Page 1 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.005_00.000 Instrument Variable Name: FLAPLYLM QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill1: Are/Is]
* Read names
(fill roster of persons age 0-4)
limited in the kind or amount of play activities [fill2: they/he/she] can do because of a physical, mental, or emotional
problem?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons less than 5 years of age
SkipInstructions: <1> [if only one child less than 5 years of age, store the person number in PLAPLYLM and goto PLAPLYUN; else,
goto PLAPLYLM]
<2,R,D> [goto FSPEDEIS]
Question ID: FHS.010_00.000 Instrument Variable Name: PLAPLYLM QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons less than five years of age and at least one is limited in play activities
SkipInstructions: goto PLAPLYUN
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.020_00.000 Instrument Variable Name: PLAPLYUN QuestionnaireFileName: Family
QuestionText: Is [fill: ALIAS] able to take part AT ALL in the usual kinds of play activities done by most children [fill: ALIAS]’s age?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons less than 5 years of age who are limited in play activities
SkipInstructions: repeat this question for all persons listed at PLAPLYLM, then goto FSPEDEIS
Page 2 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.050_00.000 Instrument Variable Name: FSPEDEIS QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill: Do you/Does/Do any of these family members,
* Read names
(fill roster of persons less than age 18)]
receive Special Educational or Early Intervention Services?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons less than 18 years of age
SkipInstructions: <1> [if only one person less than 18 years of age, store the person number in PSPEDEIS and goto PSPEDEM; else,
goto PSPEDEIS]
<2,R,D> [goto FLAADL]
Question ID: FHS.060_00.000 Instrument Variable Name: PSPEDEIS QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons less than 18 years of age and at least one receives Special Educational or Early
Intervention Services
SkipInstructions: goto PSPEDEM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.065_00.000 Instrument Variable Name: PSPEDEM QuestionnaireFileName: Family
QuestionText: [fill: Do you/Does ALIAS] receive these services because of an emotional
or behavioral problem?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who receive Special Educational or Early Intervention Services
SkipInstructions: repeat this question for all persons listed at PSPEDEIS, then goto FLAADL
Page 3 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.070_00.000 Instrument Variable Name: FLAADL QuestionnaireFileName: Family
QuestionText: ? [F1]
Because of a physical, mental, or emotional problem, [fill1: do you/does anyone in the family] need the help of other persons
with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home?
[fill2: Do not include family members age 2 and under.]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons 3 years of age or older
SkipInstructions: <1> [if a single-person family, store the person number in PLAADL and goto LABATH; else, goto PLAADL]
<2,R,D> [goto FLAIADL]
Question ID: FHS.080_00.000 Instrument Variable Name: PLAADL QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons 3 years of age or older and at least one needs the help of other persons with
personal care needs
SkipInstructions: goto LABATH
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.090_01.000 Instrument Variable Name: LABATH QuestionnaireFileName: Family
QuestionText: [fill: Do you/Does ALIAS] need the help of other persons with...
Bathing or showering?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LADRESS
Page 4 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.090_02.000 Instrument Variable Name: LADRESS QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Dressing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LAEAT
Question ID: FHS.090_03.000 Instrument Variable Name: LAEAT QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Eating?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LABED
Question ID: FHS.090_04.000 Instrument Variable Name: LABED QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting in or out of bed or chairs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LATOILT
Page 5 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.090_05.000 Instrument Variable Name: LATOILT QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Using the toilet, including getting to the toilet?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LAHOME
Question ID: FHS.090_06.000 Instrument Variable Name: LAHOME QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting around inside the home?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 3 years of age or older who need help with personal care needs
SkipInstructions: goto LABATH for the next persons listed at PLAADL; else, goto FLAIADL
Question ID: FHS.150_00.000 Instrument Variable Name: FLAIADL QuestionnaireFileName: Family
QuestionText: ? [F1]
Because of a physical, mental, or emotional problem, do [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
need the help of other persons in handling ROUTINE NEEDS, such as everyday household chores, doing necessary
business, shopping, or getting around for other purposes?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons 18 years of age or older
SkipInstructions: <1> [if only one person 18 years of age or older, store the person number in PLAIADL and goto FLAWKNOW;
else, goto PLAIADL]
<2,R,D> [goto FLAWKNOW]
Page 6 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.160_00.000 Instrument Variable Name: PLAIADL QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons 18 years of age or older and at least one needs the help of other persons in
handling routine needs
SkipInstructions: goto FLAWKNOW
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.170_00.000 Instrument Variable Name: FLAWKNOW QuestionnaireFileName: Family
QuestionText: ? [F1]
Does a physical, mental, or emotional problem NOW keep [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
from working at a job or business?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons 18 years of age or older
SkipInstructions: <1> [if only one person 18 years of age or older, store the person number in PLAWKNOW and goto FLAWALK;
else, goto PLAWKNOW]
<2,R,D> [goto FLAWKLIM]
Page 7 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.180_00.000 Instrument Variable Name: PLAWKNOW QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't Know
UniverseText: All families with two or more persons 18 years of age or older and at least one is unable to work due to a physical,
mental, or emotional problem
SkipInstructions: all persons selected goto FLAWALK; else, goto FLAWKLIM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.190_00.000 Instrument Variable Name: FLAWKLIM QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill: Are you limited in the kind OR amount of work you/ Is ALIAS limited in the kind OR amount of work he/she/ Are
any of these family members,
* Read names
(fill roster of persons age 18 or older)]
limited in the kind OR amount of work they] can do because of a physical, mental or emotional problem?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons 18 years of age or older not listed as being unable to work due to a physical,
mental, or emotional problem
SkipInstructions: <1> [if only one person 18 years of age or older not selected at PLAWKNOW, store person number in PLAWKLIM
and goto FLAWALK; else, goto PLAWKLIM]
<2,R,D> [goto FLAWALK]
Page 8 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.200_00.000 Instrument Variable Name: PLAWKLIM QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
0 Unable to work
1 Limited in work
2 Not limited in work
7 Refused
9 Don't Know
UniverseText: All families with two or more persons 18 years of age or older able to work and at least one is limited in the kind or
amount of work he/she can do
SkipInstructions: goto FLAWALK
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.210_00.000 Instrument Variable Name: FLAWALK QuestionnaireFileName: Family
QuestionText: ? [F1]
Because of a health problem, [fill: do you/does anyone in the family]
have difficulty walking without using any special equipment?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families
SkipInstructions: <1> [if a single-person family, store the person number in PLAWALK and goto FLAREMEM; else, goto
PLAWALK]
<2,R,D> [goto FLAREMEM]
Question ID: FHS.220_00.000 Instrument Variable Name: PLAWALK QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons and at least one has difficulty walking without using special equipment
SkipInstructions: goto FLAREMEM
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Page 9 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.230_00.000 Instrument Variable Name: FLAREMEM QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill1: Are you/Is anyone in the family] LIMITED IN ANY WAY because of difficulty remembering or because
[fill2: you/they] experience periods of confusion?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families
SkipInstructions: <1> [if a single-person family, store person number in PLAREMEM and goto LAHCC; else, goto PLAREMEM]
<2,R,D> [goto FLIMANY]
Question ID: FHS.240_00.000 Instrument Variable Name: PLAREMEM QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons and at least one is limited due to difficulty remembering or periods of confusion
SkipInstructions: goto FLIMANY
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FHS.250_00.000 Instrument Variable Name: FLIMANY QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill: Are you/ Is ALIAS/ Are any family members
* Read names
(fill roster of applicable persons)]
LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more family members not previously mentioned as having a limitation
SkipInstructions: <1> [if a one-person family or the respondent is the only person NOT previously mentioned as having a limitation,
store person number in PLIMANY and goto LAHCC; else goto PLIMANY]
<2,R,D> [goto LAHCC]
Page 10 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.260_00.000 Instrument Variable Name: PLIMANY QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who is this?
(Anyone else?)
0 Limitation previously mentioned
1 Yes, limited in some other way
2 Not limited in any way
7 Refused
9 Don't know
UniverseText: All families with two or more persons not previously mentioned as having a limitation
SkipInstructions: goto LAHCC
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Page 11 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.270_00.000 Instrument Variable Name: LAHCC QuestionnaireFileName: Family
QuestionText: (book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]’s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions: <1-4,6-13> [goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
<5> [fill "96" in LHCL05N and fill "6" in LHCL05T]
<90> [goto LAHCC_S1]
<91> [goto LAHCC_S2]
<R,D> [repeat this question for the next person less than 18 years of age with a reported limitation; if no more
persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18
years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID: FHS.271_90.000 Instrument Variable Name: LAHCC_S1 QuestionnaireFileName: Family
QuestionText: * Read if necessary.
What is the other impairment or problem?
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
SkipInstructions: goto LHCL90N
Page 12 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.271_91.000 Instrument Variable Name: LAHCC_S2 QuestionnaireFileName: Family
QuestionText: * Read if necessary.
What is the other impairment or problem?
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
SkipInstructions: goto LHCL91N
Question ID: FHS.280_01.000 Instrument Variable Name: LHCL01N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a vision problem or problem seeing?
* Enter number for time with a vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a vision problem or problem seeing
SkipInstructions: <1-95,D> [goto LHCL01T]
<96> [fill "6" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 13 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.280_02.000 Instrument Variable Name: LHCL01T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with vision problem or problem seeing.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a vision problem or problem seeing and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL01T]
if (LHCL01T = 4 and LHCL01N > AGE) or (LHCL01T = 3 and LHCL01N > AGE in months) or (LHCL01T = 2
and LHCL01N > AGE in weeks), goto ERR1_LHCL01T
Question ID: FHS.282_01.000 Instrument Variable Name: LHCL02N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a hearing problem
SkipInstructions: <1-95,D> [goto LHCL02T]
<96> [fill "6" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 14 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.282_02.000 Instrument Variable Name: LHCL02T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with hearing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a hearing problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL02T]
if (LHCL02T = 4 and LHCL02N > AGE) or (LHCL02T = 3 and LHCL02N > AGE in months) or (LHCL02T = 2
and LHCL02N > AGE in weeks), goto ERR1_LHCL02T
Question ID: FHS.284_01.000 Instrument Variable Name: LHCL03N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a speech problem?
* Enter number for time with a speech problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a speech problem
SkipInstructions: <1-95,D> [goto LHCL03T]
<96> [fill "6" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 15 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.284_02.000 Instrument Variable Name: LHCL03T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with speech problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a speech problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL03T]
if (LHCL03T = 4 and LHCL03N > AGE) or (LHCL03T = 3 and LHCL03N > AGE in months) or (LHCL03T = 2
and LHCL03N > AGE in weeks), goto ERR1_LHCL03T
Question ID: FHS.286_01.000 Instrument Variable Name: LHCL04N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had asthma or a breathing problem?
* Enter number for time with an asthma or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to asthma/breathing problem
SkipInstructions: <1-95,D> [goto LHCL04T]
<96> [fill "6" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 16 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.286_02.000 Instrument Variable Name: LHCL04T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with asthma or a breathing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to asthma/breathing problem and 1-95, D was entered
for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL04T]
if (LHCL04T = 4 and LHCL04N > AGE) or (LHCL04T = 3 and LHCL04N > AGE in months) or (LHCL04T = 2
and LHCL04N > AGE in weeks), goto ERR1_LHCL04T
Question ID: FHS.288_01.000 Instrument Variable Name: LHCL06N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had the injury that caused [fill2:your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to an injury
SkipInstructions: <1-95,D> [goto LHCL06T]
<96> [fill "6" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 17 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.288_02.000 Instrument Variable Name: LHCL06T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with the injury that caused [fill: your/his/her] limitation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to an injury and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL06T]
if (LHCL06T = 4 and LHCL06N > AGE) or (LHCL06T = 3 and LHCL06N > AGE in months) or (LHCL06T = 2
and LHCL06N > AGE in weeks), goto ERR1_LHCL06T
Question ID: FHS.290_01.000 Instrument Variable Name: LHCL07N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to mental retardation
SkipInstructions: <1-95,D> [goto LHCL07T]
<96> [fill "6" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 18 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.290_02.000 Instrument Variable Name: LHCL07T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with mental retardation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to mental retardation and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL07T]
if (LHCL07T = 4 and LHCL07N > AGE) or (LHCL07T = 3 and LHCL07N > AGE in months) or (LHCL07T = 2
and LHCL07N > AGE in weeks), goto ERR1_LHCL07T
Question ID: FHS.292_01.000 Instrument Variable Name: LHCL08N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to some other developmental problem
SkipInstructions: <1-95,D> [goto LHCL08T]
<96> [fill "6" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 19 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.292_02.000 Instrument Variable Name: LHCL08T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to some other developmental problem and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL08T]
if (LHCL08T = 4 and LHCL08N > AGE) or (LHCL08T = 3 and LHCL08N > AGE in months) or (LHCL08T = 2
and LHCL08N > AGE in weeks), goto ERR1_LHCL08T
Question ID: FHS.294_01.000 Instrument Variable Name: LHCL09N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a mental, emotional, or behavioral problem?
* Enter number for time with a mental, emotional, or behavioral problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a mental, emotional, or behavioral problem
SkipInstructions: <1-95,D> [goto LHCL09T]
<96> [fill "6" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 20 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.294_02.000 Instrument Variable Name: LHCL09T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with mental, emotional, or behavioral problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a mental, emotional, or behavioral problem and 1-
95, D was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL09T]
if (LHCL09T = 4 and LHCL09N > AGE) or (LHCL09T = 3 and LHCL09N > AGE in months) or (LHCL09T = 2
and LHCL09N > AGE in weeks), goto ERR1_LHCL09T
Question ID: FHS.296_01.000 Instrument Variable Name: LHCL10N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a bone, joint, or muscle problem?
* Enter number for time with a bone, joint, or muscle problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a bone, joint, or muscle problem
SkipInstructions: <1-95,D> [goto LHCL10T]
<96> [fill "6" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 21 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.296_02.000 Instrument Variable Name: LHCL10T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with bone, joint, or muscle problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a bone, joint, or muscle problem and 1-95, D was
entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL10T]
if (LHCL10T = 4 and LHCL10N > AGE) or (LHCL10T = 3 and LHCL10N > AGE in months) or (LHCL10T = 2
and LHCL10N > AGE in weeks), goto ERR1_LHCL10T
Question ID: FHS.298_01.000 Instrument Variable Name: LHCL11N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epileplsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to epilepsy or seizures
SkipInstructions: <1-95,D> [goto LHCL11T]
<96> [fill "6" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 22 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.298_02.000 Instrument Variable Name: LHCL11T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with epilepsy or seizures.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to epilepsy or seizures and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL11T]
if (LHCL11T = 4 and LHCL11N > AGE) or (LHCL11T = 3 and LHCL11N > AGE in months) or (LHCL11T = 2
and LHCL11N > AGE in weeks), goto ERR1_LHCL11T
Question ID: FHS.300_01.000 Instrument Variable Name: LHCL12N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a learning disability?
* Enter number for time with a learning disability.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a learning disability
SkipInstructions: <1-95,D> [goto LHCL12T]
<96> [fill "6" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 23 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.300_02.000 Instrument Variable Name: LHCL12T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with learning disability.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to a learning disability and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL12T]
if (LHCL12T = 4 and LHCL12N > AGE) or (LHCL12T = 3 and LHCL12N > AGE in months) or (LHCL12T = 2
and LHCL12N > AGE in weeks), goto ERR1_LHCL12T
Question ID: FHS.302_01.000 Instrument Variable Name: LHCL13N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had attention deficit/hyperactivity disorder?
* Enter number for time with attention deficit/hyperactivity disorder.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to Attention Deficit/Hyperactivity Disorder
SkipInstructions: <1-95,D> [goto LHCL13T]
<96> [fill "6" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 24 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.302_02.000 Instrument Variable Name: LHCL13T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with attention deficit/hyperactivity disorder.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to Attention Deficit/Hyperactivity Disorder and 1-95,
D was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL13T]
if (LHCL13T = 4 and LHCL13N > AGE) or (LHCL13T = 3 and LHCL13N > AGE in months) or (LHCL13T = 2
and LHCL13N > AGE in weeks), goto ERR1_LHCL13T
Question ID: FHS.304_01.000 Instrument Variable Name: LHCL90N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S1]?
* Enter number for time with [fill1: problem in LAHCC_S1]?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S1
SkipInstructions: <1-95,D> [goto LHCL90T]
<96> [fill "6" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 25 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.304_02.000 Instrument Variable Name: LHCL90T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with [fill: problem in LAHCC_S1].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S1 and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL90T]
if (LHCL90T = 4 and LHCL90N > AGE) or (LHCL90T = 3 and LHCL90N > AGE in months) or (LHCL90T = 2
and LHCL90N > AGE in weeks), goto ERR1_LHCL90T
Question ID: FHS.306_01.000 Instrument Variable Name: LHCL91N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S2]?
* Enter number for time with [fill1: problem in LAHCC_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S2
SkipInstructions: <1-95,D> [goto LHCL91T]
<96> [fill "6" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
<R> [store "R" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Page 26 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.306_02.000 Instrument Variable Name: LHCL91T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with [fill: problem in LAHCC_S2].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons less than 18 years of age who have a limitation due to the problem entered at LAHCC_S2 and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for
next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
<6> [goto ERR2_LHCL91T]
if (LHCL91T = 4 and LHCL91N > AGE) or (LHCL91T = 3 and LHCL91N > AGE in months) or (LHCL91T = 2
and LHCL91N > AGE in weeks), goto ERR1_LHCL91T
Page 27 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.350_00.000 Instrument Variable Name: LAHCA QuestionnaireFileName: Family
QuestionText: (book) F2
What conditions or health problems cause [fill: your/ALIAS’s] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Page 28 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions: <1-12,14-35> [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
<13> [fill "96" in LHAL13N and fill "6" in LHAL13T]
<90> [goto LAHCA_S1]
<91> [goto LAHCA_S2]
<R,D> [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons
18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age
or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID: FHS.351_90.000 Instrument Variable Name: LAHCA_S1 QuestionnaireFileName: Family
QuestionText: * Read if necessary.
What is the other impairment or problem?
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
SkipInstructions: goto LHAL90N
Question ID: FHS.351_91.000 Instrument Variable Name: LAHCA_S2 QuestionnaireFileName: Family
QuestionText: * Read if necessary.
What is the other impairment or problem?
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
SkipInstructions: goto LHAL91N
Page 29 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.360_01.000 Instrument Variable Name: LHAL01N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a vision problem or problem seeing?
* Enter number for time with a vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a vision problem or problem seeing
SkipInstructions: <1-95,D> [goto LHAL01T]
<96> [fill "6" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.360_02.000 Instrument Variable Name: LHAL01T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with vision problem or problem seeing.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a vision problem or problem seeing and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL01T]
if LHAL01T = 4 and LHAL01N > AGE, goto ERR1_LHAL01T
Page 30 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.362_01.000 Instrument Variable Name: LHAL02N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a hearing problem
SkipInstructions: <1-95,D> [goto LHAL02T]
<96> [fill "6" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.362_02.000 Instrument Variable Name: LHAL02T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with hearing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a hearing problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL02T]
if LHAL02T = 4 and LHAL02N > AGE, goto ERR1_LHAL02T
Page 31 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.364_01.000 Instrument Variable Name: LHAL03N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to arthritis/rheumatism
SkipInstructions: <1-95,D> [goto LHAL03T]
<96> [fill "6" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.364_02.000 Instrument Variable Name: LHAL03T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with arthritis or rheumatism.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to arthritis/rheumatism and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL03T]
if LHAL03T = 4 and LHAL03N > AGE, goto ERR1_LHAL03T
Page 32 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.366_01.000 Instrument Variable Name: LHAL04N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a back or neck problem?
* Enter number for time with a back or neck problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a back or neck problem
SkipInstructions: <1-95,D> [goto LHAL04T]
<96> [fill "6" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.366_02.000 Instrument Variable Name: LHAL04T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with back or neck problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a back or neck problem and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL04T]
if LHAL04T = 4 and LHAL04N > AGE, goto ERR1_LHAL04T
Page 33 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.368_01.000 Instrument Variable Name: LHAL05N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone or joint injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a fracture or bone/joint injury
SkipInstructions: <1-95,D> [goto LHAL05T]
<96> [fill "6" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.368_02.000 Instrument Variable Name: LHAL05T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with fracture, bone, or joint injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a fracture or bone/joint injury and 1-95, D was
entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL05T]
if LHAL05T = 4 and LHAL05N > AGE, goto ERR1_LHAL05T
Page 34 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.370_01.000 Instrument Variable Name: LHAL06N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had the other injury that caused [fill2: your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to some "other" injury
SkipInstructions: <1-95,D> [goto LHAL06T]
<96> [fill "6" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.370_02.000 Instrument Variable Name: LHAL06T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with other injury that caused [fill: your/his/her] limitation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to some "other" injury and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL06T]
if LHAL06T = 4 and LHAL06N > AGE, goto ERR1_LHAL06T
Page 35 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.372_01.000 Instrument Variable Name: LHAL07N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a heart problem?
* Enter number for time with a heart problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a heart problem
SkipInstructions: <1-95,D> [goto LHAL07T]
<96> [fill "6" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.372_02.000 Instrument Variable Name: LHAL07T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with heart problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a heart problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL07T]
if LHAL07T = 4 and LHAL07N > AGE, goto ERR1_LHAL07T
Page 36 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.374_01.000 Instrument Variable Name: LHAL08N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a stroke problem
SkipInstructions: <1-95,D> [goto LHAL08T]
<96> [fill "6" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.374_02.000 Instrument Variable Name: LHAL08T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with stroke problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a stroke problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL08T]
if LHAL08T = 4 and LHAL08N > AGE, goto ERR1_LHAL08T
Page 37 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.376_01.000 Instrument Variable Name: LHAL09N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to hypertension/high blood pressure
SkipInstructions: <1-95,D> [goto LHAL09T]
<96> [fill "6" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.376_02.000 Instrument Variable Name: LHAL09T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with hypertension or high blood pressure.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to hypertension/high blood pressure and 1-95, D was
entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL09T]
if LHAL09T = 4 and LHAL09N > AGE, goto ERR1_LHAL09T
Page 38 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.378_01.000 Instrument Variable Name: LHAL10N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had diabetes?
* Enter number for time with diabetes.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to diabetes
SkipInstructions: <1-95,D> [goto LHAL10T]
<96> [fill "6" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.378_02.000 Instrument Variable Name: LHAL10T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with diabetes.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to diabetes and 1-95, D was entered for the "number"
part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL10T]
if LHAL10T = 4 and LHAL10N > AGE, goto ERR1_LHAL10T
Page 39 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.380_01.000 Instrument Variable Name: LHAL11N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a lung problem or breathing problem (e.g., asthma and emphysema)?
* Enter number for time with a lung problem or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a lung/breathing problem
SkipInstructions: <1-95,D> [goto LHAL11T]
<96> [fill "6" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.380_02.000 Instrument Variable Name: LHAL11T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with lung problem or breathing problem (e.g., asthma and emphysema).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a lung/breathing problem and 1-95, D was entered
for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL11T]
if LHAL11T = 4 and LHAL11N > AGE, goto ERR1_LHAL11T
Page 40 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.382_01.000 Instrument Variable Name: LHAL12N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had cancer?
* Enter number for time with cancer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to cancer
SkipInstructions: <1-95,D> [goto LHAL12T]
<96> [fill "6" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.382_02.000 Instrument Variable Name: LHAL12T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with cancer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to cancer and 1-95, D was entered for the "number"
part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL12T]
if LHAL12T = 4 and LHAL12N > AGE, goto ERR1_LHAL12T
Page 41 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.384_01.000 Instrument Variable Name: LHAL14N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to mental retardation
SkipInstructions: <1-95,D> [goto LHAL14T]
<96> [fill "6" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.384_02.000 Instrument Variable Name: LHAL14T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with mental retardation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to mental retardation and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL14T]
if LHAL14T = 4 and LHAL14N > AGE, goto ERR1_LHAL14T
Page 42 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.386_01.000 Instrument Variable Name: LHAL15N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to some other developmental problem
SkipInstructions: <1-95,D> [goto LHAL15T]
<96> [fill "6" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.386_02.000 Instrument Variable Name: LHAL15T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with developmental problem (e.g. cerebral palsy).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to some other developmental problem and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL15T]
if LHAL15T = 4 and LHAL15N > AGE, goto ERR1_LHAL15T
Page 43 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.388_01.000 Instrument Variable Name: LHAL16N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had senility?
* Enter number for time with senility.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to senility
SkipInstructions: <1-95,D> [goto LHAL16T]
<96> [fill "6" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.388_02.000 Instrument Variable Name: LHAL16T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with senility.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to senility and 1-95, D was entered for the "number"
part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL16T]
if LHAL16T = 4 and LHAL16N > AGE, goto ERR1_LHAL16T
Page 44 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.390_01.000 Instrument Variable Name: LHAL17N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety or an emotional problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to depression/anxiety/emotional problem
SkipInstructions: <1-95,D> [goto LHAL17T]
<96> [fill "6" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.390_02.000 Instrument Variable Name: LHAL17T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with depression, anxiety, or an emotional problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to depression/anxiety/emotional problem and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL17T]
if LHAL17T = 4 and LHAL17N > AGE, goto ERR1_LHAL17T
Page 45 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.392_01.000 Instrument Variable Name: LHAL18N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a weight problem?
* Enter number for time with a weight problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a weight problem
SkipInstructions: <1-95,D> [goto LHAL18T]
<96> [fill "6" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.392_02.000 Instrument Variable Name: LHAL18T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with weight problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a weight problem and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL18T]
if LHAL18T = 4 and LHAL18N > AGE, goto ERR1_LHAL18T
Page 46 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.394_01.000 Instrument Variable Name: LHAL19N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to missing limbs
SkipInstructions: <1-95,D> [goto LHAL19T]
<96> [fill "6" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.394_02.000 Instrument Variable Name: LHAL19T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with missing limb (finger, toe, or digit).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to missing limbs and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL19T]
if LHAL19T = 4 and LHAL19N > AGE, goto ERR1_LHAL19T
Page 47 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.396_01.000 Instrument Variable Name: LHAL20N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a kidney, bladder, or renal problem
SkipInstructions: <1-95,D> [goto LHAL20T]
<96> [fill "6" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.396_02.000 Instrument Variable Name: LHAL20T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with kidney, bladder or renal problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a kidney, bladder, or renal problem and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL20T]
if LHAL20T = 4 and LHAL20N > AGE, goto ERR1_LHAL20T
Page 48 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.398_01.000 Instrument Variable Name: LHAL21N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to circulation problems
SkipInstructions: <1-95,D> [goto LHAL21T]
<96> [fill "6" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.398_02.000 Instrument Variable Name: LHAL21T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with circulation problem (including blood clots).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to circulation problems and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL21T]
if LHAL21T = 4 and LHAL21N > AGE, goto ERR1_LHAL21T
Page 49 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.400_01.000 Instrument Variable Name: LHAL22N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to benign tumors or cysts
SkipInstructions: <1-95,D> [goto LHAL22T]
<96> [fill "6" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.400_02.000 Instrument Variable Name: LHAL22T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with benign tumors or cysts.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to benign tumors or cysts and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL22T]
if LHAL22T = 4 and LHAL22N > AGE, goto ERR1_LHAL22T
Page 50 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.402_01.000 Instrument Variable Name: LHAL23N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to fibromyalgia or lupus
SkipInstructions: <1-95,D> [goto LHAL23T]
<96> [fill "6" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.402_02.000 Instrument Variable Name: LHAL23T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with fibromyalgia or lupus.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to fibromyalgia or lupus and 1-95, D was entered for
the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL23T]
if LHAL23T = 4 and LHAL23N > AGE, goto ERR1_LHAL23T
Page 51 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.404_01.000 Instrument Variable Name: LHAL24N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to osteoporosis or tendinitis
SkipInstructions: <1-95,D> [goto LHAL24T]
<96> [fill "6" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.404_02.000 Instrument Variable Name: LHAL24T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with osteoporosis or tendinitis.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to osteoporosis or tendinitis and 1-95, D was entered
for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL24T]
if LHAL24T = 4 and LHAL24N > AGE, goto ERR1_LHAL24T
Page 52 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.406_01.000 Instrument Variable Name: LHAL25N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to epilepsy or seizures
SkipInstructions: <1-95,D> [goto LHAL25T]
<96> [fill "6" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.406_02.000 Instrument Variable Name: LHAL25T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with epilepsy or seizures.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to epilepsy or seizures and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL25T]
if LHAL25T = 4 and LHAL25N > AGE, goto ERR1_LHAL25T
Page 53 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.408_01.000 Instrument Variable Name: LHAL26N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dtstrophy (MD)?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to multiple sclerosis or muscular dystrophy
SkipInstructions: <1-95,D> [goto LHAL26T]
<96> [fill "6" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.408_02.000 Instrument Variable Name: LHAL26T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with multiple sclerosis (MS) or muscular dystrophy (MD).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to multiple sclerosis or muscular dystrophy and 1-95,
D was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL26T]
if LHAL26T = 4 and LHAL26N > AGE, goto ERR1_LHAL26T
Page 54 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.410_01.000 Instrument Variable Name: LHAL27N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis) paralysis or para/quadriplegia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to polio, paralysis, or para/quadriplegia
SkipInstructions: <1-95,D> [goto LHAL27T]
<96> [fill "6" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.410_02.000 Instrument Variable Name: LHAL27T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to polio, paralysis, or para/quadriplegia and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL27T]
if LHAL27T = 4 and LHAL27N > AGE, goto ERR1_LHAL27T
Page 55 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.412_01.000 Instrument Variable Name: LHAL28N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had Parkinson’s disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to Parkinson's disease or other tremors
SkipInstructions: <1-95,D> [goto LHAL28T]
<96> [fill "6" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.412_02.000 Instrument Variable Name: LHAL28T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with Parkinson’s disease or tremors.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to Parkinson's disease or other tremors and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL28T]
if LHAL28T = 4 and LHAL28N > AGE, goto ERR1_LHAL28T
Page 56 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.414_01.000 Instrument Variable Name: LHAL29N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerve damage.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to other nerve damage, including carpal tunnel
syndrome
SkipInstructions: <1-95,D> [goto LHAL29T]
<96> [fill "6" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.414_02.000 Instrument Variable Name: LHAL29T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with nerve damage (including carpal tunnel syndrome).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to other nerve damage, including carpal tunnel
syndrome, and 1-95, D was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL29T]
if LHAL29T = 4 and LHAL29N > AGE, goto ERR1_LHAL29T
Page 57 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.416_01.000 Instrument Variable Name: LHAL30N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a hernia?
* Enter number for time with a hernia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a hernia
SkipInstructions: <1-95,D> [goto LHAL30T]
<96> [fill "6" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.416_02.000 Instrument Variable Name: LHAL30T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with hernia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to a hernia and 1-95, D was entered for the "number"
part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL30T]
if LHAL30T = 4 and LHAL30N > AGE, goto ERR1_LHAL30T
Page 58 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.418_01.000 Instrument Variable Name: LHAL31N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had an ulcer?
* Enter number for time with an ulcer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to an ulcer
SkipInstructions: <1-95,D> [goto LHAL31T]
<96> [fill "6" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.418_02.000 Instrument Variable Name: LHAL31T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with ulcer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to an ulcer and 1-95, D was entered for the "number"
part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL31T]
if LHAL31T = 4 and LHAL31N > AGE, goto ERR1_LHAL31T
Page 59 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.420_01.000 Instrument Variable Name: LHAL32N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to varicose veins or hemorrhoids
SkipInstructions: <1-95,D> [goto LHAL32T]
<96> [fill "6" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.420_02.000 Instrument Variable Name: LHAL32T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to varicose veins or hemorrhoids and 1-95, D was
entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL32T]
if LHAL32T = 4 and LHAL32N > AGE, goto ERR1_LHAL32T
Page 60 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.422_01.000 Instrument Variable Name: LHAL33N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a thyroid problem, Grave’s disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to thyroid problems, Grave's disease, or gout
SkipInstructions: <1-95,D> [goto LHAL33T]
<96> [fill "6" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.422_02.000 Instrument Variable Name: LHAL33T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with thyroid problem, Grave’s disease or gout.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to thyroid problems, Grave's disease, or gout and 1-
95, D was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL33T]
if LHAL33T = 4 and LHAL33N > AGE, goto ERR1_LHAL33T
Page 61 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.424_01.000 Instrument Variable Name: LHAL34N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had a knee problem?
* Enter number for time with a knee problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to knee problems
SkipInstructions: <1-95,D> [goto LHAL34T]
<96> [fill "6" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.424_02.000 Instrument Variable Name: LHAL34T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with knee problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to knee problems and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL34T]
if LHAL34T = 4 and LHAL34N > AGE, goto ERR1_LHAL34T
Page 62 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.426_01.000 Instrument Variable Name: LHAL35N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill: have you/has ALIAS] had migraine headaches?
* Enter number for time with migrane headaches.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to migraine headaches
SkipInstructions: <1-95,D> [goto LHAL35T]
<96> [fill "6" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.426_02.000 Instrument Variable Name: LHAL35T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with migraine headaches.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to migraine headaches and 1-95, D was entered for the
"number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL35T]
if LHAL35T = 4 and LHAL35N > AGE, goto ERR1_LHAL35T
Page 63 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.450_01.000 Instrument Variable Name: LHAL90N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S1]?
* Enter number for time with [fill1: LAHCA_S1].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S1
SkipInstructions: <1-95,D> [goto LHAL90T]
<96> [fill "6" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.450_02.000 Instrument Variable Name: LHAL90T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with [fill: LAHCA_S1].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S1 and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL90T]
if LHAL90T = 4 and LHAL90N > AGE, goto ERR1_LHAL90T
Page 64 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.452_01.000 Instrument Variable Name: LHAL91N QuestionnaireFileName: Family
QuestionText: 1 of 2
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S2]?
* Enter number for time with [fill1: LAHCA_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S2
SkipInstructions: <1-95,D> [goto LHAL91T]
<96> [fill "6" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
<R> [store "R" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto
PHSTAT]
Question ID: FHS.452_02.000 Instrument Variable Name: LHAL91T QuestionnaireFileName: Family
QuestionText: 2 of 2
* Enter time period for time with [fill: LAHCA_S2].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: All persons 18 years of age or older who have a limitation due to the problem entered at LAHCA_S2 and 1-95, D
was entered for the "number" part of this two-part question
SkipInstructions: <1-4,R,D> [goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for
next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
<6> [goto ERR2_LHAL91T]
if LHAL91T = 4 and LHAL91N > AGE, goto ERR1_LHAL91T
Page 65 of 65
2007 NHIS Questionnaire - Family
Family Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: FHS.500_00.000 Instrument Variable Name: PHSTAT QuestionnaireFileName: Family
QuestionText: Would you say [fill: your/ALIAS’s] health in general is excellent, very good, good, fair, or poor?
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
UniverseText: All persons
SkipInstructions: repeat for all persons in the family, goto FINJ3M
| File Type | application/msword |
| Author | Howard Riddick |
| Last Modified By | Howard Riddick |
| File Modified | 2006-09-29 |
| File Created | 2006-09-29 |