Skip Navigation

   

Back to Contents |___|___| : |___|___|

Time

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

 

© , Johns Hopkins University. All rights reserved.
Web policies, 615 N. Wolfe Street, Baltimore, MD 21205