Start
alspac_00_msdh
My Daughter's Health
This should be completed by the study child's chief carer
All answers are confidential
To answer simply tick the box that is most accurate in your opinion.
If you cannot answer certain questions leave them out and go on to the next one.
THANK YOU FOR YOUR HELP
SECTION A: YOUR CHILD'S HEALTH
The health of your study child is still of great importance to us. We would like to know about any recent illnesses or medical treatments.

How would you assess the health of your child nowadays? in the past month

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

How would you assess the health of your child nowadays? in the past year

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

In the past 12 months has the doctor been called to your home because your daughter was unwell?

1
Yes
2
No
If no, go to A3 below
If yes,
qc_A2_a == 1

how many times?

1
once
2
2 times
3
3-4 times
4
5 or more times
Has she had any of the following in the past 12 months?
-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
snuffles/cold
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
urinary infection
headache(s )
constipation
worm infections
head lice
scabies
asthma
eczema
hay fever

Has she had any of the following in the past 12 months? In the past 12 months: other (please tick and describe)

1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other
In the past 12 months, has she had any of the following infections?
-

1 - Yes

2 - No

measles
chicken pox
mumps
meningitis
cold sores
whooping cough
urinary infection
eye infection
ear infection
chest infection
tonsillitis or laryngitis
german measles
scarlet fever
influenza (flu)
a cold

In the past 12 months, has she had any of the following infections? In the past 12 months: other infection (please tick & describe)

1
Yes
2
No
Other

Has your child been admitted to hospital in the past 2 years?

1
Yes
2
No
If no, go to A6 below
If yes,
qc_A5_a == 1

how many times?

How many
please describe for each admission:
Age of child (years) Reason for admission No. of nights child stayed in hospital
How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many
1
2
3
If more than 3 admissions please describe on separate sheet

How often did you see her while she was in hospital? 1st admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her

How often did you see her while she was in hospital? 2nd admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her

How often did you see her while she was in hospital? 3rd admission

1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her

Has she ever had any of the following operations? hernia repair

1
Yes
If yes,
qc_A6_a == 1

please give type

Generic text

Has she ever had any of the following operations? tonsils out

1
Yes

Has she ever had any of the following operations? adenoids out

1
Yes

Has she ever had any of the following operations? appendicectomy (appendix out)

1
Yes

Has she ever had any of the following operations? tubes (grommets) put in her ears

1
Yes

Has she ever had any of the following operations? squint repair (to put eyes straight)

1
Yes

Has she ever had any of the following operations? teeth pulled out

1
Yes

Has she ever had any of the following operations? other operations (please describe)

1
Yes
Other
How many days has she had to take off school for health reasons?
No. of days off school Guess? please describe
GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess
For one or more infections (including colds, cough, flu)
For hospital investigation including admission
For other investigation(s)

How many days has she had to take off school for health reasons? For asthma, eczema or hayfever No. of days off school

How many

How many days has she had to take off school for health reasons? For asthma, eczema or hayfever Guess?

Guess
How many days has she had to take off school for health reasons? For other reasons
No. of days off school Guess?
How manyGuessHow manyGuess How manyGuessHow manyGuess
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months.
- If yes, please give full names of substances if you can

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text
cough medicine
antibiotics/penicillin
throat medicine
vitamins
paracetamol/calpol
ointment for skin
eye ointment
diarrhoea mixture or pills
dimotapp/decongestant
ear drops
eye drops
iron
laxative
homeopathic medicine
herbal medicine
asthma medication
vaporiser

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months. In the last 12 months: other (please tick and describe)

2
Yes for 1-2 episodes only
3
Yes for 3 or more episodes
Other
If yes,
qc_A8_r == 2 || qc_A8_r == 3

please give full names of substances if you can

Generic text

Are there any pills, ointments or medicines that she has taken every day or nearly every day for the last 3 months? (Include vitamins, skin cream, inhaler, laxatives as well as antibiotics, homeopathic and herbal remedies etc.)

1
Yes
2
No
If no, go to A10a below
If yes,
qc_A9_a == 1

please describe:

Generic text

In the past year has she had any periods when there was wheezing with whistling on her chest when she breathed?

1
Yes
2
No
If no, go to A10k on page 10
If yes,
qc_A10_a == 1

How many separate times has this happened in the past 12 months?

1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know

How many days altogether would you say she has wheezed in the past 12 months?

1
1 day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know

Was she breathless during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

Did she have a fever during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

How often, on average, has your child's sleep been disturbed due to wheezing in the past 12 months?

1
Never woken with wheezing
2
Less than one night per week
3
One or more nights per week

Has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths in the past 12 months?

1
Yes
2
No

Do you think the wheezing attacks are worse during any particular time of year?

1
yes, worse in spring and/or summer
2
yes, worse in autumn and/or winter
3
not particularly
4
other (please tick & describe)
Other

What do you think brings on the wheezing attacks ? chest infection or bronchitis

1
Yes
2
No

What do you think brings on the wheezing attacks ? being in a smoky room

1
Yes
2
No

What do you think brings on the wheezing attacks ? cold weather

1
Yes
2
No

What do you think brings on the wheezing attacks ? I don't know

1
Yes

What do you think brings on the wheezing attacks ? other (please tick & describe)

1
Yes
2
No
Other

In the past 12 months has your child's chest sounded wheezy during or after exercise?

1
Yes
2
No

In the past 12 months has your child had a dry cough at night, apart from a cough associated with a cold or chest infection?

1
Yes
2
No

Have any of your other children ever had spells of wheezing with whistling on the chest?

1
Yes
2
No
7
have no other children

Has your child had any itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms) in the past year?

1
Yes
2
No
If no, go to A12a below
If yes,
qc_A11_a == 1

How bad was this?

1
very bad
2
quite bad
3
mild
4
no problem

Does she have this sort of rash now?

1
Yes
2
No

Did the rash ever become sore and oozy?

1
Yes
2
No

Was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?

1
Yes
2
No

Has she had an itchy, dry, rash on her hands in the past year?

1
Yes
2
No

Has she had an itchy, dry rash on her feet in the past year?

1
Yes
2
No
If no, go to A12c on page 12
If yes,
qc_A12_b == 1

please describe which parts of her feet

Generic text

In the past 12 months how often, on average, has your child been kept awake at night by an itchy rash?

1
Never in the past 12 months
2
Less than one night per week
3
One or more nights per week

Does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)

1
Yes
2
No

Has she had a skin reaction in the past year (e.g. redness or itching) which you thought was due to some food that she had eaten?

1
Yes
2
No
If no, go to A14 below
If yes,
qc_A13 == 1

please describe the food(s)

Generic text

how long after the food was eaten did the reaction appear?

Generic text

where was the reaction? (please describe)

1
mouth
2
other part
Generic text
This question is about problems which occur when your child does not have a cold or the flu.

Has your child ever had sneezing episodes, or a runny or blocked nose, when she did not have a cold or the flu?

1
Yes
2
No
If no, go to A14c below
qc_A14_a == 2
Else

In the past 12 months, has your child had sneezing episodes, or a runny or blocked nose, when she did not have a cold or the flu?

1
Yes
2
No

In the past 12 months, has she had itchy-watery eyes?

1
Yes
2
No

In which of the past 12 months did these nose and/or eye problems occur?

7
Hasn't had a nose or eye problem
If Hasn't had a nose or eye problem to question A14d go to A15a below
qc_A14_d_i == 7
Else
In which of the past 12 months did these nose and/or eye problems occur?
-

1 - Yes

January
February
March
April
May
June
July
August
September
October
November
December

In the past 12 months, how much did these nose and eye problems interfere with your child's activities?

1
Not at all
2
A little
3
A moderate amount
4
A lot

Has she had vomiting spells in the past year?

1
Yes
2
No
If no, go to A16a on page 14
If yes,
qc_A15_a == 1

How many times?

1
once
2
twice
3
3-9 times
4
10 or more times

How often have these been associated with: diarrhoea

1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never

How often have these been associated with: chestiness (wheezing or coughing or grunting)

1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never

In the past year has she had diarrhoea or gastro-enteritis?

1
Yes
2
No
If no, go to A17a below
If yes,
qc_A16_a == 1

how many times in the past 12 months?

How many

how many days did the worst attack last?

How many

In the past year has your child ever had a time when she has coughed off and on for at least 2 days?

1
Yes
2
No
If no, go to A18 below
If yes,
qc_A17_a == 1

How many times has this happened in the past year?

1
once
2
twice
3
3-9 times
4
10 or more times

Did she have a fever at any of these times?

1
Yes for all
2
Yes for some
3
No, not at all

Did she have a runny nose during any of these spells?

1
Yes for all
2
Yes for some
3
No, not at all

Has pus or sticky mucus (not ear wax) leaked out of her ear in the past year?

1
never
2
once
3
more than once
9
don't know

Does she breathe through her mouth rather than through her nose? when asleep

1
all the time
2
much of the time
3
sometimes
4
rarely
5
never
9
don't know

Does she breathe through her mouth rather than through her nose? when awake

1
all the time
2
much of the time
3
sometimes
4
rarely
5
never
9
don't know

Does she snore for more than a few minutes at a time?

1
most nights
2
quite often
3
sometimes
4
only rarely
5
never
9
don't know

Have there been times in the past year when she has had a pain in her stomach?

1
Yes
2
No
If no, go to A22a on page 16
If yes,
qc_A21_a == 1

How many separate times has this happened in the past year?

1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know

Did she have vomiting or diarrhoea at the same time as the pain?

1
yes every time
2
yes, for some of the times
3
no, not at all
What do you think were the causes of her stomach pains? (Tick all that apply)
-

1 - Yes

something she ate
an infection
constipation
don't know

What do you think were the causes of her stomach pains? (Tick all that apply) other (please describe)

1
Yes
Other

Does she often have aches and pains in her arms or legs?

1
yes arm(s)
2
yes leg(s)
3
yes both
4
no, not often
If no, go to A23a on page 17
If yes,
qc_A22_a >= 1 && qc_A22_a <= 3

does this happen especially when she is tired?

1
Yes
2
No

what do you think is the cause ?

Generic text

do you find any particular treatment helps ?

1
Yes
2
No
If yes,
qc_A22_a_iii == 1

please describe

Generic text

Since her 7th birthday has she had any form of convulsion, fit, seizure or other turn in which consciousness was lost or any part of the body made an abnormal movement?

1
Yes
2
No
9
Not known
If no, or not known, go to B1 on page 19
If yes,
qc_A23_a == 1

Please describe the first attack since her 7th birthday:

Generic text

Did the child have a high temperature at the time?

1
Yes
2
No
9
Not known

How old was she at the time?

1
7 years
2
8 years
3
9 years

How many attacks has she had since her 7th birthday?

1
one
2
two
3
3-4
4
5 or more
By whom was she seen for these attack(s)? (Tick all that apply)
Yes

1 - Yes

general practitioner at home
general practitioner at surgery
hospital outpatient department
admitted to hospital

What investigations, if any, have been carried out?

Generic text

Did later attacks differ from the first one?

1
yes
2
no
7
Has only had one attack since 7th birthday
If yes,
qc_A23_h == 1

please describe

Generic text
What was/were the attack(s) thought to be due to? (Tick all that apply)
-

1 - Yes

febrile convulsions
fainting and blackouts
epilepsy
breath holding
reaction to immunisation
don't know

What was/were the attack(s) thought to be due to? (Tick all that apply) other (please describe)

1
Yes
Other
SECTION B: COMPLEMENTARY/ALTERNATIVE MEDICINE
We are interested to know if you have ever used complementary/alternative medicine for your child and how helpful you found it.

Has your child ever received any of the following: Acupuncture

1
Yes
2
No

Has your child ever received any of the following: Aromatherapy

1
Yes
2
No

Has your child ever received any of the following: Bach/Flower essences

1
Yes
2
No

Has your child ever received any of the following: Cranial osteopathy

1
Yes
2
No

Has your child ever received any of the following: Herbal medicine

1
Yes
2
No

Has your child ever received any of the following: Homeopathy

1
Yes
2
No

Has your child ever received any of the following: Hypnosis

1
Yes
2
No

Has your child ever received any of the following: Osteopathy

1
Yes
2
No

Has your child ever received any of the following: Reflexology

1
Yes
2
No

Has your child ever received any of the following: Other (please tick and describe)

1
Yes
2
No
Other
If none of these go to Section C [qc_B1_
a-j] == 2
Else
Describe each treatment separately:

Name of 1st treatment (e.g. acupuncture, reflexology etc.):

Generic text
If medicine or preparation was given,

please state the name(s):

Generic text

Child's condition / illness:

Generic text

Age of child when this treatment started: ... years

Age
If less than 1 year
qc_B2_a_iv < '1'

please state in months (put 00 for less than 1 month) months

Months

How helpful did you find this treatment?

1
very helpful
2
somewhat helpful
3
not at all helpful
4
unsure

Name of 2nd treatment (e.g. acupuncture, reflexology etc.):

Generic text
If medicine or preparation was given,

please state the name(s):

Generic text

Child's condition / illness:

Generic text

Age of child when this treatment started: ... years

Age
If less than 1 year {qc_B2_b_iv < '1']

please state in months (put 00 for less than 1 month) months

Months

How helpful did you find this treatment?

1
very helpful
2
somewhat helpful
3
not at all helpful
4
unsure

Name of 3rd treatment (e.g. acupuncture, reflexology etc.):

Generic text
If medicine or preparation was given,

please state the name(s):

Generic text

Child's condition / illness:

Generic text

Age of child when this treatment started: ... years

Age
If less than 1 year {qc_B2_c_iv < '1']

please state in months (put 00 for less than 1 month) months

Months

How helpful did you find this treatment?

1
very helpful
2
somewhat helpful
3
not at all helpful
4
unsure

Name of 4th treatment (e.g. acupuncture, reflexology etc.):

Generic text
If medicine or preparation was given,

please state the name(s):

Generic text

Child's condition / illness:

Generic text

Age of child when this treatment started: ... years

Age
If less than 1 year {qc_B2_d_iv < '1']

If less than 1 year please state in months (put 00 for less than 1 month) months

Months

How helpful did you find this treatment?

1
very helpful
2
somewhat helpful
3
not at all helpful
4
unsure

Name of 5th treatment (e.g. acupuncture, reflexology etc.):

Generic text
If medicine or preparation was given,

please state the name(s):

Generic text

Child's condition / illness:

Generic text

Age of child when this treatment started: ... years

Age
If less than 1 year {qc_B2_e_iv < '1']

please state in months (put 00 for less than 1 month) months

Months

How helpful did you find this treatment?

1
very helpful
2
somewhat helpful
3
not at all helpful
4
unsure
If there were more than 5 different types of treatment please list on a separate page describing them as above.
SECTION C: ALLERGIES

Are there any foods or drinks that your child has had an allergic reaction to since her 7th birthday?

1
yes definitely
2
yes possibly
3
no, not at all
9
don't know
If no, or don't know go to C2a on page 23
If yes,
qc_C1 == 1 || qc_C1 == 2

please describe which foods or drinks

Generic text

was the reaction caused by eating or touching the food or drink?

1
eating/drinking
2
touching
3
both

what happens when she does have the reaction? (Tick all that apply) bright red rash

1
Yes
If yes,
qc_C1_c_i == 1

over what part of body?

Generic text

what happens when she does have the reaction? (Tick all that apply) hives (white raised bumps on skin)

1
Yes
If yes,
qc_C1_c_ii == 1

over what part of body?

Generic text

what happens when she does have the reaction? (Tick all that apply) wheezing or whistling in the chest

1
Yes

what happens when she does have the reaction? (Tick all that apply) vomiting

1
Yes

what happens when she does have the reaction? (Tick all that apply) diarrhoea

1
Yes

what happens when she does have the reaction? (Tick all that apply) difficulty breathing

1
Yes

what happens when she does have the reaction? (Tick all that apply) stop breathing

1
Yes

what happens when she does have the reaction? (Tick all that apply) headache

1
Yes

what happens when she does have the reaction? (Tick all that apply) swelling

1
Yes
If yes,
qc_C1_c_ix == 1

describe where

Generic text

what happens when she does have the reaction? (Tick all that apply) other reaction (please describe )

1
Yes
Other

How long after eating or drinking or touching does this usually happen?

1
less than 1 hr
2
1-2 hrs
3
3-5 hrs
4
6 hrs or more
9
don't know

How many times has a reaction happened in the past year?

1
once
2
2-3 times
3
4-9 times
4
10 or more times
9
don't know
What have you done about these reactions? (Tick all that apply)
-

1 - Yes

Avoided the foods that caused them
Took to GP to investigate
Investigated in hospital

What have you done about these reactions? (Tick all that apply) Other (please describe)

1
Yes
Other

What treatment has your child been given for the problem?

1
None
2
Yes, some treatment
If Yes, some treatment to question C1g
qc_C1_g == 2

Please describe

Generic text

Apart from food and drink are there any other things to which she is allergic?

1
Yes
2
No
If no, go to C3 on page 24
If yes,
qc_C2_a == 1

What is she allergic to? (Tick all that apply) pollen

1
Yes

What is she allergic to? (Tick all that apply) cat

1
Yes

What is she allergic to? (Tick all that apply) dog

1
Yes

What is she allergic to? (Tick all that apply) bee sting or wasp sting

1
Yes

What is she allergic to? (Tick all that apply) house dust

1
Yes

What is she allergic to? (Tick all that apply) medicine

1
Yes
If yes,
qc_C2_b_vi == 1

please describe type of medicine

Generic text

What is she allergic to? (Tick all that apply) other (please tick and describe)

1
Yes
Other

How does she react to these? (Tick all that apply) wheezing

1
Yes

How does she react to these? (Tick all that apply) breathlessness

1
Yes

How does she react to these? (Tick all that apply) sneezing

1
Yes

How does she react to these? (Tick all that apply) rash

1
Yes

How does she react to these? (Tick all that apply) other (please tick and describe)

1
Yes
Other
Spring and Summer problems: Does your child suffer from any of the following symptoms during Spring or Summer? (Please tick all that apply)
Yes

1 - Yes

runny, red or itchy eyes
frequent sneezing bouts
constantly blocked, runny or itchy nose
nettle-like rash without obvious cause
constant cold
none of the above
Does your child take any of the following medication regularly at any time of year?
-

1 - Yes, in spring/summer

2 - Yes, in autumn/winter

3 - Yes, all year

4 - No, not at all

Piriton
Loratadine/Clarityn
Flixonase
Nasonex
Antihistamine eye drops
Triludan
Cetirizine/Zirtek
Beconase
Opticrom eye drops

Does your child take any of the following medication regularly at any time of year? Other antihistamine (please tick & describe

1
Yes, in spring/summer
2
Yes, in autumn/winter
3
Yes, all year
4
No, not at all
Other
Of course we appreciate a fully completed questionnaire but if you can't remember an exact date don't worry - just miss it out. A partly filled in questionnaire sent back to us is better than a questionnaire left in the kitchen drawer!
SECTION D: PROBLEMS AND INVESTIGATIONS

Since her 7th birthday has anyone thought there might be a problem with her hearing?

1
Yes
2
No

Has your child been seen by a hearing specialist since she was 7?

1
Yes
2
No
If no, go to D2a below
If yes,
qc_D1_b == 1

At what age?

1
7 years old
2
8 years old
3
9 years old

What was decided?

Generic text

Has your child been referred to an eye specialist since her 7th birthday?

1
Yes
2
No
If no, go to D3a on page 28
If yes,
qc_D2_a == 1

at what age?

1
7 years old
2
8 years old
3
9 years old

What was decided?

Generic text

What treatment was given?

Generic text

Has anyone ever thought that there might be a problem with her talking?

1
Yes
2
No
If no, go to D4a below
If yes,
qc_D3_a == 1

Has she ever been seen by a speech therapist?

1
Yes
2
No
If no, go to D3c below
If yes,
qc_D3_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still any worries about her talking?

1
Yes
2
No
If yes,
qc_D3_c == 1

please describe

Generic text

Has anyone ever thought she might have a problem with clumsiness, movement or coordination?

1
Yes
2
No
If no, go to D5a on page 29
If yes,
qc_D4_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to D4e on page 29
If yes,
qc_D4_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_D4_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with other aspects of her development?

1
Yes
2
No
If no, go to D6a below
If yes,
qc_D5_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to D5e below
If yes,
qc_D5_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_D5_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with her behaviour or personality?

1
Yes
2
No
If no, go to D7a on page 30
If yes,
qc_D6_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to D6e on page 30
If yes,
qc_D6_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_D6_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with aches and pains, including headache?

1
Yes
2
No
If no, go to D8a on page 31
If yes,
qc_D7_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to D7e below
If yes,
qc_D7_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_D7_e == 1

please describe

Generic text

Have there been any other problems for which your child saw (or is going to see) a specialist since her 7th birthday?

1
Yes
2
No
If no, go to section E on page 32
If yes,
qc_D8_a == 1

For how many different problems?

How many
Please list, for each problem, what has happened:
What was thought to be the problem? Has she seen a specialist? What age was she the first time she was seen for this problem ? (put 0 if less than 12 months) ... years What was decided? What treatment was given?
Generic text

1 - Yes

2 - No

3 - Not yet

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

3 - Not yet

Generic text

1 - Yes

2 - No

3 - Not yet

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textAge
Generic text

1 - Yes

2 - No

3 - Not yet

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

3 - Not yet

Generic text

1 - Yes

2 - No

3 - Not yet

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textAge
Generic text

1 - Yes

2 - No

3 - Not yet

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

3 - Not yet

Generic text

1 - Yes

2 - No

3 - Not yet

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textAge
Generic text

1 - Yes

2 - No

3 - Not yet

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

3 - Not yet

Generic text

1 - Yes

2 - No

3 - Not yet

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textAge
Generic text

1 - Yes

2 - No

3 - Not yet

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

3 - Not yet

Generic text

1 - Yes

2 - No

3 - Not yet

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

3 - Not yet

Generic textAge
Problem No.1
Problem No.2
Problem No.3
If more than 3 problems, continue below or on a separate sheet.
SECTION E: ACCIDENTS AND INJURIES
However careful a parent is, most children have accidents at some time or other. Please list on the next pages the times your child has had an accident, whether or not she was injured as a result.

Has she been burnt or scalded in the past 12 months?

1
Yes
2
No
If no, go to E2a on page 33
If yes,
qc_E1_a == 1

how many times?

How many
For each accident please describe below what happened:
Place accident happened (e.g.kitchen, park, school) What was she burnt with? (e.g. tea, iron, electric fire, bonfire, fireworks) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Burn 1

Generic text

Please describe how each accident happened: Burn 2

Generic text

Please describe how each accident happened: Burn 3

Generic text

Has she had an accident while playing sports or games in the past 12 months?

1
Yes
2
No
If no, go to E3a on page 34
If yes,
qc_E2_a == 1

how many times?

How many
For each accident please describe below what happened:
Place it happened (e.g.playground, street, school) What happened (e.g. hit by ball, fell off trampoline)? Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric date
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has she swallowed anything she shouldn't have (such as pills, buttons, disinfectant) in the past 12 months?

1
Yes
2
No
If no, go to E4a on page 35
If yes,
qc_E3_a == 1

how many times?

How many
For each time please describe below what happened:
Place accident happened (e.g. your home, school, at friend's) What did she swallow? (e.g. bleach, aspirin, marble) Date of accident (month, year) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has she had any injuries involving traffic in the past 12 months?

1
Yes
2
No
If no, go to E5a on page 36
If yes,
qc_E4_a == 1

how many times?

How many
For each accident or injury please describe below what happened:
Where was she and what was she doing (e.g. sitting in car; riding a bicycle)? What happened (e.g. car hit tree; fell off bike) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has she ever been injured by the action of another person (whether intentionally or not)?

1
Yes
2
No
If no, go to E6a on page 37
If yes,
qc_E5_a == 1

how many times?

How many
For each time please describe below what happened:
Person involved (e.g. stranger, sister, child's father) What happened ? Date of injury (month, year) Who else was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st injury
2nd injury
3rd injury

Please describe how each accident happened: Injury 1

Generic text

Please describe how each accident happened: Injury 2

Generic text

Please describe how each accident happened: Injury 3

Generic text

Has she had any other accidents or injuries in the past 12 months?

1
Yes
2
No
If no, go to E7 on page 38
If yes,
qc_E6_a == 1

how many times?

How many
For each time please describe below what happened:
Place accident happened (e.g. kitchen, garden, street, school) What happened ? Date of accident (month, year) Injuries caused (if no injury write none) What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text
Has she had any of the following happen since she was born? (tick all questions and all time periods that apply)
Yes, aged 0 - 2 years Yes, aged 3-4 years Yes, aged 5-6 years Yes, since 7th birthday

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Broken arm/hand
Broken leg/foot
Broken/cracked skull
Other broken bone (please describe)
Unconscious because of a head injury
Cut(s) requiring stitches
Burn or scald needing a skin graft
A road traffic accident
An accident in a playground
An accident at school, nursery, crèche
Stung by wasp or bee
Bitten by animal or human (please tick and describe)
Badly sunburnt
Nearly drowned
Front tooth (teeth) knocked out
Front tooth (teeth) chipped or injured
Other tooth/teeth knocked out or chipped

Has she had any of the following happen since she was born? (tick all questions and all time periods that apply) Other broken bone (please describe)

Other

Has she had any of the following happen since she was born? (tick all questions and all time periods that apply) Bitten by animal or human (please tick and describe)

Generic text
Has the study child ever had an accident that has had effects that are still present?
-

1 - Yes

yes, a scar
yes, a behaviour difference
yes, other
For any of the above,
qc_E8_a-c == 1

please describe

Generic text

This questionnaire was completed by: (tick all that apply) mother

1
Yes

This questionnaire was completed by: (tick all that apply) father

1
Yes

This questionnaire was completed by: (tick all that apply) other (please tick and describe)

1
Yes
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give the date of birth of your child:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comment you would like to make

Long text
NB Please remember we cannot reply to any comment unless you sign it.
When completed, please return the questionnaire to: Professor Jean Golding Children of the Nineties - ALSPAC Institute of Child Health
End

alspac_00_msdh

My Daughter's Health
This should be completed by the study child's chief carer
All answers are confidential
To answer simply tick the box that is most accurate in your opinion.
If you cannot answer certain questions leave them out and go on to the next one.
THANK YOU FOR YOUR HELP

SECTION A: YOUR CHILD'S HEALTH

The health of your study child is still of great importance to us. We would like to know about any recent illnesses or medical treatments.
How would you assess the health of your child nowadays? in the past month
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
How would you assess the health of your child nowadays? in the past year
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
In the past 12 months has the doctor been called to your home because your daughter was unwell?
1
Yes
2
No
If no, go to A3 below
how many times?
1
once
2
2 times
3
3-4 times
4
5 or more times

Has she had any of the following in the past 12 months?

-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
snuffles/cold
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
urinary infection
headache(s )
constipation
worm infections
head lice
scabies
asthma
eczema
hay fever
Has she had any of the following in the past 12 months? In the past 12 months: other (please tick and describe)
1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other

In the past 12 months, has she had any of the following infections?

-

1 - Yes

2 - No

measles
chicken pox
mumps
meningitis
cold sores
whooping cough
urinary infection
eye infection
ear infection
chest infection
tonsillitis or laryngitis
german measles
scarlet fever
influenza (flu)
a cold
In the past 12 months, has she had any of the following infections? In the past 12 months: other infection (please tick & describe)
1
Yes
2
No
Other
Has your child been admitted to hospital in the past 2 years?
1
Yes
2
No
If no, go to A6 below
how many times?
How many

please describe for each admission:

Age of child (years) Reason for admission No. of nights child stayed in hospital
How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many How manyAgeGeneric textHow manyAgeGeneric textAgeGeneric textHow many
1
2
3
If more than 3 admissions please describe on separate sheet
How often did you see her while she was in hospital? 1st admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her
How often did you see her while she was in hospital? 2nd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her
How often did you see her while she was in hospital? 3rd admission
1
Not at all
2
Quite often
3
Every day
4
Stayed in the hospital with her
Has she ever had any of the following operations? hernia repair
1
Yes
please give type
Generic text
Has she ever had any of the following operations? tonsils out
1
Yes
Has she ever had any of the following operations? adenoids out
1
Yes
Has she ever had any of the following operations? appendicectomy (appendix out)
1
Yes
Has she ever had any of the following operations? tubes (grommets) put in her ears
1
Yes
Has she ever had any of the following operations? squint repair (to put eyes straight)
1
Yes
Has she ever had any of the following operations? teeth pulled out
1
Yes
Has she ever had any of the following operations? other operations (please describe)
1
Yes
Other

How many days has she had to take off school for health reasons?

No. of days off school Guess? please describe
GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess GuessHow manyGeneric textGuessHow manyGeneric textHow manyGeneric textGuess
For one or more infections (including colds, cough, flu)
For hospital investigation including admission
For other investigation(s)
How many days has she had to take off school for health reasons? For asthma, eczema or hayfever No. of days off school
How many
How many days has she had to take off school for health reasons? For asthma, eczema or hayfever Guess?
Guess

How many days has she had to take off school for health reasons? For other reasons

No. of days off school Guess?
How manyGuessHow manyGuess How manyGuessHow manyGuess

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months.

- If yes, please give full names of substances if you can

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text
cough medicine
antibiotics/penicillin
throat medicine
vitamins
paracetamol/calpol
ointment for skin
eye ointment
diarrhoea mixture or pills
dimotapp/decongestant
ear drops
eye drops
iron
laxative
homeopathic medicine
herbal medicine
asthma medication
vaporiser
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months. In the last 12 months: other (please tick and describe)
2
Yes for 1-2 episodes only
3
Yes for 3 or more episodes
Other
please give full names of substances if you can
Generic text
Are there any pills, ointments or medicines that she has taken every day or nearly every day for the last 3 months? (Include vitamins, skin cream, inhaler, laxatives as well as antibiotics, homeopathic and herbal remedies etc.)
1
Yes
2
No
If no, go to A10a below
please describe:
Generic text
In the past year has she had any periods when there was wheezing with whistling on her chest when she breathed?
1
Yes
2
No
If no, go to A10k on page 10
How many separate times has this happened in the past 12 months?
1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know
How many days altogether would you say she has wheezed in the past 12 months?
1
1 day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know
Was she breathless during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
Did she have a fever during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
How often, on average, has your child's sleep been disturbed due to wheezing in the past 12 months?
1
Never woken with wheezing
2
Less than one night per week
3
One or more nights per week
Has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths in the past 12 months?
1
Yes
2
No
Do you think the wheezing attacks are worse during any particular time of year?
1
yes, worse in spring and/or summer
2
yes, worse in autumn and/or winter
3
not particularly
4
other (please tick & describe)
Other
What do you think brings on the wheezing attacks ? chest infection or bronchitis
1
Yes
2
No
What do you think brings on the wheezing attacks ? being in a smoky room
1
Yes
2
No
What do you think brings on the wheezing attacks ? cold weather
1
Yes
2
No
What do you think brings on the wheezing attacks ? I don't know
1
Yes
What do you think brings on the wheezing attacks ? other (please tick & describe)
1
Yes
2
No
Other
In the past 12 months has your child's chest sounded wheezy during or after exercise?
1
Yes
2
No
In the past 12 months has your child had a dry cough at night, apart from a cough associated with a cold or chest infection?
1
Yes
2
No
Have any of your other children ever had spells of wheezing with whistling on the chest?
1
Yes
2
No
7
have no other children
Has your child had any itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms) in the past year?
1
Yes
2
No
If no, go to A12a below
How bad was this?
1
very bad
2
quite bad
3
mild
4
no problem
Does she have this sort of rash now?
1
Yes
2
No
Did the rash ever become sore and oozy?
1
Yes
2
No
Was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?
1
Yes
2
No
Has she had an itchy, dry, rash on her hands in the past year?
1
Yes
2
No
Has she had an itchy, dry rash on her feet in the past year?
1
Yes
2
No
If no, go to A12c on page 12
please describe which parts of her feet
Generic text
In the past 12 months how often, on average, has your child been kept awake at night by an itchy rash?
1
Never in the past 12 months
2
Less than one night per week
3
One or more nights per week
Does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)
1
Yes
2
No
Has she had a skin reaction in the past year (e.g. redness or itching) which you thought was due to some food that she had eaten?
1
Yes
2
No
If no, go to A14 below
please describe the food(s)
Generic text
how long after the food was eaten did the reaction appear?
Generic text
where was the reaction? (please describe)
1
mouth
2
other part
Generic text
This question is about problems which occur when your child does not have a cold or the flu.
Has your child ever had sneezing episodes, or a runny or blocked nose, when she did not have a cold or the flu?
1
Yes
2
No
In the past 12 months, has your child had sneezing episodes, or a runny or blocked nose, when she did not have a cold or the flu?
1
Yes
2
No
In the past 12 months, has she had itchy-watery eyes?
1
Yes
2
No
In which of the past 12 months did these nose and/or eye problems occur?
7
Hasn't had a nose or eye problem

In which of the past 12 months did these nose and/or eye problems occur?

-

1 - Yes

January
February
March
April
May
June
July
August
September
October
November
December
In the past 12 months, how much did these nose and eye problems interfere with your child's activities?
1
Not at all
2
A little
3
A moderate amount
4
A lot
Has she had vomiting spells in the past year?
1
Yes
2
No
If no, go to A16a on page 14
How many times?
1
once
2
twice
3
3-9 times
4
10 or more times
How often have these been associated with: diarrhoea
1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never
How often have these been associated with: chestiness (wheezing or coughing or grunting)
1
Always
2
Frequently
3
Sometimes
4
Rarely
5
Never
In the past year has she had diarrhoea or gastro-enteritis?
1
Yes
2
No
If no, go to A17a below
how many times in the past 12 months?
How many
how many days did the worst attack last?
How many
In the past year has your child ever had a time when she has coughed off and on for at least 2 days?
1
Yes
2
No
If no, go to A18 below
How many times has this happened in the past year?
1
once
2
twice
3
3-9 times
4
10 or more times
Did she have a fever at any of these times?
1
Yes for all
2
Yes for some
3
No, not at all
Did she have a runny nose during any of these spells?
1
Yes for all
2
Yes for some
3
No, not at all
Has pus or sticky mucus (not ear wax) leaked out of her ear in the past year?
1
never
2
once
3
more than once
9
don't know
Does she breathe through her mouth rather than through her nose? when asleep
1
all the time
2
much of the time
3
sometimes
4
rarely
5
never
9
don't know
Does she breathe through her mouth rather than through her nose? when awake
1
all the time
2
much of the time
3
sometimes
4
rarely
5
never
9
don't know
Does she snore for more than a few minutes at a time?
1
most nights
2
quite often
3
sometimes
4
only rarely
5
never
9
don't know
Have there been times in the past year when she has had a pain in her stomach?
1
Yes
2
No
If no, go to A22a on page 16
How many separate times has this happened in the past year?
1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know
Did she have vomiting or diarrhoea at the same time as the pain?
1
yes every time
2
yes, for some of the times
3
no, not at all

What do you think were the causes of her stomach pains? (Tick all that apply)

-

1 - Yes

something she ate
an infection
constipation
don't know
What do you think were the causes of her stomach pains? (Tick all that apply) other (please describe)
1
Yes
Other
Does she often have aches and pains in her arms or legs?
1
yes arm(s)
2
yes leg(s)
3
yes both
4
no, not often
If no, go to A23a on page 17
does this happen especially when she is tired?
1
Yes
2
No
what do you think is the cause ?
Generic text
do you find any particular treatment helps ?
1
Yes
2
No
please describe
Generic text
Since her 7th birthday has she had any form of convulsion, fit, seizure or other turn in which consciousness was lost or any part of the body made an abnormal movement?
1
Yes
2
No
9
Not known
If no, or not known, go to B1 on page 19
Please describe the first attack since her 7th birthday:
Generic text
Did the child have a high temperature at the time?
1
Yes
2
No
9
Not known
How old was she at the time?
1
7 years
2
8 years
3
9 years
How many attacks has she had since her 7th birthday?
1
one
2
two
3
3-4
4
5 or more

By whom was she seen for these attack(s)? (Tick all that apply)

Yes

1 - Yes

general practitioner at home
general practitioner at surgery
hospital outpatient department
admitted to hospital
What investigations, if any, have been carried out?
Generic text
Did later attacks differ from the first one?
1
yes
2
no
7
Has only had one attack since 7th birthday
please describe
Generic text

What was/were the attack(s) thought to be due to? (Tick all that apply)

-

1 - Yes

febrile convulsions
fainting and blackouts
epilepsy
breath holding
reaction to immunisation
don't know
What was/were the attack(s) thought to be due to? (Tick all that apply) other (please describe)
1
Yes
Other

SECTION B: COMPLEMENTARY/ALTERNATIVE MEDICINE

We are interested to know if you have ever used complementary/alternative medicine for your child and how helpful you found it.
Has your child ever received any of the following: Acupuncture
1
Yes
2
No
Has your child ever received any of the following: Aromatherapy
1
Yes
2
No
Has your child ever received any of the following: Bach/Flower essences
1
Yes
2
No
Has your child ever received any of the following: Cranial osteopathy
1
Yes
2
No
Has your child ever received any of the following: Herbal medicine
1
Yes
2
No
Has your child ever received any of the following: Homeopathy
1
Yes
2
No
Has your child ever received any of the following: Hypnosis
1
Yes
2
No
Has your child ever received any of the following: Osteopathy
1
Yes
2
No
Has your child ever received any of the following: Reflexology
1
Yes
2
No
Has your child ever received any of the following: Other (please tick and describe)
1
Yes
2
No
Other
Describe each treatment separately:
Name of 1st treatment (e.g. acupuncture, reflexology etc.):
Generic text
please state the name(s):
Generic text
Child's condition / illness:
Generic text
Age of child when this treatment started: ... years
Age
please state in months (put 00 for less than 1 month) months
Months
How helpful did you find this treatment?
1
very helpful