Start
nshd_72_ar
1972
H5a
STRICTLY CONFIDENTIAL
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
(Medical Research Council)
ASK ALL AFTER Q. 10 (h)
ACCIDENTS

The last accident we have recorded for you was ... Have you had any accidents since then, or since we last heard from you, in which you were burnt or scalded, broke a bone, were badly cut or bruised, or injured by a chemical or foreign body?

1
Yes
2
No
(If 'Yes' please give the following details about each accident, starting with the earliest)
qc_10.5_a == 1
l_q10.5b

Type of injury (e.g. burn, cut, broken bone etc.)

Generic text

Part Injured

Generic text

Date when it happened

Generic date

TREATMENT Hosp. Inpatient Hosp. Outpatient Nursing home Doctor, etc.

Generic text

Details of how each accident occurred

Generic text

Where it happened (e.g. work, street, home, etc.)

Generic text
HOSPITAL ADMISSIONS

The last hospital admission we have recorded for you was ... Have you been in hospital as an inpatient since then or since we last heard from you?

1
Yes
2
No
(If 'Yes' please give the following details about each hospital admission)
qc_10.5_c == 1
l_q10.5d

Name of hospital

Generic text

Date of Admission

Generic date

Reason for admission

Generic text

Length of stay

Generic text

Name of doctor in charge

Generic text
End

nshd_72_ar

STRICTLY CONFIDENTIAL
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
(Medical Research Council)
ASK ALL AFTER Q. 10 (h)

ACCIDENTS

The last accident we have recorded for you was ... Have you had any accidents since then, or since we last heard from you, in which you were burnt or scalded, broke a bone, were badly cut or bruised, or injured by a chemical or foreign body?
1
Yes
2
No

Type of injury (e.g. burn, cut, broken bone etc.)
Generic text
Part Injured
Generic text
Date when it happened
Generic date
TREATMENT Hosp. Inpatient Hosp. Outpatient Nursing home Doctor, etc.
Generic text
Details of how each accident occurred
Generic text
Where it happened (e.g. work, street, home, etc.)
Generic text

HOSPITAL ADMISSIONS

The last hospital admission we have recorded for you was ... Have you been in hospital as an inpatient since then or since we last heard from you?
1
Yes
2
No

Name of hospital
Generic text
Date of Admission
Generic date
Reason for admission
Generic text
Length of stay
Generic text
Name of doctor in charge
Generic text