Item
1 Would you say, in general, your health is:
integer
C0516984 (UMLS CUI [1])
Code List
1 Would you say, in general, your health is:
Item
2 Would you say your health compares to other persons your age?
integer
C0018759 (UMLS CUI [1,1])
C0027362 (UMLS CUI [1,2])
Code List
2 Would you say your health compares to other persons your age?
CL Item
better than others your age (1)
CL Item
about the same as others your age (2)
CL Item
worse than others your age (3)
days in bed because of injury
Item
3 During the past two weeks, how many days have you stayed in bed all or most of the day because of illness or injury?
integer
C0221423 (UMLS CUI [1,1])
C0004910 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
11 Have you stayed overnight as a patient in a nursing home or rehabilitation center since we spoke to you on the phone about six months ago?
integer
C0028688 (UMLS CUI [1])
C0034993 (UMLS CUI [2])
Code List
11 Have you stayed overnight as a patient in a nursing home or rehabilitation center since we spoke to you on the phone about six months ago?
reason for admission nursing home
Item
A. If you answered YES, record the reason you were admitted, the name of the hospital, and the month and year you were a patient for EACH time you stayed overnight in a nursing home or rehabilitation center. (Use another sheet of paper to list additional admissions.) Reason for admission:
text
C0028688 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
C0034993 (UMLS CUI [2,1])
C0392360 (UMLS CUI [2,2])
C0809949 (UMLS CUI [2,3])
hospital name
Item
Hospital name:
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
city
Item
City:
text
C0008848 (UMLS CUI [1])
date of hospitalization
Item
Date of hospitalization:
date
C0019993 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
length of stay
Item
text
C0023303 (UMLS CUI [1])
Item
B. Are you currently staying in a nursing home?
integer
C0028688 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Code List
B. Are you currently staying in a nursing home?
Item
12 Have you had pneumonia since we saw you last year?
integer
C0032285 (UMLS CUI [1])
Code List
12 Have you had pneumonia since we saw you last year?
Item
13 Have you had an attack of bronchitis since we saw you last year?
integer
C0006277 (UMLS CUI [1])
Code List
13 Have you had an attack of bronchitis since we saw you last year?
Item
A. Was it confirmed by a doctor?
integer
C0006277 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
Code List
A. Was it confirmed by a doctor?
Item
4 Has a doctor ever told you that you had a myocardial infarction or heart attack?
integer
C0027051 (UMLS CUI [1])
Code List
4 Has a doctor ever told you that you had a myocardial infarction or heart attack?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis myocardial infarction
Item
B. Date of event or diagnosis:
date
C0027051 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor myocardial infarction
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0027051 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0027051 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization myocardial infarction
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0027051 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0027051 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
5 Has a doctor ever told you that you had a new incident of angina pectoris or chest pain due to heart disease since we spoke with you on the phone about six month ago?
integer
C0002962 (UMLS CUI [1])
Code List
5 Has a doctor ever told you that you had a new incident of angina pectoris or chest pain due to heart disease since we spoke with you on the phone about six month ago?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis angina
Item
B. Date of event or diagnosis:
date
C0002962 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor angina
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0002962 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0002962 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization angina
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0002962 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized angina
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0002962 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
6 Has a doctor ever told you that you had a new incident of heart failure or congestive heart failure since we spoke with you on the phone about six month ago?
integer
C0018801 (UMLS CUI [1])
C0018802 (UMLS CUI [2])
Code List
6 Has a doctor ever told you that you had a new incident of heart failure or congestive heart failure since we spoke with you on the phone about six month ago?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis congestive heart failure
Item
B. Date of event or diagnosis:
date
C0018802 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor congestive heart failure
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0018802 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0018802 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization congestive heart failure
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0018802 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized congestive heart failure
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0018802 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
7 Has a doctor ever told you that you had a new incident of intermittent claudication or pain in your legs from a blockage of the arteries since we spoke with you on the phone about six month ago?
integer
C0021775 (UMLS CUI [1])
Code List
7 Has a doctor ever told you that you had a new incident of intermittent claudication or pain in your legs from a blockage of the arteries since we spoke with you on the phone about six month ago?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis intermittent claudication
Item
B. Date of event or diagnosis:
date
C0021775 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor intermittent claudication
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0021775 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0021775 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization intermittent claudication
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0021775 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized intermittent claudication
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0021775 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
8 Has a doctor ever told you that you had a new stroke or cerebrovascular accident since we spoke with you on the phone about six month ago?
integer
C0038454 (UMLS CUI [1])
Code List
8 Has a doctor ever told you that you had a new stroke or cerebrovascular accident since we spoke with you on the phone about six month ago?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis cerebrovascular accident
Item
B. Date of event or diagnosis:
date
C0038454 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor cerebrovascular accident
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0038454 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization cerebrovascular accident
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized cerebrovascular accident
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
9 Has a doctor ever told you that you had a new transient ischemic attack or TIA or silent stroke since we spoke with you on the phone about six month ago?
integer
C0007787 (UMLS CUI [1])
Code List
9 Has a doctor ever told you that you had a new transient ischemic attack or TIA or silent stroke since we spoke with you on the phone about six month ago?
name doctor
Item
A. What was the doctor's name and city? Name
text
C0031831 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
doctor address
Item
A. What was the doctor's name and city? Address
text
C0031831 (UMLS CUI [1,1])
C1442065 (UMLS CUI [1,2])
doctor city
Item
A. What was the doctor's name and city? City
text
C0031831 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
doctor state
Item
A. What was the doctor's name and city? State
text
C0031831 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
date of diagnosis TIA
Item
B. Date of event or diagnosis:
date
C0007787 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
see doctor TIA
Item
C. How many times altogether did you see a doctor for this condition since we last spoke to you?
text
C0007787 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
Item
D. Were you in the hospital at least one night for this condition since we last spoke to you?
integer
C0019993 (UMLS CUI [1,1])
C0007787 (UMLS CUI [1,2])
Code List
D. Were you in the hospital at least one night for this condition since we last spoke to you?
hospitalization TIA
Item
E. How many different times were you in the hospital for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0007787 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
date of hospitalization
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Date of Hospitalization:
date
C0011008 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C0809949 (UMLS CUI [1,3])
hospital name
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. Hospital name
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
hospital city
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. City
text
C0019994 (UMLS CUI [1,1])
C0008848 (UMLS CUI [1,2])
hospital state
Item
F. Please record the admission date of each hospitalization and the name and location of the hospital. State
text
C0019994 (UMLS CUI [1,1])
C1301808 (UMLS CUI [1,2])
days altogether hospitalized TIA
Item
G. How many days altogether were you hospitalized for this condition?
integer
C0019993 (UMLS CUI [1,1])
C0007787 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
Item
10 Have you stayed overnight as a patient in a hospital for any other reason not reported in Questions 3 through 9 since we spoke to you on the phone about six months ago?
integer
C0392360 (UMLS CUI [1,1])
C0809949 (UMLS CUI [1,2])
Code List
10 Have you stayed overnight as a patient in a hospital for any other reason not reported in Questions 3 through 9 since we spoke to you on the phone about six months ago?
hospital name
Item
Hospital name:
text
C0019994 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
city
Item
City:
text
C0008848 (UMLS CUI [1])
date of hospitalization
Item
Date of hospitalization:
date
C0019993 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
length of stay
Item
text
C0023303 (UMLS CUI [1])