Question Grid

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, Sreet, etc.)
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First Accident 1
Second 2

Usage

32 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
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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, Sreet, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
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 1954.
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)
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Whooping Cough
Measles
Mumps
Scarlet Fever
57 questions after...
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Dimensions

Code Dimension

Type
Code List
Selection Style
SelectOne
Display Code
False
Display Label
True

Code Dimension

Display Code
False
Display Label
False

Response Options

Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
1
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
2
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
3
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
4