Survey Text

2021 2017 2013 2009
2020 2016 2012 2008
2019 2015 2011 2007
2018 2014 2010
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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


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2018
Survey form view entire document:  text  image
PE150 (PE1170)
BLAISE NAME: AgeDxCancer
Context Header: {PERSON?S FIRST MIDDLE AND LAST NAME} {PERSON?S MEDICAL CONDITION.}
Question Text:
How old {were/was} {you/{PERSON}} when the {CONDITION} was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
ENTER AGE.
Responses: 
1 PE160 (PE1175)
REFUSED RF PE160 (PE1175)
DON?T KNOW DK PE160 (PE1175)
Programmer Instructions: Hard range check: 0 to person?s current age.
Display Instructions: For {PERSON?S MEDICAL CONDITION} in the header, display the type of cancer enumerated at PE140 or PE140OS that is currently being asked about.

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2017
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old [were/was] [you/[PERSON]] when the [CONDITION] was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON?S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON?S CURRENT AGE
----------------------------------------------------

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2016
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2015
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2014
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2013
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2012
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2011
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2010
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2009
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2008
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2007
Survey form view entire document:  text  image
PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------