Question Grid
Name
qg_4_b_ii
Label
4 b(ii)
Question Text
Please give the following details about each accident starting with the earliest:
DETAIILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or oil stove) | WHERE IT OCCURRED (Own Home, School, Street, etc) | |
---|---|---|
Generic textGeneric textGeneric textGeneric text | Generic textGeneric textGeneric textGeneric text | |
First Accident 1 | ||
Second 2 |
Usage
24 questions before...
Please give the following details about each accident starting with the earliest:
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, POISON, etc) | Part or Parts injured | Age when injured (in years and months) | Treatment, Hosp, I.P., Hosp. O.P., Nursing Home Own Home | If treated in own home, who gave treatment (Doctor, Nurse, other) | Details of any remaining scarring, disability or deformity | |
---|---|---|---|---|---|---|
Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | Generic textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric text | |
First Accident 1 | ||||||
Second 2 |
Please give the following details about each accident starting with the earliest:
107 questions after...
View the complete questionnaire
Dimensions
Code Dimension
Type
Code List
Selection Style
SelectOne
Display Code
False
Display Label
True
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
Text
Maximum Length
255
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