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alspac_02_babg
BEING A GIRL
This questionnaire is for the study child's mother or the person taking the role of the mother.
All answers are confidential
This questionnaire is for the study child's mother or person taking the role of mother.
To answer simply tick the box which is most accurate in your opinion.
If you do not want to answer a question or if it does not apply to you, put a line through it. There are no good or bad answers. Just tell us what is true for you.
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 ever had any of the following operations? hernia repair

1
Yes
If yes,
qc_A3_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 tick and 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
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
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?
A4dg In the past 12 months: For other reasons: please describe: cs_qA4_d-g_X cs_Yes How many cs_Yes How many

1 - Yes

1 - Yes

For asthma 1 No. of days off school
For asthma 1 Guess?
For asthma 2 No. of days off school
For asthma 2 Guess?
For eczema or itchy rash 1 No. of days off school
For eczema or itchy rash 1 Guess?
For eczema or itchy rash 2 No. of days off school
For eczema or itchy rash 2 Guess?
For hayfever or allergic rhinitis 1 No. of days off school
For hayfever or allergic rhinitis 1 Guess?
For hayfever or allergic rhinitis 2 No. of days off school
For hayfever or allergic rhinitis 2 Guess?

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 A6 below
If yes,
qc_A5 == 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

Has she had vomiting spells in the past year?

1
Yes
2
No
If no, go to A7a on page 6
If yes,
qc_A6_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 A8a below
If yes,
qc_A7_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 A9 below
If yes,
qc_A8_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 A13a on page 8
If yes,
qc_A12_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) something she ate

1
Yes

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

1
Yes

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

1
Yes

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

1
Yes
Other

What do you think were the causes of her stomach pains? (Tick all that apply) don't know

1
Yes

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 A14a below
If yes,
qc_A13_a == 1 || qc_A13_a == 2 || qc_A13_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_A13_a_iii == 1

please describe

Generic text

Since her 9th 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 A15a on page 10
If yes,
qc_A14_a == 1

Please describe the first attack since her 9th 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
9 years
2
10 years
3
11 years

How many attacks has she had altogether since her 9th 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) general practitioner at home

1
Yes

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

1
Yes

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

1
Yes

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

1
Yes

By whom was she seen for these attack(s)? (Tick all that apply) no-one

1
Yes

What investigations, if any, have been carried out?

Generic text

Did any later attacks differ from the first one since her 9th birthday?

1
yes
2
no
7
Has only had the one attack since 9th birthday
If yes,
qc_A14_h == 1

please describe

Generic text

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

1
Yes

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

1
Yes

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

1
Yes

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

1
Yes

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

1
Yes

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

1
Yes
Other

What was/were the attack(s) thought to be due to? (Tick all that apply) don't know

1
Yes

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 A15k on page 11
If yes,
qc_A15_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 cold 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 A17a below
If yes,
qc_A16_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

Did the rash clear up completely at any time in the past 12 months?

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 A17c on page 13
If yes,
qc_A17_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
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 A18c below
qc_A18_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 A18di go to Section B on page 15
qc_A18_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
SECTION B: PROBLEMS AND INVESTIGATIONS

Since her 9th birthday has anyone thought there might be a new problem with her hearing?

1
Yes
2
No

Has your child been seen by a hearing specialist since she was 9?

1
Yes
2
No
If no, go to B2a below
If yes,
qc_B1_b == 1

At what age?

1
9 years old
2
10 years old
3
11 years old

What was decided?

Generic text

Has your child been seen by an eye specialist for a new problem since her 9th birthday?

1
Yes
2
No
If no, go to B3a below
If yes,
qc_B2_a == 1

at what age?

1
9 years old
2
10 years old
3
11 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 B4a on page 16
If yes,
qc_B3_a == 1

Has she ever been seen by a speech therapist?

1
Yes
2
No
If no, go to B3c below
If yes,
qc_B3_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_B3_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 B5a on page 17
If yes,
qc_B4_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to B4e below
If yes,
qc_B4_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_B4_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 B6a below
If yes,
qc_B5_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to B5e below
If yes,
qc_B5_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_B5_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 B7a on page 18
If yes,
qc_B6_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to B6e on page 18
If yes,
qc_B6_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_B6_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 B8a on page 19
If yes,
qc_B7_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to B7e below
If yes,
qc_B7_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_B7_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 9th birthday?

1
Yes
2
No
If no, go to section C on page 20
If yes,
qc_B8_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 00 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 C: 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 since her 9th birthday?

1
Yes
2
No
If no, go to C2a on page 21
If yes,
qc_C1_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 since her 9th birthday?

1
Yes
2
No
If no, go to C3a on page 22
If yes,
qc_C2_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?
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 swallowed anything she shouldn't have (such as pills, buttons, disinfectant) since her 9th birthday?

1
Yes
2
No
If no, go to C4a on page 23
If yes,
qc_C3_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, apirin, 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 since her 9th birthday?

1
Yes
2
No
If no, go to C5a on page 24
If yes,
qc_C4_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 been injured by the action of another person, whether intentionally or not since her 9th birthday? (Don't include sports injuries here but include them in C2).

1
Yes
2
No
If no, go to C6a on page 25
If yes,
qc_C5_a == 1

how many times?

How many
For each accident 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 inury

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 since her 9th birthday?

1
Yes
2
No
If no, go to C7 on page 26
If yes,
qc_C6_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 injury (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)

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 of the following happen since she was born? (tick all questions and all time periods that apply)
Yes, aged 0 - 4 years Yes, aged 5-8 years Yes, since her 9th 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

Broken arm/hand
Broken leg/foot
Broken/cracked skull
Other broken bone (please describe)

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)
Yes, aged 0 - 4 years Yes, aged 5-8 years Yes, since her 9th 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

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)

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 she had any of the following happen since she was born? (tick all questions and all time periods that apply)
Yes, aged 0 - 4 years Yes, aged 5-8 years Yes, since her 9th 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

Badly sunburnt
Nearly drowned
Front tooth (teeth) knocked out
Front tooth (teeth) chipped or injured
Other tooth/teeth knocked out or chipped

Has the study child ever had an accident that has had effects that are still present? yes, a scar

1
Yes

Has the study child ever had an accident that has had effects that are still present? yes, a behaviour difference

1
Yes

Has the study child ever had an accident that has had effects that are still present? yes, other

1
Yes
For any of the above,
qc_C8_a == 1 || qc_C8_b == 1 || qc_C8_c == 1

please describe

Generic text
SECTION D: DISCIPLINE & LIFESTYLE

Are there rules in your home about what your study child can and cannot do?

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

Does she refuse to do what she does not want to do?

1
Yes usually
2
Yes sometimes
3
No, not at all

Who has most control over your study child? I do

1
Yes

Who has most control over your study child? My husband/partner does

1
Yes

Who has most control over your study child? Her teacher does

1
Yes

Who has most control over your study child? Someone else ? please describe

1
Yes
Other

Who usually tells her off? I do

1
Yes

Who usually tells her off? My husband/partner does

1
Yes

Who usually tells her off? Her teacher does

1
Yes

Who usually tells her off? Someone else ? please describe

1
Yes
Other

Who usually punishes her? I do

1
Yes

Who usually punishes her? My husband/partner does

1
Yes

Who usually punishes her? Her teacher does

1
Yes

Who usually punishes her? Someone else ? please describe

1
Yes
Other

How often is she punished?

1
every day
2
several times a week
3
once or twice a week
4
once or twice a month
5
rarely
6
never

How often do you slap or hit her?

1
every day
2
several times a week
3
once or twice a week
4
once or twice a a month
5
rarely
6
never

Has she ever run away from home?

1
Yes
2
No, but has tried to
3
No, but has thought of doing so
4
No, never
9
Don't know

On normal school days what time in the morning does your child usually wake up? a.m.

Generic time

On normal school days what time in the evening does your child usually go to sleep? p.m.

Generic time

On weekends what time in the morning does your child usually wake up? a.m.

Generic time

On weekends what time in the evening does your child usually go to sleep? p.m.

Generic time

Does she understand the concept of right and wrong?

1
Yes
2
No

Can she determine herself what is proper behaviour?

1
Yes usually
2
Yes sometimes
3
No
9
Don't know
What does she consider important in her life? (tick all that apply)
-

1 - Yes

school results
relationship between herself and her teachers
relationship between herself and her friends
family relationships
hobbies, interests
friends
clothes
money
material possessions
holidays, trips
What does she really like to do best? (tick all that apply)
-

1 - Yes

sports
playing a musical instrument
singing
dancing
reading
drawing
making things

What does she really like to do best? (tick all that apply) other (please tick and describe)

1
Yes
Other

Does she understand the concept of death as an irreversible event with all its emotional consequences?

1
Yes, understands
2
Yes, more or less understands
3
Not really
4
Not at all

Does she take an interest? in nationalism

1
Yes, very interested
2
Yes, somewhat interested
3
No, not interested
4
Not sure

Does she take an interest? in politics

1
Yes, very interested
2
Yes, somewhat interested
3
No, not interested
4
Not sure

Does she take an interest? in the meaning of life

1
Yes, very interested
2
Yes, somewhat interested
3
No, not interested
4
Not sure

Does she take an interest? in law and order

1
Yes, very interested
2
Yes, somewhat interested
3
No, not interested
4
Not sure

Does she take an interest? in religion

1
Yes, very interested
2
Yes, somewhat interested
3
No, not interested
4
Not sure

Does she attend a place of worship (church, mosque, etc)?

1
Yes often
2
Yes sometimes
3
No, not at all

Does she pray?

1
Yes often
2
Yes sometimes
3
No, not at all
9
Don't know

What friends does she prefer?

1
boys
2
girls
3
she doesn't mind
4
she doesn't have friends

Does she have a favourite friend of the other sex?

1
Yes
2
No

Is she at ease with children of her own age?

1
yes, fully
2
prefers younger children
3
prefers older children

How much is she influenced by her friends/mates?

1
very strongly
2
fairly strongly
3
sometimes
4
rarely
5
never

Has she ever been offered: alcohol

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so

Has she ever been offered: cigarettes

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so

Has she ever been offered: drugs

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so

Has she ever tried: alcohol

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so

Has she ever tried: cigarettes

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so

Has she ever tried: drugs

1
Yes and I know about it
2
Probably
3
Possibly
4
I do not think so
If yes to any of the above,
qc_D13_i_a == 1 || qc_D13_i_b == 1 || qc_D13_i_c == 1

At what age was she when she tried them? (put 99 if you don't know) alcohol ... years

Age

At what age was she when she tried them? (put 99 if you don't know) cigarettes ... years

Age

At what age was she when she tried them? (put 99 if you don't know) drugs ... years

Age
SECTION E: PILLS AND POTIONS
Please indicate below any medicines (pills, syrups, inhalers, drops, sprays, suppositories, ointments etc including homeopathic and herbal remedies) that your study child has used in the last 12 months.
In the past 12 months medicine, pills drops or ointment for: Other conditions (Please tick and describe) cs_qE1_X cs_R_Fd_Oo_Oot cs_Yes Generic text cs_R_Fd_Oo_Oot cs_Yes Generic text cs_Yes Generic text cs_R_Fd_Oo_Oot

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

Headache 1 -
Headache 1 Name of medicine etc.
Headache 1 How often?
Headache 2 -
Headache 2 Name of medicine etc.
Headache 2 How often?
Headache 3 -
Headache 3 Name of medicine etc.
Headache 3 How often?
Headache 4 -
Headache 4 Name of medicine etc.
Headache 4 How often?
Headache 5 -
Headache 5 Name of medicine etc.
Headache 5 How often?
Stomach ache 1 -
Stomach ache 1 Name of medicine etc.
Stomach ache 1 How often?
Stomach ache 2 -
Stomach ache 2 Name of medicine etc.
Stomach ache 2 How often?
Stomach ache 3 -
Stomach ache 3 Name of medicine etc.
Stomach ache 3 How often?
Stomach ache 4 -
Stomach ache 4 Name of medicine etc.
Stomach ache 4 How often?
Stomach ache 5 -
Stomach ache 5 Name of medicine etc.
Stomach ache 5 How often?
Earache 1 -
Earache 1 Name of medicine etc.
Earache 1 How often?
Earache 2 -
Earache 2 Name of medicine etc.
Earache 2 How often?
Earache 3 -
Earache 3 Name of medicine etc.
Earache 3 How often?
Earache 4 -
Earache 4 Name of medicine etc.
Earache 4 How often?
Earache 5 -
Earache 5 Name of medicine etc.
Earache 5 How often?
Other ache or pain 1 -
Other ache or pain 1 Name of medicine etc.
Other ache or pain 1 How often?
Other ache or pain 2 -
Other ache or pain 2 Name of medicine etc.
Other ache or pain 2 How often?
Other ache or pain 3 -
Other ache or pain 3 Name of medicine etc.
Other ache or pain 3 How often?
Other ache or pain 4 -
Other ache or pain 4 Name of medicine etc.
Other ache or pain 4 How often?
Other ache or pain 5 -
Other ache or pain 5 Name of medicine etc.
Other ache or pain 5 How often?
Vomiting 1 -
Vomiting 1 Name of medicine etc.
Vomiting 1 How often?
Vomiting 2 -
Vomiting 2 Name of medicine etc.
Vomiting 2 How often?
Vomiting 3 -
Vomiting 3 Name of medicine etc.
Vomiting 3 How often?
Vomiting 4 -
Vomiting 4 Name of medicine etc.
Vomiting 4 How often?
Vomiting 5 -
Vomiting 5 Name of medicine etc.
Vomiting 5 How often?
Diarrhoea 1 -
Diarrhoea 1 Name of medicine etc.
Diarrhoea 1 How often?
Diarrhoea 2 -
Diarrhoea 2 Name of medicine etc.
Diarrhoea 2 How often?
Diarrhoea 3 -
Diarrhoea 3 Name of medicine etc.
Diarrhoea 3 How often?
Diarrhoea 4 -
Diarrhoea 4 Name of medicine etc.
Diarrhoea 4 How often?
Diarrhoea 5 -
Diarrhoea 5 Name of medicine etc.
Diarrhoea 5 How often?
Constipation 1 -
Constipation 1 Name of medicine etc.
Constipation 1 How often?
Constipation 2 -
Constipation 2 Name of medicine etc.
Constipation 2 How often?
Constipation 3 -
Constipation 3 Name of medicine etc.
Constipation 3 How often?
Constipation 4 -
Constipation 4 Name of medicine etc.
Constipation 4 How often?
Constipation 5 -
Constipation 5 Name of medicine etc.
Constipation 5 How often?
Travel sickness 1 -
Travel sickness 1 Name of medicine etc.
Travel sickness 1 How often?
Travel sickness 2 -
Travel sickness 2 Name of medicine etc.
Travel sickness 2 How often?
Travel sickness 3 -
Travel sickness 3 Name of medicine etc.
Travel sickness 3 How often?
Travel sickness 4 -
Travel sickness 4 Name of medicine etc.
Travel sickness 4 How often?
Travel sickness 5 -
Travel sickness 5 Name of medicine etc.
Travel sickness 5 How often?
Insect bites 1 -
Insect bites 1 Name of medicine etc.
Insect bites 1 How often?
Insect bites 2 -
Insect bites 2 Name of medicine etc.
Insect bites 2 How often?
Insect bites 3 -
Insect bites 3 Name of medicine etc.
Insect bites 3 How often?
Insect bites 4 -
Insect bites 4 Name of medicine etc.
Insect bites 4 How often?
Insect bites 5 -
Insect bites 5 Name of medicine etc.
Insect bites 5 How often?
Bruising 1 -
Bruising 1 Name of medicine etc.
Bruising 1 How often?
Bruising 2 -
Bruising 2 Name of medicine etc.
Bruising 2 How often?
Bruising 3 -
Bruising 3 Name of medicine etc.
Bruising 3 How often?
Bruising 4 -
Bruising 4 Name of medicine etc.
Bruising 4 How often?
Bruising 5 -
Bruising 5 Name of medicine etc.
Bruising 5 How often?
A 'cold' 1 -
A 'cold' 1 Name of medicine etc.
A 'cold' 1 How often?
A 'cold' 2 -
A 'cold' 2 Name of medicine etc.
A 'cold' 2 How often?
A 'cold' 3 -
A 'cold' 3 Name of medicine etc.
A 'cold' 3 How often?
A 'cold' 4 -
A 'cold' 4 Name of medicine etc.
A 'cold' 4 How often?
A 'cold' 5 -
A 'cold' 5 Name of medicine etc.
A 'cold' 5 How often?
Cough 1 -
Cough 1 Name of medicine etc.
Cough 1 How often?
Cough 2 -
Cough 2 Name of medicine etc.
Cough 2 How often?
Cough 3 -
Cough 3 Name of medicine etc.
Cough 3 How often?
Cough 4 -
Cough 4 Name of medicine etc.
Cough 4 How often?
Cough 5 -
Cough 5 Name of medicine etc.
Cough 5 How often?
Sore throat 1 -
Sore throat 1 Name of medicine etc.
Sore throat 1 How often?
Sore throat 2 -
Sore throat 2 Name of medicine etc.
Sore throat 2 How often?
Sore throat 3 -
Sore throat 3 Name of medicine etc.
Sore throat 3 How often?
Sore throat 4 -
Sore throat 4 Name of medicine etc.
Sore throat 4 How often?
Sore throat 5 -
Sore throat 5 Name of medicine etc.
Sore throat 5 How often?
'Flu' 1 -
'Flu' 1 Name of medicine etc.
'Flu' 1 How often?
'Flu' 2 -
'Flu' 2 Name of medicine etc.
'Flu' 2 How often?
'Flu' 3 -
'Flu' 3 Name of medicine etc.
'Flu' 3 How often?
'Flu' 4 -
'Flu' 4 Name of medicine etc.
'Flu' 4 How often?
'Flu' 5 -
'Flu' 5 Name of medicine etc.
'Flu' 5 How often?
Infection requiring antibiotics 1 -
Infection requiring antibiotics 1 Name of medicine etc.
Infection requiring antibiotics 1 How often?
Infection requiring antibiotics 2 -
Infection requiring antibiotics 2 Name of medicine etc.
Infection requiring antibiotics 2 How often?
Infection requiring antibiotics 3 -
Infection requiring antibiotics 3 Name of medicine etc.
Infection requiring antibiotics 3 How often?
Infection requiring antibiotics 4 -
Infection requiring antibiotics 4 Name of medicine etc.
Infection requiring antibiotics 4 How often?
Infection requiring antibiotics 5 -
Infection requiring antibiotics 5 Name of medicine etc.
Infection requiring antibiotics 5 How often?
Athlete's foot 1 -
Athlete's foot 1 Name of medicine etc.
Athlete's foot 1 How often?
Athlete's foot 2 -
Athlete's foot 2 Name of medicine etc.
Athlete's foot 2 How often?
Athlete's foot 3 -
Athlete's foot 3 Name of medicine etc.
Athlete's foot 3 How often?
Athlete's foot 4 -
Athlete's foot 4 Name of medicine etc.
Athlete's foot 4 How often?
Athlete's foot 5 -
Athlete's foot 5 Name of medicine etc.
Athlete's foot 5 How often?
Wart or verrucca 1 -
Wart or verrucca 1 Name of medicine etc.
Wart or verrucca 1 How often?
Wart or verrucca 2 -
Wart or verrucca 2 Name of medicine etc.
Wart or verrucca 2 How often?
Wart or verrucca 3 -
Wart or verrucca 3 Name of medicine etc.
Wart or verrucca 3 How often?
Wart or verrucca 4 -
Wart or verrucca 4 Name of medicine etc.
Wart or verrucca 4 How often?
Wart or verrucca 5 -
Wart or verrucca 5 Name of medicine etc.
Wart or verrucca 5 How often?
Head lice 1 -
Head lice 1 Name of medicine etc.
Head lice 1 How often?
Head lice 2 -
Head lice 2 Name of medicine etc.
Head lice 2 How often?
Head lice 3 -
Head lice 3 Name of medicine etc.
Head lice 3 How often?
Head lice 4 -
Head lice 4 Name of medicine etc.
Head lice 4 How often?
Head lice 5 -
Head lice 5 Name of medicine etc.
Head lice 5 How often?
Worms 1 -
Worms 1 Name of medicine etc.
Worms 1 How often?
Worms 2 -
Worms 2 Name of medicine etc.
Worms 2 How often?
Worms 3 -
Worms 3 Name of medicine etc.
Worms 3 How often?
Worms 4 -
Worms 4 Name of medicine etc.
Worms 4 How often?
Worms 5 -
Worms 5 Name of medicine etc.
Worms 5 How often?
Eye infection 1 -
Eye infection 1 Name of medicine etc.
Eye infection 1 How often?
Eye infection 2 -
Eye infection 2 Name of medicine etc.
Eye infection 2 How often?
Eye infection 3 -
Eye infection 3 Name of medicine etc.
Eye infection 3 How often?
Eye infection 4 -
Eye infection 4 Name of medicine etc.
Eye infection 4 How often?
Eye infection 5 -
Eye infection 5 Name of medicine etc.
Eye infection 5 How often?
Psoriasis 1 -
Psoriasis 1 Name of medicine etc.
Psoriasis 1 How often?
Psoriasis 2 -
Psoriasis 2 Name of medicine etc.
Psoriasis 2 How often?
Psoriasis 3 -
Psoriasis 3 Name of medicine etc.
Psoriasis 3 How often?
Psoriasis 4 -
Psoriasis 4 Name of medicine etc.
Psoriasis 4 How often?
Psoriasis 5 -
Psoriasis 5 Name of medicine etc.
Psoriasis 5 How often?
Eczema 1 -
Eczema 1 Name of medicine etc.
Eczema 1 How often?
Eczema 2 -
Eczema 2 Name of medicine etc.
Eczema 2 How often?
Eczema 3 -
Eczema 3 Name of medicine etc.
Eczema 3 How often?
Eczema 4 -
Eczema 4 Name of medicine etc.
Eczema 4 How often?
Eczema 5 -
Eczema 5 Name of medicine etc.
Eczema 5 How often?
Asthma 1 -
Asthma 1 Name of medicine etc.
Asthma 1 How often?
Asthma 2 -
Asthma 2 Name of medicine etc.
Asthma 2 How often?
Asthma 3 -
Asthma 3 Name of medicine etc.
Asthma 3 How often?
Asthma 4 -
Asthma 4 Name of medicine etc.
Asthma 4 How often?
Asthma 5 -
Asthma 5 Name of medicine etc.
Asthma 5 How often?
Hay fever 1 -
Hay fever 1 Name of medicine etc.
Hay fever 1 How often?
Hay fever 2 -
Hay fever 2 Name of medicine etc.
Hay fever 2 How often?
Hay fever 3 -
Hay fever 3 Name of medicine etc.
Hay fever 3 How often?
Hay fever 4 -
Hay fever 4 Name of medicine etc.
Hay fever 4 How often?
Hay fever 5 -
Hay fever 5 Name of medicine etc.
Hay fever 5 How often?
Other allergies 1 -
Other allergies 1 Name of medicine etc.
Other allergies 1 How often?
Other allergies 2 -
Other allergies 2 Name of medicine etc.
Other allergies 2 How often?
Other allergies 3 -
Other allergies 3 Name of medicine etc.
Other allergies 3 How often?
Other allergies 4 -
Other allergies 4 Name of medicine etc.
Other allergies 4 How often?
Other allergies 5 -
Other allergies 5 Name of medicine etc.
Other allergies 5 How often?
Diabetes 1 -
Diabetes 1 Name of medicine etc.
Diabetes 1 How often?
Diabetes 2 -
Diabetes 2 Name of medicine etc.
Diabetes 2 How often?
Diabetes 3 -
Diabetes 3 Name of medicine etc.
Diabetes 3 How often?
Diabetes 4 -
Diabetes 4 Name of medicine etc.
Diabetes 4 How often?
Diabetes 5 -
Diabetes 5 Name of medicine etc.
Diabetes 5 How often?
Epilepsy 1 -
Epilepsy 1 Name of medicine etc.
Epilepsy 1 How often?
Epilepsy 2 -
Epilepsy 2 Name of medicine etc.
Epilepsy 2 How often?
Epilepsy 3 -
Epilepsy 3 Name of medicine etc.
Epilepsy 3 How often?
Epilepsy 4 -
Epilepsy 4 Name of medicine etc.
Epilepsy 4 How often?
Epilepsy 5 -
Epilepsy 5 Name of medicine etc.
Epilepsy 5 How often?
Sleeping 1 -
Sleeping 1 Name of medicine etc.
Sleeping 1 How often?
Sleeping 2 -
Sleeping 2 Name of medicine etc.
Sleeping 2 How often?
Sleeping 3 -
Sleeping 3 Name of medicine etc.
Sleeping 3 How often?
Sleeping 4 -
Sleeping 4 Name of medicine etc.
Sleeping 4 How often?
Sleeping 5 -
Sleeping 5 Name of medicine etc.
Sleeping 5 How often?
Fever, high temperature 1 -
Fever, high temperature 1 Name of medicine etc.
Fever, high temperature 1 How often?
Fever, high temperature 2 -
Fever, high temperature 2 Name of medicine etc.
Fever, high temperature 2 How often?
Fever, high temperature 3 -
Fever, high temperature 3 Name of medicine etc.
Fever, high temperature 3 How often?
Fever, high temperature 4 -
Fever, high temperature 4 Name of medicine etc.
Fever, high temperature 4 How often?
Fever, high temperature 5 -
Fever, high temperature 5 Name of medicine etc.
Fever, high temperature 5 How often?

Please indicate below any medicines (pills, syrups, inhalers, drops, sprays, suppositories, ointments etc including homeopathic and herbal remedies) that your study child has used in the last 12 months. No medicines, pills, drops or ointment used at all

1
Yes
Include medicines prescribed by your doctor and those you may have bought over the counter. If you need more lines for a particular category please include the additional medicines under the 'Other conditions' section at the end of the question on Page 36.
Try to give the full name of the medicine and say how often it was used.
Regularly: most days for at least 3 months, or several times every month
Few days: for a few days at a time for one or more episodes
Odd occasions: on a few odd occasions
Once or twice: on one or two isolated occasions only
Please describe below any vitamins, minerals such as iron, or other supplements given for your study child's health in the past month and indicate how often they were taken.
Vitamins -

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text
1
2
Please describe below any vitamins, minerals such as iron, or other supplements given for your study child's health in the past month and indicate how often they were taken.
Mineral supplements (e.g. iron, calcium) -

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text
1
2
Please describe below any vitamins, minerals such as iron, or other supplements given for your study child's health in the past month and indicate how often they were taken.
Oil supplements (e.g. cod liver oil, evening primrose oil) -

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text
1
2
Please describe below any vitamins, minerals such as iron, or other supplements given for your study child's health in the past month and indicate how often they were taken.
Other tonic or supplement -

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Other

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Other

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Other

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Other
1
2
To describe supplements containing a mixture of things e.g. calcium and vitamins, or vitamins and iron etc., please write them under "Other" in part d) below.
Please describe below any treatment your child has taken for asthma or wheezing in the past month and indicate how often they were taken.
-

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

"Reliever" inhaler
"Preventer" inhaler
Other inhaler or medicine for asthma
SECTION F: MOODS AND FEELINGS
These questions are about how your child may have been feeling or acting recently. For each question, please say how much you think she has felt or acted this way in the past two weeks.
-

1 - True

2 - Sometimes true

3 - Not true

She felt miserable or unhappy
She didn't enjoy anything at all
She felt so tired that she just sat around and did nothing
She was very restless
She felt she was no good any more
She cried a lot
She found it hard to think properly or concentrate
She hated herself
She felt she was a bad person
She felt lonely
She thought nobody really loved her
She thought she could never be as good as other kids
She felt she did everything wrong
SECTION G: STRENGTHS AND DIFFICULTIES
Please think how your child has been in the past 6 months
-

1 - Not true

2 - Somewhat true

3 - Certainly true

9 - Don't know

She has been considerate of other people's feelings
She has been restless, overactive, cannot stay still for long
She has often complained of headaches, stomach aches or sickness
She has shared readily with other children (treats, toys, pencils etc.)
She has often had temper trantrums or hot tempers
She is rather solitary, tends to play alone
She is generally obedient, usually does what adults request
She has many worries, often seems worried
She is helpful if someone is hurt, upset or feeling ill
She is constantly fidgeting or squirming
She has at least one good friend
She often fights with other children or bullies them
She is often unhappy, down-hearted or tearful
She is generally liked by other children
She is easily distracted, her concentration wanders
She is nervous or clingy in new situations, easily loses confidence
She is kind to younger children
She often lies or cheats
She is picked on or bullied by other children
She often volunteers to help others (parents, teachers, other children)
She thinks things out before acting
She steals from home, school or elsewhere
She gets on better with adults than with other children
She has many fears, is easily scared
She sees tasks through to the end, has good attention span
It's two years since we asked you about your daughter's school days, so now we need to update our information
Thank you so much for helping us with this questionnaire. We really do appreciate all the help you are giving to the Study
SECTION H: SCHOOL

Does she go to school?

1
Yes
2
No
If no, go to H11a on page 46
qc_H1_a == 2
Else

How many different schools has she gone to? (don't count nursery school or kindergarten) ... different schools

How many

Please describe reasons for child being at current school (tick all that apply): It was the only available choice

1
Yes

Please describe reasons for child being at current school (tick all that apply): It was the best available

1
Yes

Please describe reasons for child being at current school (tick all that apply): There were medical reasons

1
Yes
If Yes to question H1ciii
qc_H1_c_iii == 1

please describe

Generic text

Please describe reasons for child being at current school (tick all that apply): There were psychological reasons

1
Yes
If Yes to question H1civ
qc_H1_c_iv == 1

please describe

Generic text

Please describe reasons for child being at current school (tick all that apply): Other (please tick and describe)

1
Yes
Other
How does she get to school?
Going Coming back

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

1 - every or most days

2 - some days

She walks
She goes in a wheelchair
By public transport
School bus/coach
By car
Rides bicycle
Other (please tick & describe)

How does she get to school? Going Other (please tick & describe)

Other

How does she get to school? Coming back Other (please tick & describe)

Other

How far away is the school?

1
less than 1/2 mile (1km) away
2
1/2 - 1 mile (1-2 km) away
3
1 - 5 miles (2-8 km) away
4
more than 5 miles (8 km) away

How long does it take to get there in the morning? ... minutes

How many
We would like to know what happens after school.

Does she usually go straight home?

1
No
2
Yes most days
3
Yes always
If yes always, go to H4c below
If no, or most days,
qc_H4_a == 1 || qc_H4_a == 2

where else does she go? to a relative's home

1
Every day
2
Some days
3
Never

where else does she go? to a friend's home

1
Every day
2
Some days
3
Never

where else does she go? to a childminder

1
Every day
2
Some days
3
Never

where else does she go? school club

1
Every day
2
Some days
3
Never

where else does she go? plays outside

1
Every day
2
Some days
3
Never

where else does she go? other (please tick and describe)

1
Every day
2
Some days
3
Never
Other

If she goes straight home is an adult always there?

1
yes, always
2
yes, usually
3
yes, sometimes
4
no, hardly ever

How do you think she feels about school? She looks forward to seeing her teachers

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She enjoys school

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She is stimulated by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She is frightened by the teachers

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She is frightened by her school mates

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She is afraid of failure

1
Always
2
Usually
3
Sometimes
4
Not at all

How do you think she feels about school? She seems bored by school

1
Always
2