Rev Attachment F_Adult Interview Form 6_6_14

 CASE  CONTROL Form Approved

OMB No.0920-1013

Exp. Date 04/30/2017

Patient ID:__________________________

State ID:­­­­­­­­­­­­­­­­­­­­__________________________

REFERENCE Date _____/_____/______

Attachment F: Community-associated Clostridium difficile Infection (CDI) Risk Factor Study Adult Case and Control Interview

Section 1: Identifiers- CASES and CONTROLS

1.  CASE  CONTROL

   

   
   
   

   3. If Control, Reference date: _____/_____/______

   (mm/dd/yyyy)

   
   
   

   2 weeks before _____/_____/______

   4 weeks before _____/_____/______

   12 weeks before _____/_____/______

   
   
   

2. Study ID: __________________________________

4. Age (years) 

5. Sex  Male  Female

Section 2: Illness Questions- ****CASES ONLY ****CONTROLS SKIP TO SECTION 3, Q. 110****

Now I will ask you questions about your illness.

6. If yes, Do [you] remember when your diarrhea began around the time of (positive specimen date ____/_____/______)?

Yes 1 (If Yes –fill in date diarrhea began and use as reference date.)

No 2 (fill in date of specimen collection and use as reference date.)

Don’t know/Not sure 7 (fill in date of specimen collection and use as reference date.)

Refused 9 (fill in date of specimen collection and use as reference date.)

 REFERENCE DATE: _____/_____/______

(mm/dd/yyyy)

2 week before _____/_____/______

4 weeks before _____/_____/______

12 weeks before _____/_____/______

76. How many days did your diarrhea last around that time? 

Don’t know/Not sure……..………7

Refused 9

76A. On the worst day of your diarrhea that was occurring around the time of (reference date ____/_____/______), what was the approximate number of stools you had in a 24-hour period?

≥3-<5 stools 1

5-10 stools 2

>10 stools 3

Don’t know/Not sure 7

Refused 9

87. Did you have any of the following symptoms associated with your C. difficile illness around the time of (reference date ____/_____/______)?

[READ LIST] Yes No DK/NS Refused

Bloody stools 1 2 7 9

Fever 1 2 7 9

Nausea 1 2 7 9

Vomiting 1 2 7 9

Abdominal pain 1 2 7 9

Other 1 2

Specify:_­­­­­______________________________________________________________

98. Were you hospitalized overnight for your C. difficile illness around the time of (reference date ____/_____/______)?

98A. If yes, where:

(name of hospital will not be transmitted to CDC)

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

109. At the time of your C. difficile diagnosis around the time of (reference date ____/_____/______), were you told by a doctor or healthcare provider that you had any other stomach [enteric, gastrointestinal] infection?

Yes 1

No 2 (Go to Q.110)

Don’t know/Not sure 7 (Go to Q.110)

Refused 9 (Go to Q.110)

109A. If yes, what was the name of the infection?

[Read list if necessary] Yes No DK/NS Refused

Campylobacter 1 2 7 9

E. coli 1 2 7 9

Listeria 1 2 7 9

Salmonella 1 2 7 9

Shigella 1 2 7 9

Vibrio 1 2 7 9

Yersinia 1 2 7 9

Cryptosporidium 1 2 7 9

Giardia 1 2 7 9

Rotavirus 1 2 7 9

Norovirus 1 2 7 9

Other 1 2

Specify:_____________________________________________________________________

Section 3: Healthcare contacts- Cases and Controls

Now I will ask you questions about your healthcare contacts between [12 weeks before [Reference Date_____/_____/______] to [Reference Date_____/_____/______].

110. Did you receive care in any doctor’s office, dental office, hospital, or any other medical facility in the 12 weeks before [REFERENCE DATE_____/_____/_____]?

Yes 1

No 2 (Go to Q.121)

Don’t know/Not sure 7 (Go to Q.121)

Refused 9 (Go to Q.121)

110A. I will now ask you about the types of places you visited for your healthcare and when you made your visit. Did you visit any of the following places?

[READ LIST]	YES=1	NO=2	DN/NS=7	Refuse=9	If yes, how many weeks prior to [Reference Date_____/_____/_______] did you visit this place?
					2 weeks	4 weeks	12 weeks
Outpatient Procedure centerAmbulatory / Outpatient procedure center
Ambulatory / Outpatient Surgery center
Dental office
Doctor’s office
Emergency department/Room
Hemodialysis
Hospital
Outpatient lab
Physical therapy center
Urgent care
Other (Specify)

IF NO TO ALL OPTIONS IN Q.110A then SKIP to Q.121

110B. during those visits in the 12 weeks before (Reference Date_____/_____/______) did you have any of the following procedures performed?

*****If Subject answered YES to dental visits only in 110A then only ask about last two items (oral surgery and dental cleaning)********

[READ LIST]	YES=1	NO=2	DN/NS=7	Refuse=9	If yes, how many weeks prior to [Reference Date_____/_____/____] did you visit this place?
					2 weeks	4 weeks	12 weeks
Upper Endoscopy (Did the doctors pass a tube through your mouth or nose into your stomach?)
Colonoscopy or Sigmoidoscopy (Did the doctors pass a tube into your rectum to look into your colon/bowel?)
X-ray that required GI Prep (Did you have an X-ray performed where you had to swallow something first?)
Chemotherapy
Surgery in an operating room as an outpatient If yes, Specify type:
Other medical procedure (specify):
Oral Surgery
Dental Cleaning

121. Did you visit a person in or go withaccompany anyone to a doctor’s office, dental office, hospital, nursing home, or any other medical facility in the 12 weeks before [Reference Date_____/_____/______]?

Yes 1

No 2 (Go to Q.132)

Don’t know/Not sure 7 (Go to Q.132)

Refused 9 (Go to Q.132)

121A. What type of facility did you visit or go with accompany someone to in the 12 weeks before [Reference Date____/_____/______]?

[READ LIST]	YES=1	NO=2	DN/NS=7	Refuse=9	If yes, how many weeks prior to [Reference Date_____/_____/____] did you visit this place?
					2 weeks	4 weeks	12 weeks
Ambulatory / Outpatient procedure center
Ambulatory / Outpatient surgery center
Dental office
Doctor’s office
Emergency department/Room
Hemodialysis
Hospital
Long term care/ skilled nursing facility
Outpatient lab
Physical therapy center
Urgent care
Other (specify):

Section 4: Household contacts

The next few questions are about you and persons who lived with you during the 12 weeks before [Reference Date_____/_____/______].

132. How many people lived in your household including yourself during that time?  If answer is one (subject lives alone) skip to Q.2019

132A. What were the ages of your household members?How household members, not including yourself were in each of these age groups? [List number of people in each group]

Ages <1 1 to 3 4 to 10 11 to 17 18 to 34 35 to 59 60+

143. Did any household member excluding yourself wear diapers in the 12 weeks before (reference date ____/_____/______)? (Including adults in diapers)

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

154. Did you have household members excluding yourself that attended a group childcare setting, daycare, or adult daycare in the 12 weeks before (reference date ____/_____/______)? We consider daycare to be any place inside or outside your home where a household member spends at least 4 hours per week under an adult’s care with at least two adults or children who did not live with you

Yes 1

No 2 (Skip to Q 165)

Don’t know/Not sure 7 (Skip to Q 165)

Refused 9 (Skip to Q 165)

154A. If yes, which household members attended daycare and what type(s) of daycare setting was it?

[Read description of setting types if necessary]

Home……………………………………1

Center…………………………………..2

Members attend both types of daycare………….3

Don’t know / Not Sure………………..7

Refused……………………………….9

AGE Group	Type of Daycare Setting
	Home	Center	Other (specify)	Don’t know	Refused
< 1	1	2		7	9
1 to 3	1	2		7	9
4 to 10	1	2		7	9
11 to 17	1	2		7	9
18 to 34	1	2		7	9
35 to 59	1	2		7	9
60 +	1	2		7	9

Home – care is provided in someone’s home typically by one person

Center- care is provided typically in a commercial building with many providers and rooms

165. In the 12 weeks before [Reference Date_____/_____/______], did any household member stay overnight in a hospital?

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

176. In the 12 weeks before [Reference Date_____/_____/______], did any household member stay overnight in a nursing home?

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

187. In the 12 weeks before [Reference Date_____/_____/______], did anyone else in your household have diarrhea?

Yes 1

No 2 (Go to Q.198)

Don’t know/Not sure 7 (Go to Q.198)

Refused 9 (Go to Q.198)

187A. If yes, did you assist this person with toileting (including diaper changes)?

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

187B. Was this person diagnosed with C. difficile?

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

198. Did any of your household members work or volunteer, in any capacity, at a hospital, other medical facility, or in any facility where patient care is provided in the 12 weeks before [Reference Date_____/_____/______]? Volunteering can mean doing anything that requires you to enter a healthcare facility. Examples include: playing a musical instrument in the lobby, helping to direct patients to the correct area.

Yes 1

No 2 (Go to Q.2019)

Don’t know/Not sure 7 (Go to Q. 2019)

Refused 9 (Go to Q.2019)

198A. If yes, what type of healthcare setting?

(READ LIST) Yes No DK/NS Refused

Hospital 1 2 7 9

Emergency department/room 1 2 7 9

Doctor’s office 1 2 7 9

Dentist 1 2 7 9

Long term care (skilled nursing facility) 1 2 7 9

Hemodialysis facility 1 2 7 9

Other facility 1 2

Specify:_____________________________________________________________________

198B. Did their job involve direct physical contact with the patients? For example, touching the patient to help her get out of a chair

Yes 1

No 2 (Go to Q.2019)

Don’t know/Not sure 7 (Go to Q. 2019)

Refused 9 (Go to Q.2019)

198B1. If yes, what was their main job?

_____________________________________________________________________________

198B2. Job Code- (Fill in job code after interview is finished)

2019. Did you work or volunteer, in any capacity, at a hospital, other medical facility, or in any facility where patient care is provided in the 12 weeks before [Reference Date_____/_____/______]? Volunteering can mean doing anything that requires you to enter a healthcare facility. Examples include: playing a musical instrument in the lobby, helping to direct patients to the correct area.

Yes 1

No 2 (Go to Q.210)

Don’t know/Not sure 7 (Go to Q. 210)

Refused 9 (Go to Q.210)

2019A. If yes, what type of healthcare setting?

(READ LIST) Yes No DK/NS Refused

Hospital 1 2 7 9

Emergency department/room 1 2 7 9

Doctor’s office 1 2 7 9

Dentist 1 2 7 9

Long term care (skilled nursing facility) 1 2 7 9

Hemodialysis facility 1 2 7 9

Other facility 1 2

Specify:_____________________________________________________________________

2019B. Did your job involve direct physical contact with the patients? For example, touching the patient to help her get out of a chair

Yes 1

No 2 (Go to Q.210)

Don’t know/Not sure 7 (Go to Q. 210)

Refused 9 (Go to Q.210)

2019B1. If yes, what was your main job?

_____________________________________________________________________________

2019B2. Job Code- (Fill in job code after interview is finished)

20. Did you attend an adult daycare in the 12 weeks before [Reference Date_____/_____/______)]? We consider daycare to be any place inside or outside your home where a household member spends at least 4 hours per week under an adult’s care with at least two adults who do not live with you

Yes 1

No 2 (Skip to Q.21)

Don’t know/Not sure 7 (Skip to Q.21)

Refused 9 (Skip to Q.21)

20A. If yes, what type of care setting? [Read list if necessary]

Home – care is provided in someone’s home typically by one person 1

Center- care is provided typically in a commercial building with many providers and rooms . 2

Other 4

Specify: __________________________________________________

Don’t know/Not sure 7

Refused 9

Section 5: Diet Exposures

I’d like to change direction now and ask you about the foods you generally eat in a given week and the kind of water you drink.

21. In a current typical week, not in the past timeframe we have talked about, how frequently do you consume the following foods?

[READ LIST]	Often	Sometimes	Rarely	Never	DK/NS	Refused
	>5/week	2-5 /week	<2/ week	Never
Eggs	1	2	3	4	7	9
Dairy (milk, yogurt)	1	2	3	4	7	9
Fresh raw Vegetables	1	2	3	4	7	9
Plant based protein (tofu, tempeh, seitan)	1	2	3	4	7	9
Red Meat (beef, lamb, pork, other game meat)	1	2	3	4	7	9
Poultry (chicken, turkey)	1	2	3	4	7	9
Seafood (fish, shellfish)	1	2	3	4	7	9

21.

22. Did you receive food / formula through a feeding tube called a G-tube or J-tube in the 12 weeks before [Reference Date_____/_____/______]?

Yes 1

No 2

Don’t know/Not sure 7

Refused 9

22. In a typical week how frequently do you consume the following foods?

[READ LIST]	Often	Sometimes	Rarely	Never	DK/NS	Refused
	>5/week	2-5 /week	<2/ week	Never
Eggs	1	2	3	4	7	9
Dairy (milk, yogurt)	1	2	3	4	7	9
Fresh raw Vegetables	1	2	3	4	7	9
Plant based protein (tofu, tempeh, seitan)	1	2	3	4	7	9
Red Meat (beef, lamb, pork, other game meat)	1	2	3	4	7	9
Poultry (chicken, turkey)	1	2	3	4	7	9
Seafood (fish, shellfish)	1	2	3	4	7	9

23. Which one of the following wasis the source of tap water in your home around the time of (reference date ____/_____/______) (select only one):

 water utility  private well  spring  unknown  other

Name of the water utility, if known ______________________________________

If other, specify type and location ______________________________________

23A. At home, what type of unboiled water dido you most often use for drinking around the time of (reference date ____/_____/______) (chose only one)?

______ Tap water not treated in the home

______ Tap water treated in the home (for example, filtered, UV light, distilled, or whole house point-of-entry device)

______Commercially bottled water

______Other ________________________

Section 6: Medical History

The next sets of questions are about medications you may have been taking in the 12 weeks before [Reference Date_____/_____/______]. Medicine bottles or records may help you remember about specific medications. Would you like to gather this information before we go on?

24. Did you take any antibiotics by mouth or in an I.V. (in your vein) in the 12 weeks before [Reference Date_____/_____/______]?

Yes 1

No 2 (Go to Q.258)

Don’t know/Not sure 7 (Go to Q.258)

Refused 9 (Go to Q.258)

24A. Why did you take these antibiotic(s)? Note: Subjects may indicate more than one reason (For example, if more than one course of antibiotics was taken for different illnesses or if one antibiotic was taken for and ear infection and a pneumonia)

[DO NOT READ LIST]	Yes	No
Acne	1	2
Bronchitis/ pneumonia	1	2
Dental cleaning	1	2
Ear, sinus, upper respiratory infection	1	2
Eye infection	1	2
Oral surgery	1	2
Skin or soft tissue infection (abscess or cellulitis)	1	2
Surgery	1	2
Urinary tract infection	1	2
Urinary tract prophylaxis	1	2
Refused	9	9
Don’t know/Not sure	7	7
Other	1	2
Specify:

24B. Which antibiotic(s) did you take in the 12 weeks before [Reference Date_____/_____/______]?

[DO NOT READ LIST]		If yes, how many weeks prior to [Reference Date_____/_____/______] did you take this antibiotic?
	YES	2 weeks	4 weeks	12 weeks
Amoxicillin	1
Amoxicillin/Clavulanate or Augmentin	1
Ampicillin	1
Azithromycin	1
Cefaclor	1
Cefadroxil	1
Cefdinir	1
Cefixime	1
Cefuroxime	1
Cefprozil	1
Cephalexin or keflex	1
Cephradine	1
Ciprofloxacin or Cipro	1
Clarithromycin	1
Clindamycin	1
Dapsone	1
Doxycycline	1
Erythromycin	1
Erythromycin/sulfa	1
Fosfomycin	1
Levofloxacin or levaquin	1
Metronidazole or flagyl	1
Norfloxacin or Norflox	1
Ofloxacin or Oflox	1
Penicillin or Pen VK	1
Tetracycline	1
Trimethoprim/Sulfa or Bactrim, Septra	1
Vancomycin	1
Other antibiotic 1	1
Specify other antibiotic 1	1
Other antibiotic 2	1
Specify other antibiotic 2	1
Don’t know/Not sure	7
Refused	9

25. Did you use any antibiotic eye dropsdrops or ointments in the 12 weeks before [Reference Date_____/_____/______]?

Yes 1

No 2 (Go to Q.26)

Don’t know/Not sure 7 (Go to Q.26)

Refused 9 (Go to Q.26)

25 A. If yes, what was the name of the drop (read list if necessary)?

Polytrim (Polymyxin sulfate / TMP)……..1

Ciloxan (Ciprofloxacin)…………………..2

Ocuflox (Ofloxacin)……………………….3

Vigamox, Moxeza (Moxifloxacin) ………4

Other……………………………………….9

Specify : ______________________

26. In the 12 weeks before [Reference Date_____/_____/______], did you regularly take any acid-reducing medications to treat excessive stomach acid, heartburn, or gastroesophageal reflux disease (GERD)? We define regular use as use of the product at least 3 days per week. Such medications might include Tums, Prevacid, Maalox, Mylanta, Tagamet, Zantac, Prilosec, or Nexium.

Yes 1

No 2 (Go to Q.27)

Don’t know/Not sure 7 (Go to Q.27)

Refused 9 (Go to Q.27)

26A. If Yes, please specify which medicine you regularly took in the 12 weeks before [Reference Date_____/_____/______]

[DO NOT READ LIST]	YES=1	NO=2	If yes, How many weeks prior to (Reference Date_____/_____/______ ) did you take this medication?
			2 weeks	4 weeks	12 weeks
Aciphex/rabeprazole	1	2
Alka-Seltzer	1	2
Maalox	1	2
Mylanta	1	2
Nexium/esomeprazole	1	2
Pepcid/famotidine	1	2
Prevacid/lansoprazole	1	2
Prilosec/omeprazole	1	2
Protonix/pantoprazole	1	2
Rolaids	1	2
Tums	1	2
Tagamet/cimetidine	1	2
Zantac/ranitidine	1	2
Other:	1	2
Don’t know/Not sure	7	7
Refuse	9	9

If yes, in the

2 weeks before

I am now going to ask about medications that are given for many reasons. These reasons include including things like chronic pain, depression, anxiety, to stop smoking, and to help sleep. We are asking about these medications to determine if they could put people at risk for C. diff. Examplessleep. Examples of these medications include: Prozac, Celexa, Remeron, Paxil, and Trazadone.

27. In the 12 weeks before [Reference Date_____/_____/______], did you regularly take any such medications? We define regular use as use of the product at least 3 days per week.

Yes 1

No 2 (Go to Q.28)

Don’t know/Not sure 7 (Go to Q.28)

Refused 9 (Go to Q.28)

27A. If Yes, please specify which medicine you regularly took in the 12 weeks before [Reference Date_____/_____/______]

[DO NOT READ LIST]			If yes, How many weeks prior to (Reference Date_____/_____/______ ) did you take this medication?
	YES	NO	2 weeks	4 weeks	12 weeks
Amitriptyline	1	2
Anafranil (Clomipramine)	1	2
Asendin (Amoxapine)	1	2
Celexa, Cipramil (Citalopram)	1	2
Cymbalta (Duloxetine)	1	2
Effexor (Venlafaxine)	1	2
Eldepryl, Emsam, Zelapar (Selegiline)	1	2
Escitalopram	1	2
Limbitrol (Chlordiazepoxide/Amitriptyline)	1	2
Ludiomil,(Maprotiline)	1	2
Luvox (Fluvoxamine)	1	2
Marplan, (Isocarboxazid)	1	2
Nardil, Nardelzine (Phenelzine sulfate)	1	2
Norpramin (Desipramine)	1	2
Nortriptyline	1	2
Parnate,(Tranylcypromine)	1	2
Paxil (Paroxetine)	1	2
Pristiq (Desvenlafaxine)	1	2
Prozac, Sarafem, Fontex (Fluoxetine)	1	2
Remeron, Avanza, Zispin (Mirtazapine)	1	2
Savella, (Milnacipran)	1	2
Serzone, (Nefazodone)	1	2
Silenor, Prudoxin, Zonalon (Doxepin)	1	2
Surmontil (Trimipramine)	1	2
Symbyax (Olanzapine/fluoxetine)	1	2
Tofranil, (Imipramine)	1	2
Trazadone	1	2
Triptafen (amitriptyline/perphenazine)	1	2
Viibryd (Vilazodone)	1	2
Vivactil, (Protriptyline)	1	2
Wellbutrin, Zyban (Bupropion)	1	2
Zoloft, Lustral (Sertraline)	1	2
Other (specify):	1	2
Don’t know/Not Sure	7	7
Refuse	9	9

Now I am going to ask you about medical conditions you may have had.

28. Prior to [Reference Date_____/_____/______], were you told by a medical provider that you had any of the following medical conditions?

[READ LIST – including information in parentheses]

READ LIST	Yes	No	DK/NS	Refused
Diabetes
Heart attack
Congestive heart failure
Stroke
High blood pressure
Peripheral vascular disease (intermittent claudication, gangrene, peripheral arterial bypass) arterial bypass)
Chronic renal (kidney) failure
If yes, are you on dialysis or awaiting dialysis?
Chronic lung disease (COPD, emphysema)
Asthma
Cystic fibrosis
Chronic Hepatitis B infection
Chronic Hepatitis C infection
Organ transplant
Bone marrow transplant
Leukemia or lymphoma
Sickle cell disease (not sickle cell trait)
Solid tumor cancer (e.g. bone, liver, brain)
Short gut disease (bowel/ intestinal insufficiency
Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis)
Lupus
Rheumatoid arthritis
Depression
Other illness (specify)

29. What is your current height and Weight?

Height: Ft in or ______cm

Weight: lbs or ________ Kg

Don’t Know/ Not Sure….7

Refused ………………..9

Section 8: Demographics

Now I would like to ask you a few final questions.

30. Do you consider yourself to be? [Read responses 1 & 2]

___1 Hispanic or Latino

___2 Not Hispanic or Latino

___7 Don’t Know/Not Sure (DO NOT READ)

___9 Refused (DO NOT READ)

___10 Other racial category (DO NOT READ)

31. I am going to read a list of racial categories. Which one or more of the following do you consider yourself to be…? [Read responses 1-5 and allow respondent to select one or more]

___1 White/Caucasian

___2 Black or African-American

___3 American Indian or Alaska Native

___4 Native Hawaiian or Other Pacific Islander

___5 Asian

___7 Don’t Know/Not Sure (DO NOT READ)

___9 Refused (DO NOT READ)

___10. Other racial category (DO NOT READ)

32. What is your occupation?

33. What was your main type of health care coverage during 12 weeks before [Reference Date_____/_____/_____ ] I’m going to read all the choices.

Private insurance, such as an HMO, PPO or a managed care plan 1

Public insurance, such as Medicaid, Medicare or state assistance program 2

A combination of private and public insurance 3

No health insurance 4

DO NOT READ: Other [specify] _________________________ 8

Don’t know/Not sure 7

Refused 9

34. What is the highest grade or year of school you completed?

___1 Never attended school or kindergarten only

___2 Elementary or middle school; 1^st-8^th grade

___3 Some high school; 9^th-11^th grade

___4 High school graduate; 12^th grade or GED

___5 College or technical school for 1-3 years

___6 College for 4 years, with or without a degree

___9 Refused

35. In your home, what is the annual gross household income from all sources, including social security and pensions? Read each response in order until respondent agrees.

___0 Dependent college student
___1 Less than $15,000	___5 Less than $70,000
___2 Less than $25,000	___6 $70,000 or more
___3 Less than $35,000	___7 Don’t know or not sure
___4 Less than $50,000	___9 Refused

That was my last interview question. Thank you very much for your time and participation!

36. Comments: ______________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

37. Interview Completed?  Yes  No

38. Date of interview: ____/____/______

(mm/dd/yyyy)

39. Interviewer initials: ______________

Health Interview Appendix—Job Codes

OFFICE OF MANAGEMENT AND BUDGET - 1998 Standard Occupational Classification

29-0000 Healthcare Practitioners and Technical Occupations

29-1000 Health Diagnosing and Treating Practitioners

29-1010 Chiropractors

29-1020 Dentists

29-1021 Dentists, General

29-1022 Oral and Maxillofacial Surgeons

29-1023 Orthodontists

29-1024 Prosthodontists

29-1029 Dentists, All Other Specialists

29-1030 Dietitians and Nutritionists

29-1040 Optometrists

29-1050 Pharmacists

29-1060 Physicians and Surgeons

29-1061 Anesthesiologists

29-1062 Family and General Practitioners

29-1063 Internists, General

29-1064 Obstetricians and Gynecologists

29-1065 Pediatricians, General

29-1066 Psychiatrists

29-1067 Surgeons

29-1069 Physicians and Surgeons, All Other

29-1070 Physician Assistants

29-1080 Podiatrists

29-1110 Registered Nurses

29-1120 Therapists

29-1121 Audiologists

29-1122 Occupational Therapists

29-1123 Physical Therapists

29-1124 Radiation Therapists

29-1125 Recreational Therapists

29-1126 Respiratory Therapists

29-1127 Speech-Language Pathologists

29-1129 Therapists, All Other

29-1130 Veterinarians

29-1190 Miscellaneous Health Diagnosing and Treating Practitioners

29-1199 Health Diagnosing and Treating Practitioners, All Other

29-2000 Health Technologists and Technicians

29-2010 Clinical Laboratory Technologists and Technicians

29-2011 Medical and Clinical Laboratory Technologists

29-2012 Medical and Clinical Laboratory Technicians

29-2020 Dental Hygienists

29-2030 Diagnostic Related Technologists and Technicians

29-2031 Cardiovascular Technologists and Technicians

29-2032 Diagnostic Medical Sonographers

29-2033 Nuclear Medicine Technologists

29-2034 Radiologic Technologists and Technicians

29-2040 Emergency Medical Technicians and Paramedics

29-2050 Health Diagnosing and Treating Practitioner Support Technicians

29-2051 Dietetic Technicians

29-2052 Pharmacy Technicians

29-2053 Psychiatric Technicians

29-2054 Respiratory Therapy Technicians

29-2055 Surgical Technologists

29-2056 Veterinary Technologists and Technicians

29-2060 Licensed Practical and Licensed Vocational Nurses

29-2070 Medical Records and Health Information Technicians

29-2080 Opticians, Dispensing

29-2090 Miscellaneous Health Technologists and Technicians

29-2091 Orthotists and Prosthetists

29-2099 Health Technologists and Technicians, All Other

29-9000 Other Healthcare Practitioners and Technical Occupations

29-9010 Occupational Health and Safety Specialists and Technicians

29-9011 Occupational Health and Safety Specialists

29-9012 Occupational Health and Safety Technicians

29-9090 Miscellaneous Health Practitioners and Technical Workers

29-9091 Athletic Trainers

29-9099 Healthcare Practitioners and Technical Workers, All Other

31-0000 Healthcare Support Occupations

31-1000 Nursing, Psychiatric, and Home Health Aides

31-1010 Nursing, Psychiatric, and Home Health Aides

31-1011 Home Health Aides

31-1012 Nursing Aides, Orderlies, and Attendants

31-1013 Psychiatric Aides

31-2000 Occupational and Physical Therapist Assistants and Aides

31-2010 Occupational Therapist Assistants and Aides

31-2011 Occupational Therapist Assistants

31-2012 Occupational Therapist Aides

31-2020 Physical Therapist Assistants and Aides

31-2021 Physical Therapist Assistants

31-2022 Physical Therapist Aides

31-9000 Other Healthcare Support Occupations

31-9010 Massage Therapists

31-9090 Miscellaneous Healthcare Support Occupations

31-9091 Dental Assistants

31-9092 Medical Assistants

31-9093 Medical Equipment Preparers

31-9094 Medical Transcriptionists

31-9095 Pharmacy Aides

31-9096 Veterinary Assistants and Laboratory Animal Caretakers

31-9099 Healthcare Support Workers, All Other

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1013).

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