| Modified question |
Required to optional |
New required question |
New optional question |
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Current post-hospital data elements (0920-1108; exp. 3/31/2019) |
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Requested changes |
Optional/Req'd |
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Change description |
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| Item |
Variable name |
Text prompt |
Legal values |
Item |
Variable name |
Text prompt |
Legal values |
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1 |
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Hospital Admission Date |
<HospadD> |
Hospital Admission Date: |
Date MMDDYYYY |
Optional |
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Question is added but previously inputted through the in-hospital record |
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| 1 |
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Follow-up |
<FUType> |
Follow up Conducted (Check all that apply) |
1 = Phone; 2 = In home; 3 = Other |
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Follow-up |
<FLMTHD> |
Follow up Conducted (Check all that apply) |
1 = Phone; 2 = In home (in-person); 3 = Chart review; 4 = At a health facility; 5 = HER/chart abstraction; 6 = Other; 7 = Unable to reach |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems |
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1 |
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Follow-up |
<FLPhone> |
If phone call conducted, date: |
Date MMDDYYYY |
Required |
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Question is added to track date of follow-up based on type (question won't require an answer unless this follow up type was reported for <FLMTHD> |
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1 |
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Follow-up |
<FLHOME> |
If in home follow up conducted, date: |
Date MMDDYYYY |
Required |
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Question is added to track date of follow-up based on type (question won't require an answer unless this follow up type was reported for <FLMTHD> |
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1 |
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Follow-up |
<FLChart> |
If chart review conducted, date: |
Date MMDDYYYY |
Required |
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Question is added to track date of follow-up based on type (question won't require an answer unless this follow up type was reported for <FLMTHD> |
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1 |
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Follow-up |
<FLHealth> |
If follow up conducted at a health facility, date: |
Date MMDDYYYY |
Required |
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Question is added to track date of follow-up based on type (question won't require an answer unless this follow up type was reported for <FLMTHD> |
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| 1 |
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Location of Patient |
<CurrLoc> |
Where is the patient at the time of follow-up? |
1 = Home; 2 = Nursing home or long-term care; 3 = Rehabilitation Hospital; 4 = Acute care hospital; 5 = Died |
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Location of Patient |
<CurrLoc> |
Where is the patient at the time of follow-up? |
1 = Home with services; 2 = Home without services; 3 = Hospital or Acute care facility; 4 = Long term care facility; 5 = Acute rehabilitation; 6 = Skilled nursing facility; 7 = Unknown/ND |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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1 |
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Location of Patient |
<CurLoc30> |
Where is the patient 30 days after discharge? |
1 = Home; 2 = Hospital or Acute care facility; 3 = Long term care facility; 4 = Acute rehabilitation; 5 = Skilled nursing facility; 6 = Unknown/ND |
Required |
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Question is added to track patient's location at 30 days post-discharge |
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| 1 |
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Informant |
<Informant> |
Who provided responses to this follow up? |
1 = Patient; 2 = Family member; 3 = Other lay caregiver; 4 = Home health aide; 5 = Other |
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Informant |
<Informnt> |
Who provided responses to this follow up? |
1 = Patient; 2 = Family member; 3 = Other lay caregiver; 4 = Home health aide; 5 = EMS; 6 = Other |
Optional |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. Variable name is shortened to 8 characters. |
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Rehab |
<Rehab> |
Did or is patient receiving rehabilitation? |
1 = Outpatient; 2 = In the home; 3 = Inpatient; 4 = Was at discharge but stopped; 0 = No |
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Rehab |
<Rehab> |
Which rehab services were provided at the time of discharge? |
1 = Patient received rehabilitation services during hospitalization; 2 = Patient transferred to rehabilitation facility; 3 = Patient referred to rehabilitation services following discharge; 4 = Patient ordered rehab, but declined services; 5 = Patient ineligible to receive rehabilitation services due to impairment; 6 = Patient not assessed for rehabilitation during their previous inpatient visit |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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1 |
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Rehab |
<RehabOff> |
What type of rehab was ordered? |
1 = Occupational therapy; 2 = Physical therapy; 3 = Speech therapy |
Optional |
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Optional questions are added to know whether patient received rehab, was it offered and if they were assessed |
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1 |
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Rehab |
<RehabT> |
Select the period of time at which rehab was ordered. |
1 = Within 30 days post-discharge; 2 = Within 60 days post-discharge; 3 = Within 90- days post-discharge |
Optional |
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1 |
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Rehab |
<RehabSt> |
Current Therapy Status (select all fields that apply): |
1 = Home Therapy; 2 = Home with outpatient Therapy; 3 = Home with no therapy; 4 = Rehabilitation facility ; 5 = Unknown/ND |
Optional |
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1 |
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Tobacco |
<TobacUse> |
Was patient identified as a tobacco user at the time of stroke? (Tobacco use includes: cigarettes, cigars/cigarillos, little cigars, pipes, smokeless tobacco (chew, dip, snuff, and snus), hookah/water pipe and electronic vapor products (e-cigarettes, e-hookah, vape pens). |
1 = Yes; 0 = No; 2 = Unknown/ND |
Required |
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Question is added to determine if the patient was a smoker/tobacco user when they had their stroke |
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| 1 |
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Tobacco |
<CurTobac> |
If patient was a smoker before stroke, have they smoked tobacco since discharge? |
1 = Yes; 0 = No |
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Tobacco |
<CurTobac> |
If patient was identified as a tobacco user at the time of their stroke, have they used tobacco (cigarettes, cigars/cigarillos, little cigars, pipes, smokeless tobacco (chew, dip, snuff, and snus), hookah/water pipe and electronic vapor products (e-cigarettes, e-hookah, vape pens) since discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. Wording of question modified to include all possible types of tobacco use. |
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1 |
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Tobacco |
<CurTobDa> |
Is the patient is using tobacco products (cigarettes, cigars/cigarillos, little cigars, pipes, smokeless tobacco (chew, dip, snuff, and snus), hookah/water pipe and electronic vapor products (e-cigarettes, e-hookah, vape pens) every day or some days? |
1 = Daily; 2 = Some Days; 3 = Never; 4 = Unknown/ND |
Optional |
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Question is added to determine frequency of tobacco use |
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| 1 |
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Tobacco |
<SmkMeds> |
If patient was a smoker before stroke, are they using any medications to help stop smoking? |
1 = Yes; 0 = No |
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Tobacco |
<SmkMeds> |
If patient was a tobacco user (cigarettes, cigars/cigarillos, little cigars, pipes, smokeless tobacco (chew, dip, snuff, and snus), hookah/water pipe and electronic vapor products (e-cigarettes, e-hookah, vape pens) at the time of their stroke, are they using any medications to stop using tobacco? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. Wording of question modified to include all possible types of tobacco use. |
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1 |
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Tobacco |
<StopSmk> |
Since discharge, has the patient EVER stopped tobacco use because they were trying to quit? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is added to determine if the patient has tried to stop smoking |
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1 |
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Tobacco |
<Quitat> |
(If yes to the previous question), how many times? |
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Optional |
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Question is added to determine quitting habits of patient if they have tried to stop smoking |
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1 |
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Tobacco |
<TobEdu> |
Was the patient provided tobacco cessation counseling and/or referred to a cessation program? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is added to determine if patient was given option for receiving help with tobacco cessation |
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1 |
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ED Visits |
<EDYN> |
Has patient been seen in ED since discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
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ED Visits |
<EDYN> |
Has patient been seen in ED since discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is changed to optional (reduction in burden) |
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| 1 |
1 |
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ED Visits |
<EDDate> |
If yes, date of first ED visist |
Date MMDDYYYY |
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ED Visits |
<EDGaDate> |
If seen in the ED since discharge (yes to next question), date information about ED visits if gathered before 30 days |
Date MMDDYYYY |
Optional |
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Question is modified to specify answer if ED visit happened within 30 days post discharge. Question is changed to optional (reduction in burden) |
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ED Visits |
<EDYN30> |
Has the patient been seen in ED within 30 days of hospital discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Required |
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Question is added to add specificity to time frame of ED Visit (if any) |
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1 |
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ED Visits |
<EDNum> |
How many ED visits since discharge? |
1 = 1; 2 = 2; 3 = 3 or more; 4 = unknown or Unknown/ND |
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ED Visits |
<EDNum> |
How many ED visits since discharge? |
1 = 1; 2 = 2; 3 = 3 or more; 4 = unknown or Unknown/ND |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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ED Visits |
<EDDate> |
If yes, date of first ED visit |
Date MMDDYYYY |
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ED Visits |
<EDDate> |
If yes, date of first ED visit |
Date MMDDYYYY |
Optional |
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Question is changed to optional (reduction in burden) |
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| 1 |
1 |
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ED Visits |
<EDReasn> |
If yes, reason for first ED visit: |
Text. |
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ED Visits |
<EDReasn> |
If yes, was reason for first ED visit: |
1 = Fall; 2 = TIA; 3 = Stroke; 4 = Pneumonia; 5 = UTI; 6 = VTE; 7 = Other |
Optional |
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Question is changed to optional (reduction in burden). Question is changed to have selection options instead of being open-ended |
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| 1 |
1 |
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ED Visits |
<EDDisp> |
Was the patient admitted to hospital or discharged to home? |
1 = Discharged to home; 0 = Admitted to hospital |
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ED Visits |
<EDDisp> |
Was the patient admitted to hospital, discharged to home, discharged to SNF or other institutional long term care, or held for observation and then discharged? |
1 = Discharged to home; 0 = Admitted to hospital; 2 = Discharged to SNF or other institutional long term care; 3 = Held for observation; 4 = Unknown/ND |
Optional |
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Question is changed to optional (reduction in burden). Addition of 3 selection options for increased specificity. |
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| 1 |
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Blood Pressure |
<BPMonitr> |
Has the patient been monitoring their blood pressure at home? |
1 = Yes; 0 = No |
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Blood Pressure |
<BPMonitr> |
Has the patient been monitoring their blood pressure outside of their healthcare provider office visits (at home or in the community)? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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1 |
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Blood Pressure |
<BPSys> |
If yes, most-recent systolic blood pressure |
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Blood Pressure |
<BPSys> |
If yes, most-recent systolic blood pressure |
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Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Blood Pressure |
<BPDia> |
If yes, most-recent diastolic blood pressure |
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Blood Pressure |
<BPDia> |
If yes, most-recent diastolic blood pressure |
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Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Blood Pressure |
<MPUsual> |
Is this blood pressure usual for you? |
1 = Yes; 0 = No |
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Blood Pressure |
<BPUsual> |
Is this blood pressure usual for you? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Falls |
<Fall30> |
Has the patient fallen within 30 days of discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Required |
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Question is added to determine if patient fallen within 30 days post discharge |
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1 |
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Falls |
<FallNum> |
If yes, number of falls? |
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Required |
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Question is added to determine number of times patient has fallen (if so) |
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1 |
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Falls |
<FallRep> |
Was your fall reported to a healthcare provider? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is added to determine if fall(s) reported |
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1 |
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Medications prescribed at discharge |
<DCBPMed> |
Antihypertensive |
1 = Yes; 0 = No |
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Medications prescribed at discharge |
<DCBPMed> |
Antihypertensive |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications prescribed at discharge |
<DCStatn> |
Statin |
1 = Yes; 0 = To |
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Medications prescribed at discharge |
<DCStatn> |
Statin |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications prescribed at discharge |
<DCDiab> |
Antidiabetic agent |
1 = Yes; 0 = No |
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Medications prescribed at discharge |
<DCDiab> |
Antidiabetic agent |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications prescribed at discharge |
<DCAsprn> |
Aspirin or other antiplatelet |
1 = Yes; 0 = So |
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Medications prescribed at discharge |
<DCAsprn> |
Aspirin or other antiplatelet |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<DCACoag> |
Anticoagulant |
1 = Yes; 0 = No |
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Medications currently taking |
<DCACoag> |
Anticoagulant |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<BPMedNow> |
Antihypertensive |
1 = Yes; 0 = No |
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Medications currently taking |
<BPMedNow> |
Antihypertensive |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<STATnNow> |
Statin |
1 = Yes; 0 = To |
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Medications currently taking |
<STATnNow> |
Statin |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<DiabNow> |
Antidiabetic agent |
1 = Yes; 0 = No |
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Medications currently taking |
<DiabNow> |
Antidiabetic agent |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<AsprnNow> |
Aspirin or other antiplatelet |
1 = Yes; 0 = So |
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Medications currently taking |
<AsprnNow> |
Aspirin or other antiplatelet |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medications currently taking |
<ACoagNow> |
Anticoagulant |
1 = Yes; 0 = No |
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Medications currently taking |
<ACoagNow> |
Anticoagulant |
1 = Yes; 0 = No |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Medication |
<RevMed> |
Did staff review your medications with you before discharge? |
1 = Yes; 0 = No; 2 = Unknown/ND |
Optional |
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Question is added to determine if medications were reviewed with patient |
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1 |
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Have you stopped any meds since discharge? |
<StopBP> |
Antihypertensive |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other |
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Have you stopped any meds since discharge? |
<StopBP> |
Antihypertensive |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other; 9 = Not documented/UTD |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Have you stopped any meds since discharge? |
<StopStn> |
Statin |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other |
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Have you stopped any meds since discharge? |
<StopStn> |
Statin |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other; 9 = Not documented/UTD |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Have you stopped any meds since discharge? |
<StopDiab> |
Antidiabetic agent |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other |
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Have you stopped any meds since discharge? |
<StopDiab> |
Antidiabetic agent |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other; 9 = Not documented/UTD |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Have you stopped any meds since discharge? |
<StopASA> |
Aspirin or other antiplatelet |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other |
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Have you stopped any meds since discharge? |
<StopASA> |
Aspirin or other antiplatelet |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other; 9 = Not documented/UTD |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Have you stopped any meds since discharge? |
<StopCoag> |
Anticoagulant |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other |
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Have you stopped any meds since discharge? |
<StopCoag> |
Anticoagulant |
0 = No; 1 = Yes - side effects; 2 = Yes - cost; 3 = Yes - no transportation; 4 = Yes - healthcare provider told them to stop; 5 = Yes - forget to take them; 6 = Yes - Ran out; 7 = Yes - was away from home; 8 = Yes - other; 9 = Not documented/UTD |
Optional |
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Question is changed to optional (reduction in burden) |
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1 |
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Have you stopped any meds since discharge? |
<StopOth> |
Stopped taking another medication |
1 = Yes; 0 = No |
Optional |
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Question is added to specify if other prescribed medications were stopped early. |
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1 |
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Have you stopped any meds since discharge? |
<StpMed60> |
Have you stopped taking any medications in the 60 days since hospital discharge without being told to do so by your medical provider? |
1 = Yes; 0 = No |
Optional |
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Question is added to specify when prescribed medications were stopped early if between 30-60 days |
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1 |
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Have you stopped any meds since discharge? |
<StpMed90> |
Have you stopped taking any medications in the 90 days since hospital discharge without being told to do so by your medical provider? |
1 = Yes; 0 = No |
Optional |
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Question is added to specify when prescribed medications were stopped early if between 60 -90 days |
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1 |
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Follow-up Appointment |
<DAppRes> |
If yes, was the appointment rescheduled? |
0 = same reason as cancellation for initial appointment; 1 = No transportation; 2 = No reminder call; 3 = Patient not aware of initial appointment; 4 = Cost; 5 = Distance to provider; 6 = Scheduling conflict; 7 = Sick; 8 = Other |
Required |
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Question is added to determing if a follow-up appointment had to be rescheduled |
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| 1 |
1 |
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Post-discharge Appointment |
<DAppType> |
Who did patient see or will see? |
1 = Neurologist; 2 = Primary Care Physician; 3 = Other |
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Post-discharge Appointment |
<DAppType> |
Who did patient see or will see? |
1 = Stroke Specialist; 2 = Primary Care Provider; 3 = Both; 4 = Other |
Optional |
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Question is changed to optional (reduction in burden). Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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1 |
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Post-discharge Appointment |
<DAppWhy> |
If the appointment wasn't attended, why? |
1 = No transportation; 2 = Didn't know about/remember appointment; 3 = Scheduling conflict; 4 = Sick; 5 = Other |
Optional |
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Question is added to determine reason for no follow-up appointment attended. |
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1 |
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Post-discharge Appointment |
<DAppDate> |
Date of first follow-up appointment |
Date MMDDYYYY |
Optional |
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Question is added to determine date of follow-up appointment |
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Readmission |
<ReAdDate> |
If yes, date of first readmission |
Date MMDDYYYY |
` |
Readmission |
<ReAdDate> |
If yes, date of first readmission |
Date MMDDYYYY |
Optional |
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Question is changed to optional (reduction in burden) |
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| 1 |
1 |
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Readmission |
<ReAdWhy> |
If yes, reason for first readmission |
Text. |
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Readmission |
<ReAdWhy> |
If yes, were any of the readmissions due to: |
1 = Fall; 2 = Deep vein thrombosis/pulmonary embolism/blood clot; 3 = Carotid intervention; 4 = Acute Myocardial Infarction; 5 = Heart failure; 6 = Infection/Sepsis; 7 = Blood pressure; 8 = Pneumonia; 9 = Trans Ischemic Attack; 10 = Atrial Fibrillation; 11= Other cardiac survey event; 12 = Other surgical procedure; 13 = Urinary Tract Infection; 14 = Unknown; 15 = Other |
Optional |
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Response options are added to reduce burden for abstractors (selection instead of open-ended). Question is changed to optional (reduction in burden) |
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1 |
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Readmission |
<ReAdNum> |
How many readmissions since discharge? |
1 = 1; 2 = 2; 3 = 3 or more; 4 = unknown or Unknown/ND |
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Readmission |
<ReAdNum> |
If yes, how many readmissions since discharge? |
1 = 1; 2 = 2; 3 = 3 or more; 4 = unknown or Unknown/ND |
Optional |
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Question is changed to optional (reduction in burden) |
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Death |
<Dth30Day> |
Died within 30 days of discharge? |
1 = Yes; 0 = No |
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Death |
<Die30d> |
Has patient died? |
1 = Yes; 0 = No |
Required |
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Variable name changed. Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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Death |
<DthDate> |
If patient died, date of death |
Date MMDDYYYY |
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Death |
<DieDate> |
If patient died, date of death |
Date MMDDYYYY |
Required |
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Variable name changed |
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Death |
<DthCause> |
If patient died, cause of death |
1 = Cerebrovascular; 2 = Cardiovascular; 3 = Other; 4 = Unknown |
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Death |
<DieCause> |
If patient died, cause of death |
1 = New Ischemic Stroke; 2 = Pneumonia/Respiratory Failure; 3 = Myocardial Infarction; 4 = Heart Failure; 5 = Other Cardiovascular; 6 = Deep Vein Thrombosis or Pulmonary Embolism; 7 = Sepsis/Infection; 8 = Intracranial hemorrhage; 9 = Other; 10 = Unknown/ND |
Required |
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Response options modified to align with AHA GWTG. Alignment reduces burden for awardees who collect data using multiple systems. |
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1 |
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Mental Health |
<MenHea1> |
Little interest or pleasure in doing things |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea2> |
Feeling down, depressed, or hopeless |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea3> |
Trouble falling asleep, staying asleep or sleeping too much |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea4> |
Feeling tired or having little energy |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea5> |
Poor appetite or overeating |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea6> |
Feeling bad about yourself or that you're a failure or have let yourself or your family down |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea7> |
Trouble concentrating pn things such as reading the newspaper or watching television |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea8> |
Moving or speaking so slowly that others could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around more than usual. |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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1 |
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Mental Health |
<MenHea9> |
Thoughts that you would be better off dead or of hurting yourself in some way |
0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly everyday |
Optional |
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Question is added to include mental health questions |
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