Question Grid

Name

qg_10_i

Label

10 i

Question Text

please give details in the table below. Use one row for each medication. Be sure to include use of puffer or inhaler or any medication for breathing, and any medications bought from a pharmacy.Use spare medication sheets if necessary and attach to questionaire

Name of medicine How many hours ago did you last take the medicine? Do you take this medicine regularly? Is this medicine prescribed by your GP or consultant?
Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

1
2
3
4
5
6
7
8
9
10
11
12
13

Usage

40 questions before...

Check whether they have brought their regular medicines with them and ask: Have you taken any medicines, prescribed or non-prescribed, in the last 24 hours?

1
Yes
0
No
please give details in the table below. Use one row for each medication. Be sure to include use of puffer or inhaler or any medication for breathing, and any medications bought from a pharmacy.Use spare medication sheets if necessary and attach to questionaire
Name of medicine How many hours ago did you last take the medicine? Do you take this medicine regularly? Is this medicine prescribed by your GP or consultant?
Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

Generic textHow many

1 - Yes

0 - No

1 - Yes

0 - No

How many

1 - Yes

0 - No

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How many

1 - Yes

0 - No

Generic text

1 - Yes

0 - No

How manyGeneric text

1 - Yes

0 - No

1
2
3
4
5
6
7
8
9
10
11
12
13

Has a doctor told you that you have any of the following health problems? Health Problem High blood pressure

1
YES
0
NO
304 questions after...

Dimensions

Code Dimension

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

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
Numeric
Type
Integer
Minimum
0
Variable is a Weight
False
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
2
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
3
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
4
Type
Numeric
Type
Integer
Minimum
0
Variable is a Weight
False
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
5
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
6
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
7
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
8
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
9
Type
Numeric
Type
Integer
Minimum
0
Variable is a Weight
False
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
10
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
11
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
12
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
13
Type
Numeric
Type
Integer
Minimum
0
Variable is a Weight
False
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
14
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
15
Type
Code List
Selection Style
SelectOne
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
16