Name | Label | Folder | |
---|---|---|---|
mh_anx
Do you have an anxiety disorder?
|
Do you have an anxiety disorder?
Medical History Questionnaire |
Medical History | |
mh_bpd
Do you have bipolar disorder?
|
Do you have bipolar disorder?
Medical History Questionnaire |
Medical History | |
mh_health
How would you rate your overall health?
|
How would you rate your overall health?
Medical History Questionnaire |
Medical History | |
mh_mdd
Do you have depression?
|
Do you have depression?
Medical History Questionnaire |
Medical History | |
mh_ptsd
Do you have post-traumatic stress disorder (PTSD)?
|
Do you have post-traumatic stress disorder (PTSD)?
Medical History Questionnaire |
Medical History | |
mh_pzd
Do you have schizophrenia, schizoaffective disorder, or another psychotic disorder?
|
Do you have schizophrenia, schizoaffective disorder, or another psychotic disorder?
Medical History Questionnaire |
Medical History | |
mh_szd
Do you have a seizure disorder, or have had seizures?
|
Do you have a seizure disorder, or have had seizures?
Medical History Questionnaire |
Medical History | |
mh_meds_1
Are you taking any medications (prescription or over-the-counter)?
|
Are you taking any medications (prescription or over-the-counter)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_1_dose
How much of the first medication do you take?
|
How much of the first medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_1_name
What is the name of the first medication?
|
What is the name of the first medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_1_reason
Why do you take the first medication?
|
Why do you take the first medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_1_timing
Approximately when do you take the first medication (in military time)?
|
Approximately when do you take the first medication (in military time)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_2
Do you take another medication?
|
Do you take another medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_2_dose
How much of the second medication do you take?
|
How much of the second medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_2_name
What is the name of the second medication?
|
What is the name of the second medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_2_reason
Why do you take the second medication?
|
Why do you take the second medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_2_timing
Approximately when do you take the second medication (in military time)?
|
Approximately when do you take the second medication (in military time)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_3
Do you take another medication?
|
Do you take another medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_3_dose
How much of the third medication do you take?
|
How much of the third medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_3_name
What is the name of the third medication?
|
What is the name of the third medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_3_reason
Why do you take the third medication?
|
Why do you take the third medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_3_timing
Approximately when do you take the third medication (in military time)?
|
Approximately when do you take the third medication (in military time)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_4
Do you take another medication?
|
Do you take another medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_4_dose
How much of the fourth medication do you take?
|
How much of the fourth medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_4_name
What is the name of the fourth medication?
|
What is the name of the fourth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_4_reason
Why do you take the fourth medication?
|
Why do you take the fourth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_4_timing
Approximately when do you take the fourth medication (in military time)?
|
Approximately when do you take the fourth medication (in military time)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_5
Do you take another medication?
|
Do you take another medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_5_dose
How much of the fifth medication do you take?
|
How much of the fifth medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_5_name
What is the name of the fifth medication?
|
What is the name of the fifth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_5_reason
Why do you take the fifth medication?
|
Why do you take the fifth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_5_timing
Approximately when do you take the fifth medication (in military time)?
|
Approximately when do you take the fifth medication (in military time)?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_6
Do you take another medication?
|
Do you take another medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_6_dose
How much of the sixth medication do you take?
|
How much of the sixth medication do you take?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_6_name
What is the name of the sixth medication?
|
What is the name of the sixth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_6_reason
Why do you take the sixth medication?
|
Why do you take the sixth medication?
Medical History Questionnaire |
Medical History/Medications | |
mh_meds_6_timing
Approximately when do you take the sixth medication (in military time)?
|
Approximately when do you take the sixth medication (in military time)?
Medical History Questionnaire |
Medical History/Medications |