Question Grid
qg_7_c
7 c
Please give the following details about each Clinic attended.
Name of School Clinic or Out-Patient Dept. | Reason for attending | Date of FIRST attendance (month and year) | Date of LAST attendance (month and year) (if still attending strike through) | Number of attendances | Present condition | |
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1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
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Usage
Name of School Clinic or Out-Patient Dept. | Reason for attending | Date of FIRST attendance (month and year) | Date of LAST attendance (month and year) (if still attending strike through) | Number of attendances | Present condition | |
---|---|---|---|---|---|---|
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text1 - cured 2 - improved 3 - un-changed 4 - worse How manyGeneric textHow manyGeneric textGeneric dateGeneric date1 - cured 2 - improved 3 - un-changed 4 - worse 1 - cured 2 - improved 3 - un-changed 4 - worse Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many1 - cured 2 - improved 3 - un-changed 4 - worse |
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(Only absences of more than one week are recorded)
Information from School Absence Record: Period of Absence: From | Information from School Absence Record: Period of Absence: To | Information from School Absence Record: Reason for Absence | Please give these additional details: If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home | Please give these additional details: If child was ill: If treated at home who gave treatement ? (Doctor Chemist Nurse, Other) | Please give these additional details: Remarks | |
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Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | |
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Dimensions
Code Dimension
Code Dimension
Response Options
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1 cured
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2 improved
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3 un-changed
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4 worse
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1 cured
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2 improved
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3 un-changed
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4 worse
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1 cured
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2 improved
-
3 un-changed
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4 worse
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1 cured
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2 improved
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3 un-changed
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4 worse
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1 cured
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2 improved
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3 un-changed
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4 worse
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1 cured
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2 improved
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3 un-changed
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4 worse