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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

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2017

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2016

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2015

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2014

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2013

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2012

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2011

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2010

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2009

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2008

Survey form view entire document: text image

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

Survey Text