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SECTION H: PHYSICAL HEALTH
These questions ask about health, use of health services and medical care. We’ll start with questions about your health.
| H1. In general, would you say that your physical health is very poor, poor, fair, good, very good, or excellent? | VERY POOR 01 POOR 02 FAIR 03 GOOD 04 VERY GOOD 05 EXCELLENT 06 |
| H30. In the past year have you ever been limited in the amount of activities you could do for more than 2 weeks because of an impairment or health? | YES 01 NO 02 |
| H31. In the past six months, have you taken any prescription medications by mouth or injection for problems with behaviors, feelings, or drugs or alcohol? | YES (SPECIFY) 01 MED 1 __________________________ MED 2 __________________________ MED 3 __________________________ NO 02 |
| H32. In the past six months, have you taken any prescription medications by mouth or injection for health or medical problems other than problems with behaviors, feelings, or drugs or alcohol? | YES (SPECIFY) 01 MED 1 __________________________ MED 2 __________________________ MED 3 __________________________ NO 02 |
| H39. In the past 12 months, have you been covered by any private health insurance or by any public health insurance such as Medicaid? | YES 01 NO (GO TO SV1) 02 |
| H39a. What is the name of your main insurance plan provider (e.g., Blue Cross Blue Shield, Medicaid, Medicare)? | ____________________________________ NAME OF INSURANCE PROVIDER |
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