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Question Index: Disease Outcomes


Questions

Year(s) Asked on Long Forms

(Click on year to view PDF of questionnaire.)
High blood pressure x x x x x x x x x x x x x x
Diabetes mellitus x x x x x x x x x x x x x x
Elevated cholesterol x x x x x x x x x x x x x x
Myocardial Infarction (MI) x x x x x x x x x x x x x x
- Hospitalized for MI? x x x x x x
Angina pectoris x x x x x x x x x x x x x x
Peripheral venous thrombosis x x x
Peripheral artery disease or claudation of the legs x x x x x x x x
Pulmonary emboli x x x x x x x x x x x x
Fibrocystic breast disease x x x x x x x x x x x x x x
Other benign breast disease x x x x x x x x x
Breast cancer x x x x x x x x x x x x x x
Cancer of the cervix - in situ included x x x x x x x x x x x x
Cancer of the uterus (endometrium) x x x x x x x x x x x x x
Cancer of the ovary x x x x x x x x x x x x x
Cancer of the colon (large bowel) x x x x x x x x x x x x x
Cancer of the rectum x x x x x x x x x x x x x
Colon (or rectal) polyps x x x x x x x x x x
Cancer of the lung x x x x x x x x x x x x x
Cancer of the liver x x
Other cancer (specify) x x x x x x x x x x x x x x
Other illness (specify) x x x x x x x x x x x x x
Melanoma x x x x x x x x x x x
Osteoporosis x x x x x x x x x x x
Osteoarthritis x x x
Increasted intraocular pressure x x x
Fracture of hip or forearm x x x x x x x x x x x
Fracture of wrist x x x x x x
Vertebral fracture x x x x x x x x
Hip replacement x x x x x x x
Knee replacement x
Rheumatoid arthritis x x x x x x x x x
- Rheumatoid factor x x x x x
Other arthritis x x x x x x
Gout x x x x x
Systemic Lupus Erythematosis (SLE) x x x x x x x x
Cholecystectomy x x x x x x x x x x x
Gall stones x x x
Stroke x x x x x x
Gastric or duodenal ulcer x x x x x x x x x
Ulcerative colitis x x x x x x x x x
Coronary artery surgery x x x x x x x x x
Cataract (1st diagnosis) x x x x x
Cataract extraction x x x x x x x x x x
Basal cell skin cancer x x x x x x x x x x
Squamous cell skin cancer x x x x x x x x x x
Glaucoma x x x x x x x x x
Macular degeneration x x x x x x x x x
Asthma, Dr. diagnosed x x x x x x x x
Emphysema, Dr. diagnosed x x x x x x x x
Chronic bronchitis, Dr. diagnosed x x x x x x x x
Uterine fibroids x
Carotid artery surgery x x x x x x x
TIA x x x x x x x
Chronic kidney failure x x
Multiple Sclerosis x x x x x x
ALS x x x x x x
Diverticulitis x x x x x
Kidney Stones x x x x x x
Scleroderma x
Polymyositis/ Dermatomyositis x
Sjogren's Syndrome x
Appendectomy or Appendicitis x
Appendectomy, incidental x
Alcohol dependence problem x
Herniated Disk (confirmed by CT/MRI?) x
Surgery for varicose veins x
Parkinson's Disease x x x x x
Interstitial cystitis (Dx by cytoscopy) x x x x
Active TB (X-ray or culture Dx) x x x x

Ever been diagnosed with:
- Pernicious Anemia x x
- Congestive heart failure x x x
- Periodontal bone loss x x
- Shingles x
- Depression x x
- Epilepsy x
- Restless leg syndrome (Dr. Dx) x
- Hyperthyroidism/Graves disease x
- Hypothyroidism x
- Barrett's Esophagus x
Ever been diagnosed with with atrial fibrillation? (and year of 1st Dx) x x
What is the pattern of your atrial fibrillation? x

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