cvriskprofile.qst

.title=Risk Profile Recording Form
instances=1

.qu=intro,type=void
This form will ask you a series of questions about your cardiovascular
health.  For each question, please select or type the appropriate response
and press "next".  You may exit the survey by clicking "Save and Close", and
return to it later by signing into myOSCAR and clicking the 'Surveys' link on
the left hand-menu.  The survey will save by default every 3 questions.
.an
.next

.qu=E1,type=select
Is this a repeat visit?
.an
1 = Yes
2 = No
.if (E1 = 1) finish
.next

.qu=E2,type=select
In general, would you say your health is:
.an
1 = Poor
2 = Fair
3 = Good
4 = Very Good
5 = Excellent
.next

.qu=E3,type=number
What is your height in cm?
.an
.lo=0
.hi=500
.next

.qu=E4,type=number
What is your weight in kg?
.an
.lo=0
.hi=1000
.next

.qu=E5,type=select
Have you ever had a transient ischemic attack (TIA or mini-stroke)?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E6,type=select
Have you ever had a stroke?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E7,type=select
Have you ever had a heart attack?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E8,type=select
Has your doctor told you that your cholesterol is high?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E9,type=select
Has your doctor told you that you have diabetes?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E10,type=select
Have you ever been diagnosed with high blood pressure by a doctor?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E11,type=select
Are you currently taking prescription pills for high blood pressure?
.an
1 = Yes
2 = No
3 = Not Sure
.if (E11 = 1) E12
.next=E13

.qu=E12,type=select
Do you take pills for high blood pressure each day?
.an
1 = Yes
2 = No
.next

.qu=E13,type=select
Do you currently smoke?
.an
1 = Yes
2 = No
.next

.qu=E14,type=select
In a typical week, how many times do you eat high fat or fast foods?
.an
0 = Zero
1 = 1-2
3 = 3 or more
.next

.qu=E15,type=select
Typically, do you drink 2 or more alcoholic drinks a day?
.an
1 = Yes
2 = No
.next

.qu=E16,type=select
Do you eat 5 servings or more of fruits and vegetables a day?
.an
1 = Yes
2 = No
.next

.qu=E17,type=select
How frequently do you add salt to foods during cooking or at the table?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E18,type=select
In a typical week, how frequently do you feel overwhelmed or stressed?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E19,type=select
Are you moderately physically active for 30 to 60 minutes, most days of .title=Risk Profile Recording Form
instances=1

.qu=intro,type=void
This form will ask you a series of questions about your cardiovascular
health.  For each question, please select or type the appropriate response
and press "next".  You may exit the survey by clicking "Save and Close", and
return to it later by signing into myOSCAR and clicking the 'Surveys' link on
the left hand-menu.  The survey will save by default every 3 questions.
.an
.next

.qu=E1,type=select
Is this a repeat visit?
.an
1 = Yes
2 = No
.if (E1 = 1) finish
.next

.qu=E2,type=select
In general, would you say your health is:
.an
1 = Poor
2 = Fair
3 = Good
4 = Very Good
5 = Excellent
.next

.qu=E3,type=number
What is your height in cm?
.an
.lo=0
.hi=500
.next

.qu=E4,type=number
What is your weight in kg?
.an
.lo=0
.hi=1000
.next

.qu=E5,type=select
Have you ever had a transient ischemic attack (TIA or mini-stroke)?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E6,type=select
Have you ever had a stroke?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E7,type=select
Have you ever had a heart attack?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E8,type=select
Has your doctor told you that your cholesterol is high?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E9,type=select
Has your doctor told you that you have diabetes?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E10,type=select
Have you ever been diagnosed with high blood pressure by a doctor?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E11,type=select
Are you currently taking prescription pills for high blood pressure?
.an
1 = Yes
2 = No
3 = Not Sure
.if (E11 = 1) E12
.next=E13

.qu=E12,type=select
Do you take pills for high blood pressure each day?
.an
1 = Yes
2 = No
.next

.qu=E13,type=select
Do you currently smoke?
.an
1 = Yes
2 = No
.next

.qu=E14,type=select
In a typical week, how many times do you eat high fat or fast foods?
.an
0 = Zero
1 = 1-2
3 = 3 or more
.next

.qu=E15,type=select
Typically, do you drink 2 or more alcoholic drinks a day?
.an
1 = Yes
2 = No
.next

.qu=E16,type=select.title=Risk Profile Recording Form
instances=1

.qu=intro,type=void
This form will ask you a series of questions about your cardiovascular
health.  For each question, please select or type the appropriate response
and press "next".  You may exit the survey by clicking "Save and Close", and
return to it later by signing into myOSCAR and clicking the 'Surveys' link on
the left hand-menu.  The survey will save by default every 3 questions.
.an
.next

.qu=E1,type=select
Is this a repeat visit?
.an
1 = Yes
2 = No
.if (E1 = 1) finish
.next

.qu=E2,type=select
In general, would you say your health is:
.an
1 = Poor
2 = Fair
3 = Good
4 = Very Good
5 = Excellent
.next

.qu=E3,type=number
What is your height in cm?
.an
.lo=0
.hi=500
.next

.qu=E4,type=number
What is your weight in kg?
.an
.lo=0
.hi=1000
.next

.qu=E5,type=select
Have you ever had a transient ischemic attack (TIA or mini-stroke)?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E6,type=select
Have you ever had a stroke?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E7,type=select
Have you ever had a heart attack?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E8,type=select
Has your doctor told you that your cholesterol is high?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E9,type=select
Has your doctor told you that you have diabetes?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E10,type=select
Have you ever been diagnosed with high blood pressure by a doctor?
.an
1 = Yes
2 = No
3 = Not Sure
.next

.qu=E11,type=select
Are you currently taking prescription pills for high blood pressure?
.an
1 = Yes
2 = No
3 = Not Sure
.if (E11 = 1) E12
.next=E13

.qu=E12,type=select
Do you take pills for high blood pressure each day?
.an
1 = Yes
2 = No
.next

.qu=E13,type=select
Do you currently smoke?
.an
1 = Yes
2 = No
.next

.qu=E14,type=select
In a typical week, how many times do you eat high fat or fast foods?
.an
0 = Zero
1 = 1-2
3 = 3 or more
.next

.qu=E15,type=select
Typically, do you drink 2 or more alcoholic drinks a day?
.an
1 = Yes
2 = No
.next

.qu=E16,type=select
Do you eat 5 servings or more of fruits and vegetables a day?
.an
1 = Yes
2 = No
.next

.qu=E17,type=select
How frequently do you add salt to foods during cooking or at the table?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E18,type=select
In a typical week, how frequently do you feel overwhelmed or stressed?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E19,type=select
Are you moderately physically active for 30 to 60 minutes, most days of
the week? (e.g. brisk walking, active gardening, swimming, dancing or biking)
.an
1 = Yes
2 = No
.next

.qu=E20,type=select
Do you live alone?
.an
1 = Yes
2 = No
.next

.qu=finish,type=void
Thank you for completing this questionnaire.
Click "Next" to save your answers and exit.
.an
.next
Do you eat 5 servings or more of fruits and vegetables a day?
.an
1 = Yes
2 = No
.next

.qu=E17,type=select
How frequently do you add salt to foods during cooking or at the table?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E18,type=select
In a typical week, how frequently do you feel overwhelmed or stressed?
.an
1 = Rarely
2 = Sometimes
3 = Often
.next

.qu=E19,type=select
Are you moderately physically active for 30 to 60 minutes, most days of
the week? (e.g. brisk walking, active gardening, swimming, dancing or biking)
.an
1 = Yes
2 = No
.next

.qu=E20,type=select
Do you live alone?
.an
1 = Yes
2 = No
.next

.qu=finish,type=void
Thank you for completing this questionnaire.
Click "Next" to save your answers and exit.
.an
.next
the week? (e.g. brisk walking, active gardening, swimming, dancing or biking)
.an
1 = Yes
2 = No
.next

.qu=E20,type=select
Do you live alone?
.an
1 = Yes
2 = No
.next

.qu=finish,type=void
Thank you for completing this questionnaire.
Click "Next" to save your answers and exit.
.an
.next