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
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? A. High blood pressure
integer
C0020538 (UMLS CUI [1])
Code List
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? A. High blood pressure
CL Item
FIRST TOLD DURING THE PAST YEAR (2)
CL Item
FIRST TOLD MORE THAN ONE YEAR AGO (3)
Item
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? B. Diabetes
integer
C0011849 (UMLS CUI [1])
Code List
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? B. Diabetes
CL Item
FIRST TOLD DURING THE PAST YEAR (2)
CL Item
FIRST TOLD MORE THAN ONE YEAR AGO (3)
Item
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? C. Atrial Fibrillation
integer
C0004238 (UMLS CUI [1])
Code List
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? C. Atrial Fibrillation
CL Item
FIRST TOLD DURING THE PAST YEAR (2)
CL Item
FIRST TOLD MORE THAN ONE YEAR AGO (3)
Item
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? D. Deep vein thrombosis (or blood clots in your legs)
integer
C0149871 (UMLS CUI [1])
Code List
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? D. Deep vein thrombosis (or blood clots in your legs)
CL Item
FIRST TOLD DURING THE PAST YEAR (2)
CL Item
FIRST TOLD MORE THAN ONE YEAR AGO (3)
Item
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? E. Rheumatic fever or heart valve problems
integer
C3536892 (UMLS CUI [1])
Code List
14 Has a doctor ever told you that you had any of the following conditions or diseases; and if so, when were you FIRST told that you had the condition? E. Rheumatic fever or heart valve problems
CL Item
FIRST TOLD DURING THE PAST YEAR (2)
CL Item
FIRST TOLD MORE THAN ONE YEAR AGO (3)
Item
15 Has a doctor ever told you that you had other heart or circulatory problems since we saw you last year?
integer
C0007222 (UMLS CUI [1])
Code List
15 Has a doctor ever told you that you had other heart or circulatory problems since we saw you last year?
other heart problem
Item
Specify:
text
C0795691 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? A. High blood pressure
integer
C0013227 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Code List
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? A. High blood pressure
Item
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? B. Diabetes
integer
C0013227 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
Code List
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? B. Diabetes
Item
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? C. Atrial Fibrillation
integer
C0013227 (UMLS CUI [1,1])
C0004238 (UMLS CUI [1,2])
Code List
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? C. Atrial Fibrillation
Item
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? D. Deep vein thrombosis (or blood clots in your legs)
integer
C0013227 (UMLS CUI [1,1])
C0149871 (UMLS CUI [1,2])
Code List
16 Are you currently taking medication prescribed by a doctor for any of the following conditions? D. Deep vein thrombosis (or blood clots in your legs)
Item
17 Have you had coronary angiography or heart catheterization as an out patient procedure since we saw you last year?
integer
C0085532 (UMLS CUI [1])
C0018795 (UMLS CUI [2])
Code List
17 Have you had coronary angiography or heart catheterization as an out patient procedure since we saw you last year?
pain in chest
Item
18 Have you ever had any pain or discomfort in your chest?
boolean
C0008031 (UMLS CUI [1])
Item
A. Do you feel pain when you walk uphill or hurry?
integer
C0008031 (UMLS CUI [1,1])
C3842654 (UMLS CUI [1,2])
Code List
A. Do you feel pain when you walk uphill or hurry?
CL Item
never hurry or walk uphill (9)
chest pain walking
Item
B. Do you feel the pain when you walk at an ordinary pace or level?
boolean
C0008031 (UMLS CUI [1,1])
C0080331 (UMLS CUI [1,2])
Item
C. What do you do if you feel it while you are walking?
integer
C0008031 (UMLS CUI [1])
Code List
C. What do you do if you feel it while you are walking?
CL Item
stop or slow down, or continue at same pace after taking nitroglycerine (1)
CL Item
stop or slow down (2)
Item
D. If you stand still, what happens to the pain?
integer
C0008031 (UMLS CUI [1,1])
C0035253 (UMLS CUI [1,2])
Code List
D. If you stand still, what happens to the pain?
CL Item
relieved in 10 minutes or less (1)
CL Item
takes longer than 10 minutes to be relieved (2)
Item
E. Where do you get this pain or discomfort?
text
C0008031 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
Code List
E. Where do you get this pain or discomfort?
chest pain localization other
Item
Other, specify:
text
C0008031 (UMLS CUI [1,1])
C0475264 (UMLS CUI [1,2])
chest pain past two weeks
Item
F. Have you had this pain in the past two weeks?
boolean
C0008031 (UMLS CUI [1,1])
C0332185 (UMLS CUI [1,2])
chest pain frequency
Item
If yes, how many times in the past two weeks have you had this pain?
text
C0008031 (UMLS CUI [1,1])
C0332185 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,3])
worsening chest pain
Item
G. Has there been an increase in the frequency or severity in the past two weeks?
boolean
C0332271 (UMLS CUI [1,1])
C0008031 (UMLS CUI [1,2])
C0332185 (UMLS CUI [1,3])
chest pain seen by doctor
Item
H. Have you seen a doctor about this pain?
boolean
C0008031 (UMLS CUI [1,1])
C0583527 (UMLS CUI [1,2])
severe chest pain
Item
I. Have you ever had a severe pain accross the front of your chest lasting for half an hour or more?
boolean
C0008031 (UMLS CUI [1,1])
C0205082 (UMLS CUI [1,2])
severe chest pain seen by doctor
Item
J. Did you see a doctor because of this pain?
text
C0008031 (UMLS CUI [1,1])
C0205082 (UMLS CUI [1,2])
C0583527 (UMLS CUI [1,3])
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])