Question Grid
Name
qg_5_c_i
Label
5 c(i)
Question Text
Please give the following details about each admission :
Nature of illness | Nature of operation performed (if any) | Date of Admission | |
---|---|---|---|
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | |
1 | |||
2 |
Usage
30 questions before...
Please give the following details about each admission :
Nature of illness | Nature of operation performed (if any) | Date of Admission | |
---|---|---|---|
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text | |
1 | |||
2 |
Please give the following details about each admission:
Name and Address of Hospital or Nursing Home | Length of stay in Hospital or Nursing Home | Name of Doctor or Specialist in charge of Child | |
---|---|---|---|
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text | |
1 | |||
2 |
101 questions after...
View the complete questionnaire
Dimensions
Code Dimension
Display Code
False
Display Label
False
Code Dimension
Type
Code List
Selection Style
SelectOne
Codes
Display Code
False
Display Label
False
Response Options
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
1
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
2
Type
Date/Time
Type
Date
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
3
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
4
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
5
Type
Date/Time
Type
Date
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
6
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
7
Type
Date/Time
Type
Date
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
8
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
9