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
PE30F (PE1055)
BLAISE NAME: DxStroke
Context Header: {PERSON?S FIRST MIDDLE AND LAST NAME}
Question Text:
{Now I?m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had...]
f. a stroke, ministroke, or TIA? A TIA is short for Transient Ischemic Attack.
HELP:F1
Responses: 
YES 1 PE30G (PE1060)
NO 2 PE30G (PE1060)
REFUSED RF PE30G (PE1060)
DON?T KNOW DK PE30G (PE1060)
Programmer Instructions: If coded ?1? (YES), add ?STROKE-TIA? to person?s-medical-conditions-roster.
Display Instructions:

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2017
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PE13
====

[PERSON?S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
IF CODED ?1? (YES), ADD THE PRIORITY CONDITION ?STROKE-TIA? TO PERSON?S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

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2016
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PE13
====

[Have/Has] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2015
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2014
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2013
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2012
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PE20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the high cholesterol was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2011
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a stoke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------
PE14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the stroke or TIA was first diagnosed?
IF MORE THAN ONE STROKE, PROBE FOR AGE WHEN FIRST STROKE DIAGNOSED.
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

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2010
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a stoke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2009
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a stoke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2008
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PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a stoke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

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2007
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PC12_05
=======
[(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had ...]
...A stroke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke. ( )
----------------------------------------------------
DISPLAY '(Have/Has) (PERSON)... that (PERSON) had...' IF PC12_04 IS CODED '1' (YES). OTHERWISE, DISPLAY '[Have/Has...'
----------------------------------------------------