Other diseases (CHRIS baseline)

md_x0_0056

History of other diseases collected by interview-administered questionnaire during the visit at study center

No sub-modules.
Permanent injury #1

Have you ever had an accident with injuries?

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Permanent injury #1 elaborated (description/free text)

Description of the injury

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Permanent injury #1 (age)

When?

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Permanent injury #2

Have you had another accident with injuries?

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Permanent injury #2 elaborated (description/free text)

Description of the injury

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Permanent injury #2 (age)

When?

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Permanent injury #3

Have you had another accident with injuries?

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Permanent injury #3 elaborated (description/free text)

Description of the injury

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Permanent injury #3 (age)

When?

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Permanent injury #4

Have you had another accident with injuries?

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Permanent injury #4 elaborated (description/free text)

Description of the injury

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Permanent injury #4 (age)

When?

x0ot04c
Other disease #1

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

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Other disease #1 elaborated (description/free text)

Describe the disease as precisely as possible

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Other disease #1 (age at diagnosis)

Since when?

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Other disease #2

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

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Other disease #2 elaborated (description/free text)

Describe the disease as precisely as possible

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Other disease #2 (age at diagnosis)

Since when?

x0ot12c
Other disease #3

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

x0ot13
Other disease #3 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot13a2
Other disease #3 (age at diagnosis)

Since when?

x0ot13c
Other disease #4

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

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Other disease #4 elaborated (description/free text)

Describe the disease as precisely as possible

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Other disease #4 (age at diagnosis)

Since when?

x0ot14c
Other disease #5

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

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Other disease #5 elaborated (description/free text)

Describe the disease as precisely as possible

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Other disease #5 (age at diagnosis)

Since when?

x0ot15c
Other disease #6

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

x0ot16
Other disease #6 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot16a2
Other disease #6 (age at diagnosis)

Since when?

x0ot16c
Other disease #7

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

x0ot17
Other disease #7 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot17a2
Other disease #7 (age at diagnosis)

Since when?

x0ot17c
Other disease #8

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

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Other disease #8 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot18a2
Other disease #8 (age at diagnosis)

Since when?

x0ot18c
Other disease #9

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

x0ot19
Other disease #9 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot19a2
Other disease #9 (age at diagnosis)

Since when?

x0ot19c
Other disease #10

Have you any other disease we did not mention yet, which was diagnosed by a doctor?

x0ot20
Other disease #10 elaborated (description/free text)

Describe the disease as precisely as possible

x0ot20a2
Other disease #10 (age at diagnosis)

Since when?

x0ot20c
Other surgery #1

Did you have any surgery we did not mention yet?

x0ot21
Other surgery #1 elaborated (description/free text)

What type of surgery did you have?

x0ot21a2
Other surgery #1 (age)

When?

x0ot21c
Other surgery #2

Did you have any other surgery we did not mention yet?

x0ot22
Other surgery #2 elaborated (description/free text)

What type of surgery did you have?

x0ot22a2
Other surgery #2 (age)

When?

x0ot22c
Other surgery #3

Did you have any other surgery we did not mention yet?

x0ot23
Other surgery #3 elaborated (description/free text)

What type of surgery did you have?

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Other surgery #3 (age)

When?

x0ot23c
Other surgery #4

Did you have any other surgery we did not mention yet?

x0ot24
Other surgery #4 elaborated (description/free text)

What type of surgery did you have?

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Other surgery #4 (age)

When?

x0ot24c
Other diseases notes elaborated (permanent injury)

Other diseases notes (permanent injury)

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Other diseases notes elaborated (disease)

Other diseases notes elaborated (disease)

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Other diseases notes elaborated (surgery)

Other diseases notes elaborated (surgery)

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Other diseases notes elaborated

Other diseases notes elaborated

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Other diseases version

Other diseases version

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