Name

qg_4_b_ii

Label

4 b(ii)

Question Text

Please give the following details about each accident starting with the earliest :

DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Street, etc.)
First Accident 1
Second 2
30 questions before...
Please give the following details about each accident starting with the earliest :
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or Parts injured Age when injured (in years and months) Treatment, Hosp. I.P., Hosp. O.P., Nursing Home, Own home If treated in own home, who gave treatment (Doctor, Nurse, other) Details of any remaining scarring, disability or deformity
First Accident 1
Second 2
Please give the following details about each accident starting with the earliest :
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Street, etc.)
First Accident 1
Second 2
Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since OCTOBER 1955.
Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment ? (Doctor, Nurse, other)
Whooping Cough
Measles
Mumps
Scarlet Fever
76 questions after...
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Code Dimension

Multiple Choice Response Options

Selection Style
SelectOne
Display Code
False
Display Label
True

Code Dimension

Multiple Choice Response Options

Display Code
False
Display Label
False