS (01)
CL Item
9th-12th GRADE NO DIPLOMA (02)
CL Item
HIGH SCHOOL GRADUATE OR GED COMPLETED (03)
CL Item
COMPLETED A VOCATIONAL TRADE, OR BUSINESS SCHOOL PROGRAM (04)
CL Item
SOME COLLEGE CREDIT BUT NO DEGREE (05)
CL Item
ASSOCIATE DEGREE (AA, AS) (06)
CL Item
BACHELOR'S DEGREE (BA, BS, AB) (07)
CL Item
MASTER'S DEGREE (MA, MSW, MBA) (08)
CL Item
DOCTORATE (PhD, EdD) OR PROFESSIONAL DEGREE (MD, DDS, DVM, JD) (09)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Is this a condition that has lasted or is expected to last 12 months or longer?
integer
C0496675 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0348080 (UMLS CUI [1,5])
C0392360 (UMLS CUI [1,6])
C0348080 (UMLS CUI [1,7])
C2826184 (UMLS CUI [1,8])
C10Q20
Code List
Is this a condition that has lasted or is expected to last 12 months or longer?
CL Item
8th GRADE OR LESS (01)
CL Item
9th-12th GRADE NO DIPLOMA (02)
CL Item
HIGH SCHOOL GRADUATE OR GED COMPLETED (03)
CL Item
COMPLETED A VOCATIONAL TRADE, OR BUSINESS SCHOOL PROGRAM (04)
CL Item
SOME COLLEGE CREDIT BUT NO DEGREE (05)
CL Item
ASSOCIATE DEGREE (AA, AS) (06)
CL Item
BACHELOR'S DEGREE (BA, BS, AB) (07)
CL Item
MASTER'S DEGREE (MA, MSW, MBA) (08)
CL Item
DOCTORATE (PhD, EdD) OR PROFESSIONAL DEGREE (MD, DDS, DVM, JD) (09)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Is [CHILD'S NAME] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do?
integer
C0449295 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C10Q02A
Code List
Is [CHILD'S NAME] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do?
CL Item
BIOLOGICAL MOTHER (01)
CL Item
STEP MOTHER (02)
CL Item
FOSTER MOTHER (03)
CL Item
ADOPTIVE MOTHER (04)
CL Item
MOTHER, but TYPE REFUSED (05)
CL Item
BIOLOGICAL FATHER (06)
CL Item
STEP FATHER (07)
CL Item
FOSTER FATHER (08)
CL Item
ADOPTIVE FATHER (09)
CL Item
FATHER, but TYPE REFUSED (10)
CL Item
GRANDMOTHER (11)
CL Item
GRANDFATHER (12)
CL Item
AUNT (13)
CL Item
UNCLE (14)
CL Item
FEMALE GUARDIAN (15)
CL Item
MALE GUARDIAN (16)
CL Item
SISTER (BIOLOGICAL) (17)
CL Item
SISTER ( STEP) (18)
CL Item
SISTER ( FOSTER) (19)
CL Item
SISTER (HALF) (20)
CL Item
SISTER (ADOPTIVE) (21)
CL Item
BROTHER (BIOLOGICAL) (22)
CL Item
BROTHER (STEP) (23)
CL Item
BROTHER (FOSTER) (24)
CL Item
BROTHER ( HALF) (25)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
CL Item
BROTHER (ADOPTIVE) (26)
CL Item
COUSIN (27)
CL Item
IN-LAW OF ANY TYPE (28)
CL Item
OTHER RELATIVE/FAMILY MEMBER (29)
CL Item
PARENT'S BOYFRIEND/MALE PARTNER (30)
CL Item
PARENT'S GIRLFRIEND/FEMALE PARTNER (31)
CL Item
PARENT'S PARTNER, but SEX REFUSED (32)
CL Item
OTHER NON-RELATIVE OR FRIEND (33)
Item
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
integer
C0449295 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0348080 (UMLS CUI [1,5])
HISPANIC
Code List
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
CL Item
Hispanic (1)
CL Item
Latino (2)
CL Item
Spanish (3)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Is this a condition that has lasted or is expected to last 12 months or longer?
integer
C0449295 (UMLS CUI [1,1])
C0439093 (UMLS CUI [1,2])
C0030767 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0348080 (UMLS CUI [1,5])
C2826184 (UMLS CUI [1,6])
C10Q32_X
Code List
Is this a condition that has lasted or is expected to last 12 months or longer?
CL Item
White (1)
CL Item
Black or African American (2)
CL Item
American Indian (3)
CL Item
Alaska Native (4)
CL Item
Asian (5)
CL Item
Native Hawaiian (6)
CL Item
other Pacific Islander (7)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Does [CHILD'S NAME] need or get special therapy, such as physical, occupational, or speech therapy?
integer
C0949766 (UMLS CUI [1])
C10Q02A
Code List
Does [CHILD'S NAME] need or get special therapy, such as physical, occupational, or speech therapy?
CL Item
BIOLOGICAL MOTHER (01)
CL Item
STEP MOTHER (02)
CL Item
FOSTER MOTHER (03)
CL Item
ADOPTIVE MOTHER (04)
CL Item
MOTHER, but TYPE REFUSED (05)
CL Item
BIOLOGICAL FATHER (06)
CL Item
STEP FATHER (07)
CL Item
FOSTER FATHER (08)
CL Item
ADOPTIVE FATHER (09)
CL Item
FATHER, but TYPE REFUSED (10)
CL Item
GRANDMOTHER (11)
CL Item
GRANDFATHER (12)
CL Item
AUNT (13)
CL Item
UNCLE (14)
CL Item
FEMALE GUARDIAN (15)
CL Item
MALE GUARDIAN (16)
CL Item
SISTER (BIOLOGICAL) (17)
CL Item
SISTER ( STEP) (18)
CL Item
SISTER ( FOSTER) (19)
CL Item
SISTER (HALF) (20)
CL Item
SISTER (ADOPTIVE) (21)
CL Item
BROTHER (BIOLOGICAL) (22)
CL Item
BROTHER (STEP) (23)
CL Item
BROTHER (FOSTER) (24)
CL Item
BROTHER ( HALF) (25)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
CL Item
BROTHER (ADOPTIVE) (26)
CL Item
COUSIN (27)
CL Item
IN-LAW OF ANY TYPE (28)
CL Item
OTHER RELATIVE/FAMILY MEMBER (29)
CL Item
PARENT'S BOYFRIEND/MALE PARTNER (30)
CL Item
PARENT'S GIRLFRIEND/FEMALE PARTNER (31)
CL Item
PARENT'S PARTNER, but SEX REFUSED (32)
CL Item
OTHER NON-RELATIVE OR FRIEND (33)
Item
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
integer
C0949766 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0348080 (UMLS CUI [1,3])
C10Q40
Code List
Is [his/her]’s limitation in abilities because of ANY medical, behavioral or other health condition?
CL Item
ENGLISH (01)
CL Item
SPANISH (02)
CL Item
ANY OTHER LANGUAGE (03)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Is this a condition that has lasted or is expected to last 12 months or longer?
integer
C0949766 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0348080 (UMLS CUI [1,3])
C2826184 (UMLS CUI [1,4])
C10Q41
Code List
Is this a condition that has lasted or is expected to last 12 months or longer?
CL Item
OWNED OR BEING BOUGHT (01)
CL Item
RENTED (02)
CL Item
SOME OTHER ARRANGEMENT (03)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
Item
Do any of your children have any kind of emotional, developmental, or behavioral problem for which they need treatment or counseling?
integer
C0848067 (UMLS CUI [1])
C10Q02A
Code List
Do any of your children have any kind of emotional, developmental, or behavioral problem for which they need treatment or counseling?
CL Item
BIOLOGICAL MOTHER (01)
CL Item
STEP MOTHER (02)
CL Item
FOSTER MOTHER (03)
CL Item
ADOPTIVE MOTHER (04)
CL Item
MOTHER, but TYPE REFUSED (05)
CL Item
BIOLOGICAL FATHER (06)
CL Item
STEP FATHER (07)
CL Item
FOSTER FATHER (08)
CL Item
ADOPTIVE FATHER (09)
CL Item
FATHER, but TYPE REFUSED (10)
CL Item
GRANDMOTHER (11)
CL Item
GRANDFATHER (12)
CL Item
AUNT (13)
CL Item
UNCLE (14)
CL Item
FEMALE GUARDIAN (15)
CL Item
MALE GUARDIAN (16)
CL Item
SISTER (BIOLOGICAL) (17)
CL Item
SISTER ( STEP) (18)
CL Item
SISTER ( FOSTER) (19)
CL Item
SISTER (HALF) (20)
CL Item
SISTER (ADOPTIVE) (21)
CL Item
BROTHER (BIOLOGICAL) (22)
CL Item
BROTHER (STEP) (23)
CL Item
BROTHER (FOSTER) (24)
CL Item
BROTHER ( HALF) (25)
CL Item
DON'T KNOW (77)
CL Item
REFUSED (99)
CL Item
BROTHER (ADOPTIVE) (26)
CL Item
COUSIN (27)
CL Item
IN-LAW OF ANY TYPE (28)
CL Item
OTHER RELATIVE/FAMILY MEMBER (29)
CL Item
PARENT'S BOYFRIEND/MALE PARTNER (30)
CL Item
PARENT'S GIRLFRIEND/FEMALE PARTNER (31)
CL Item
PARENT'S PARTNER, but SEX REFUSED (32)
CL Item
OTHER NON-RELATIVE OR FRIEND (33)
CSHCN5_A_X
Item
Has [his/her]’s emotional, developmental, or behavioral problem lasted or expected to last for 12 months or longer?
integer
C0848067 (UMLS CUI [1,1])
C2826184 (UMLS CUI [1,2])
Back to the top of the page