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Childhood Adenotonsillectomy Trial

Name Label Folder
med1a1
Ever had acute life threatening episode (ALTE)?
Ever had acute life threatening episode (ALTE)? Medical History
med1a2
Diagnosed or treated by a physician for acute life threatening episode (ALTE)?
Diagnosed or treated by a physician for acute life threatening episode (ALTE)? Medical History
med1a3
Acute life threatening episode (ALTE) still present?
Acute life threatening episode (ALTE) still present? Medical History
med1a4
Currently taking medication for the acute life threatening episode (ALTE)?
Currently taking medication for the acute life threatening episode (ALTE)? Medical History
med1b1
Ever had an anxiety disorder?
Ever had an anxiety disorder? Medical History
med1b2
Diagnosed or treated by a physician for an anxiety disorder?
Diagnosed or treated by a physician for an anxiety disorder? Medical History
med1b3
Anxiety disorder still present?
Anxiety disorder still present? Medical History
med1b4
Currently taking medication your anxiety disorder?
Currently taking medication your anxiety disorder? Medical History
med1c1
Ever had asthma?
Ever had asthma? Medical History
med1c2
Diagnosed or treated by a physician for asthma?
Diagnosed or treated by a physician for asthma? Medical History
med1c3
Asthma still present?
Asthma still present? Medical History
med1c4
Currently taking medication for asthma?
Currently taking medication for asthma? Medical History
med1d1
Ever had Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?
Ever had Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?

Also known as Attention Deficit Hyperactivity Disorder (ADHD)

Medical History
med1d2
Diagnosed or treated by a physician for Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?
Diagnosed or treated by a physician for Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?

Also known as Attention Deficit Hyperactivity Disorder (ADHD)

Medical History
med1d3
Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD) still present?
Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD) still present?

Also known as Attention Deficit Hyperactivity Disorder (ADHD)

Medical History
med1d4
Currently taking medication for Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?
Currently taking medication for Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder(ADHD)?

Also known as Attention Deficit Hyperactivity Disorder (ADHD)

Medical History
med1e1
Ever had cancer?
Ever had cancer? Medical History
med1e2
Diagnosed or treated by a physician for cancer?
Diagnosed or treated by a physician for cancer? Medical History
med1e3
Cancer still present?
Cancer still present? Medical History
med1e4
Currently taking medication for cancer?
Currently taking medication for cancer? Medical History
med1f1
Ever had cerebral palsy?
Ever had cerebral palsy? Medical History
med1f2
Diagnosed or treated by a physician for cerebral palsy?
Diagnosed or treated by a physician for cerebral palsy? Medical History
med1f3
Cerebral palsy still present?
Cerebral palsy still present? Medical History
med1f4
Currently taking medication for cerebral palsy?
Currently taking medication for cerebral palsy? Medical History
med1g1
Ever had heartburn or acid reflux?
Ever had heartburn or acid reflux? Medical History
med1g2
Diagnosed or treated by a physician for heartburn or acid reflux?
Diagnosed or treated by a physician for heartburn or acid reflux? Medical History
med1g3
Heartburn or acid reflux still present?
Heartburn or acid reflux still present? Medical History
med1g4
Currently taking medication for heartburn or acid reflux?
Currently taking medication for heartburn or acid reflux? Medical History
med1h1
Ever had depression?
Ever had depression? Medical History
med1h2
Diagnosed or treated by a physician for depression?
Diagnosed or treated by a physician for depression? Medical History
med1h3
Depression still present?
Depression still present? Medical History
med1h4
Currently taking medication for depression?
Currently taking medication for depression? Medical History
med1i1
Ever had diabetes?
Ever had diabetes? Medical History
med1i2
Diagnosed or treated by a physician for diabetes?
Diagnosed or treated by a physician for diabetes? Medical History
med1i3
Diabetes still present?
Diabetes still present? Medical History
med1i4
Currently taking medication for diabetes?
Currently taking medication for diabetes? Medical History
med1j1
Ever had an eating disorder?
Ever had an eating disorder?

This includes anorexia and bulimia

Medical History
med1j2
Diagnosed or treated by a physician for an eating disorder?
Diagnosed or treated by a physician for an eating disorder?

This includes anorexia and bulimia

Medical History
med1j3
Eating Disorder still present?
Eating Disorder still present?

This includes anorexia and bulimia

Medical History
med1j4
Currently taking medication for an eating disorder?
Currently taking medication for an eating disorder?

This includes anorexia and bulimia

Medical History
med1k1
Ever had eczema?
Ever had eczema?

Also known as atopic dermatitis

Medical History
med1k2
Diagnosed or treated by a physician for eczema?
Diagnosed or treated by a physician for eczema?

Also known as atopic dermatitis

Medical History
med1k3
Eczema still present?
Eczema still present?

Also known as atopic dermatitis

Medical History
med1k4
Currently taking medication for eczema?
Currently taking medication for eczema?

Also known as atopic dermatitis

Medical History
med1l1
Ever had hay fever?
Ever had hay fever?

This includes nasal allergies

Medical History
med1l2
Diagnosed or treated by a physician for hay fever?
Diagnosed or treated by a physician for hay fever?

This includes nasal allergies

Medical History
med1l3
Hay fever still present?
Hay fever still present?

This includes nasal allergies

Medical History
med1l4
Currently taking medication for hay fever?
Currently taking medication for hay fever?

This includes nasal allergies

Medical History
med1m1
Ever had hypertension (HTN)?
Ever had hypertension (HTN)?

Also known as high blood pressure

Medical History
med1m2
Diagnosed or treated by a physician for hypertension?
Diagnosed or treated by a physician for hypertension?

Also known as high blood pressure

Medical History
med1m3
Hypertension still present?
Hypertension still present?

Also known as high blood pressure

Medical History
med1m4
Currently taking medication for hypertension?
Currently taking medication for hypertension?

Also known as high blood pressure

Medical History
med1n1
Ever had high cholesterol?
Ever had high cholesterol? Medical History
med1n2
Diagnosed or treated by a physician for high cholesterol?
Diagnosed or treated by a physician for high cholesterol? Medical History
med1n3
High cholesterol still present?
High cholesterol still present? Medical History
med1n4
Currently taking medication for high cholesterol?
Currently taking medication for high cholesterol? Medical History
med1o1
Ever had insomnia?
Ever had insomnia? Medical History
med1o2
Diagnosed or treated by a physician for insomnia?
Diagnosed or treated by a physician for insomnia? Medical History
med1o3
Insomnia still present?
Insomnia still present? Medical History
med1o4
Currently taking medication for insomnia?
Currently taking medication for insomnia? Medical History
med1p1
Ever had headaches?
Ever had headaches?

Such as migraines or chronic severe headaches

Medical History
med1p2
Diagnosed or treated by a physician for headaches?
Diagnosed or treated by a physician for headaches?

Such as migraines or chronic severe headaches

Medical History
med1p3
Headaches still present?
Headaches still present?

Such as migraines or chronic severe headaches

Medical History
med1p4
Currently taking medication for headaches?
Currently taking medication for headaches?

Such as migraines or chronic severe headaches

Medical History
med1q2
Diagnosed or treated by a physician for autism?
Diagnosed or treated by a physician for autism? Medical History
med1q3
Autism still present?
Autism still present? Medical History
med1q4
Currently taking medication for autism?
Currently taking medication for autism? Medical History
med1r1
Ever had asperger's syndrome?
Ever had asperger's syndrome? Medical History
med1r2
Diagnosed or treated by a physician for asperger's syndrome?
Diagnosed or treated by a physician for asperger's syndrome? Medical History
med1r3
Asperger's syndrome still present?
Asperger's syndrome still present? Medical History
med1r4
Currently taking medication for asperger's syndrome?
Currently taking medication for asperger's syndrome? Medical History
med1s1
Ever had other significant medical conditions?
Ever had other significant medical conditions? Medical History
med1s2
Diagnosed or treated by a physician for other significant medical conditions?
Diagnosed or treated by a physician for other significant medical conditions? Medical History
med1s3
Other significant medical conditions still present?
Other significant medical conditions still present? Medical History
med1s4
Currently taking medication for other significant medical conditions?
Currently taking medication for other significant medical conditions? Medical History
med2
Does your child have allergies?
Does your child have allergies? Medical History
med2a
If Yes, has your child ever been tested (skin or blood) for allergies?
If Yes, has your child ever been tested (skin or blood) for allergies? Medical History
med2b1
Child has mold allergy
Child has mold allergy Medical History
med2b2
Child has tree allergy
Child has tree allergy Medical History
med2b3
Child has cat allergy
Child has cat allergy Medical History
med2b4
Child has insect allergy
Child has insect allergy Medical History
med2b5
Child has dust allergy
Child has dust allergy Medical History
med2b6
Child has grass or pollen allergy
Child has grass or pollen allergy Medical History
med2b7
Child has dog allergy
Child has dog allergy Medical History
med2b8
Child has food or drink allergy
Child has food or drink allergy Medical History
med2b9
Child has latex allergy
Child has latex allergy Medical History
med2b98
Child has other allergy
Child has other allergy Medical History
med2b_other
Other allergies, specify
Other allergies, specify Medical History
med2b_other_rc
Other allergies, specify (reclassed)
Other allergies, specify (reclassed) Medical History
med3
Has your child ever had surgery requiring an over night stay?
Has your child ever had surgery requiring an over night stay? Medical History
med3a2
Surgery Date performed
Surgery Date performed Medical History
med3b2
Surgery Date performed
Surgery Date performed Medical History
med4a
Referred to Cardiologist (Heart Doctor)
Referred to Cardiologist (Heart Doctor) Medical History
med4b
Referred to Gastroenterologist (Stomach Doctor)
Referred to Gastroenterologist (Stomach Doctor) Medical History
med4c
Referred to Pulmonologist (Lung Doctor)
Referred to Pulmonologist (Lung Doctor) Medical History
med4d
Referred to Neurologist
Referred to Neurologist Medical History
med4e
Referred to Otolarynologist (Ear, Nose, & Throat Doctor)
Referred to Otolarynologist (Ear, Nose, & Throat Doctor) Medical History
med4f
Referred to Psychiatrist / Psychologist
Referred to Psychiatrist / Psychologist Medical History
med4g
Referred to Sleep Specialist
Referred to Sleep Specialist Medical History
med5
Child's weight at birth?
Child's weight at birth? Medical History