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 :

DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or 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

30 questions before...
Please give the following details about each accident starting with the earliest :
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, 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
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First Accident 1
Second 2
Please give the following details about each accident starting with the earliest :
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Street, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2
Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since OCTOBER 1955.
Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment ? (Doctor, Nurse, other)
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
Whooping Cough
Measles
Mumps
Scarlet Fever
76 questions after...
View the complete questionnaire

Dimensions

Code Dimension

Type
Code List
Selection Style
SelectOne
Display Code
False
Display Label
True

Code Dimension

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