NHS Questionnaires

Question Index: Screening History

Questions
Have you been to a doctor/clinic for health reasons in the past year? How many visits?	x
Current usual blood pressure		x	x	x		x		x
Serum cholesterol			x	x		x			x
Resting pulse				x
TB skin test since 1995					x		x
- if ever positive, conversion date:					x
Have you ever had a mammogram?			x
- how many? How long since most recent?			x		x
How often did you practice breast self-examination in the past year?			x	x	x
In the past 2 years have you had a:
- physical exam			x	x	x	x	x	x	x	x
- blood pressure check			x			x
- blood cholesterol					x	x
- fasting blood sugar								x	x	x
- rectal exam			x	x	x	x
- stool occult blood test			x	x	x	x
- colonoscopy/sigmoidoscopy (and reason)			x		x	x	x	x	x	x
- (bimanual) pelvic exam			x			x	x	x	x
- breast exam by doctor			x	x	x	x	x	x	x
- ovarian ultrasound						x
- mammogram				x	x	x	x	x	x	x
- exam by eye doctor						x	x	x	x	x
How often do you usually have a bimanual pelvic exam?				x
In which years did you have a mammogram?						x
Have you ever had an endoscopy (esophagus or stomach)?
Would you be willing to provide NHS with a venous blood sample?			x
Have you ever had a colonoscopy or sigmoidoscopy? - When did you have your 1st one? - Why did you have your 1st one? - When was your most recent one?				x
Why did you have a colonoscopy? (bleeding, abdom pain, constipation, etc.)							x	x
Have you ever had any of these procedures: Breast implant, Silicone injection, Collagen injection, Parrafin injection				x

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