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Table NameData Element NameData TypeMax LengthDescriptionPermissible Value ListNotes
FollowUpFormDimensionParticipantIDvarchar50Participant ID
FollowUpFormDimensionFollow_Up_Numberint4Annual Follow-up Number
FollowUpFormDimensionFollow_Up_Completion_Datedatetime8Follow Up Completion Date
FollowUpFormDimensionPhysical_Street_Addressnvarchar200Physical address(if different)
FollowUpFormDimensionPhysical_Citynvarchar100City
FollowUpFormDimensionPhysical_Statenvarchar4State
FollowUpFormDimensionPhysical_Zipcodenvarchar10Zip code
FollowUpFormDimensionPhysical_Countynvarchar100County
FollowUpFormDimensionHeight_Feetnvarchar40Height(in feet and inches): ______ feet
FollowUpFormDimensionHeight_Inchesnvarchar40Height(in feet and inches): ______ inches
FollowUpFormDimensionWeightnvarchar40Weight(in pounds):
FollowUpFormDimensionPrimary_Care_Doctornvarchar200Who is your primary care or main doctor?
FollowUpFormDimensionPrimary_Care_Practicenvarchar200What is the name of the primary care practice where you are usually seen?
FollowUpFormDimensionCoronary_Artery_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Coronary artery disease] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionAtrial_Fibrillationnvarchar40Please indicate if you have received a new diagnosis of [Atrial fibrillation] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionHeart_Attacknvarchar40Please indicate if you have received a new diagnosis of [Heart attack or angina] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionCongestive_Heart_Failurenvarchar40Please indicate if you have received a new diagnosis of [Congestive heart failure] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionPacemaker_Placementnvarchar40Please indicate if you have received a new diagnosis of [Implantable cardiac defibrillator (ICD) or pacemaker placement] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionBreast_Cancernvarchar40Please indicate if you have received a new diagnosis of [Breast cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionColon_Cancernvarchar40Please indicate if you have received a new diagnosis of [Colon cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionLung_Cancernvarchar40Please indicate if you have received a new diagnosis of [Lung cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionProstate_Cancernvarchar40Please indicate if you have received a new diagnosis of [Prostate cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionCervical_Cancernvarchar40Please indicate if you have received a new diagnosis of [Cervical cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionMelanomanvarchar40Please indicate if you have received a new diagnosis of [Melanoma (a specific type of skin cancer)] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionSkin_Cancer_Not_Melanomanvarchar40Please indicate if you have received a new diagnosis of [Skin cancer, not melanoma] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOral_Cancernvarchar40Please indicate if you have received a new diagnosis of [Oral cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOther_Type_Of_Cancernvarchar40Please indicate if you have received a new diagnosis of [Other type of cancer] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionDiabetesnvarchar40Please indicate if you have received a new diagnosis of [Diabetes] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionHigh_Cholesterolnvarchar40Please indicate if you have received a new diagnosis of [High cholesterol] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionThyroid_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Thyroid disease] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionHigh_Blood_Pressurenvarchar40Please indicate if you have received a new diagnosis of [High blood pressure] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionObesitynvarchar40Please indicate if you have received a new diagnosis of [Obesity] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionAsthmanvarchar40Please indicate if you have received a new diagnosis of [Asthma] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionEmphysemanvarchar40Please indicate if you have received a new diagnosis of [Emphysema or "COPD"] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOsteoarthritisnvarchar40Please indicate if you have received a new diagnosis of [Osteoarthritis] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionRheumatoid_Arthritisnvarchar40Please indicate if you have received a new diagnosis of [Rheumatoid arthritis] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOther_Autoimmune_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Other autoimmune disease (Other than Multiple Sclerosis] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOsteoporosis_Osteopenianvarchar40Please indicate if you have received a new diagnosis of [Osteoporosis/Osteopenia] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionGoutnvarchar40Please indicate if you have received a new diagnosis of [Gout] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionAlzheimers_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Alzheimer's disease] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionDepressionnvarchar40Please indicate if you have received a new diagnosis of [Depression] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionOther_Mental_Illnessnvarchar40Please indicate if you have received a new diagnosis of [Other mental illness] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionStrokenvarchar40Please indicate if you have received a new diagnosis of [Stroke] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionMultiple_Sclerosisnvarchar40Please indicate if you have received a new diagnosis of [Multiple sclerosis] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionCrohns_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Crohn's disease/ulcerative colitis] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionLiver_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Liver disease] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionKidney_Diseasenvarchar40Please indicate if you have received a new diagnosis of [Kidney disease] in the past year.• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionHeart_Cardiac_Catheterizationnvarchar100Please indicate if you have had [Heart/cardiac catheterization] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionHeart_Cardiac_Angioplasty_Stentnvarchar100Please indicate if you have had [Heart/cardiac angioplasty or stent] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionCoronary_Artery_Bypass_Surgerynvarchar100Please indicate if you have had [Coronary artery bypass surgery] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionHeart_Cardiac_Stress_Testnvarchar100Please indicate if you have had [Heart/cardiac stress test] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionJoint_Replacementnvarchar100Please indicate if you have had [Joint replacement] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionWhich_Joint_Replacednvarchar200Which Joint? [Joint replacement]
FollowUpFormDimensionChest_Xraynvarchar100Please indicate if you have had [Chest x-ray] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionJoint_Xraynvarchar100Please indicate if you have had [Joint x-ray] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionWhich_Joint_Xrayednvarchar200Which Joint? [Joint x-ray]
FollowUpFormDimensionCT_Or_MRI_Scannvarchar100Please indicate if you have had [CT or MRI scan] in the past year.• Yes
• No
• No Response
• Multiple Responses
FollowUpFormDimensionWhich_Body_Part_Scannednvarchar200Which part of the body was scanned?
FollowUpFormDimensionCurrently_Smoke_Cigarettesnvarchar100Do you currently smoke cigarettes?• Yes, only some days
• Yes, everyday
• No
• No Response
• Multiple Responses
FollowUpFormDimensionDaily_Cigarette_Consumptionnvarchar100If you currently smoke cigarettes, about how many cigarettes a day do you smoke, on average?
FollowUpFormDimensionDrinks_Past_Monthnvarchar100During the past month, have you had at least one drink of any alcoholic beverage, such as beer, wine, wine coolers, or liquor?• Yes
• No
• Dont Know
• No Response
• Multiple Responses
FollowUpFormDimensionDrinks_Per_Daynvarchar100On an average day that you drink an alcoholic beverage(a can or bottle of beer, a 4-ounce glass of wine, or one cocktail containing one ounce of liquor), how many drinks do you have? Please specify a number:
FollowUpFormDimensionAlcohol_Days_Per_Weeknvarchar200During the past month, on how many days per week did you drink any alcoholic beverages, on the average?• Less than 1 day per week/don't drink alcoholic beverages
• 1-2 days per week
• 3-4 days per week
• 5-7 days per week
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Ratingnvarchar100In general, would you say your health is:• Excellent
• Very good
• Good
• Fair
• Poor
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Limit_Climbing_Stairsnvarchar100Does your health now limit you in climbing one flight of stairs?• Not at all
• Very little
• Somewhat
• Quite a lot
• Cannot do
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Limit_Walking_Milenvarchar100Does your health now limit you in walking more than a mile?• Not at all
• Very little
• Somewhat
• Quite a lot
• Cannot do
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Limit_Carry_Groceriesnvarchar100Does your health now limit you in lifting or carrying groceries?• Not at all
• Very little
• Somewhat
• Quite a lot
• Cannot do
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Limit_Bendingnvarchar100Does your health now limit you in bending, kneeling, or stooping?• Not at all
• Very little
• Somewhat
• Quite a lot
• Cannot do
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Dress_Yourselfnvarchar100Are you able to dress yourself, including tying shoelaces and doing buttons?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses
FollowUpFormDimensionHealth_Limit_Vigorous_Activitynvarchar100Does your health now limit you in doing vigorous activities, such as running, lifting heavy objects, participating in strenuous sports?• Not at all
• Very little
• Somewhat
• Quite a lot
• Cannot do
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Do_Choresnvarchar100Are you able to do chores such as vacuuming or yard work?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Wash_Bodynvarchar100Are you able to wash and dry your body?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Get_On_And_Off_Toiletnvarchar100Are you able to get on and off the toilet?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Run_Five_Milesnvarchar100Are you able to run five miles?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Fearfulnvarchar100In the past 7 days I felt fearful.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionAnxietynvarchar100In the past 7 days I found it hard to focus on anything other than my anxiety.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionWorries_Overwhelmednvarchar100In the past 7 days my worries overwhelmed me.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Uneasynvarchar100In the past 7 days I felt uneasy.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Worthlessnvarchar100In the past 7 days I felt worthless.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Unhappynvarchar100In the past 7 days I felt unhappy.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Depressednvarchar100In the past 7 days I felt depressed.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Hopelessnvarchar100In the past 7 days I felt hopeless.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Helplessnvarchar100In the past 7 days I felt helpless.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Fatiguednvarchar100During the past 7 days I felt fatigued.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionHow_Fatigued_On_Averagenvarchar100In the past 7 days how fatigued were you on average?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionHow_Run_Down_On_Averagenvarchar100In the past 7 days how run-down did you feel on average?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionTrouble_Starting_Thingsnvarchar100In the past 7 days I have had trouble starting things because I was tired.• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionHow_Tired_On_Averagenvarchar100In the past 7 days how tired did you feel on average?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionRate_Your_Pain_0_10nvarchar100In the past 7 days how would you rate your pain on average? (where 0 = 'No pain' & 10 = 'Worst imaginable pain')• 0
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• No Response
• Multiple Responses
FollowUpFormDimensionRate_Your_Pain_1_10nvarchar100In the past 7 days how would you rate your pain on average? (where 1 = 'No pain' & 10 = 'The most pain')• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• No Response
• Multiple Responses
FollowUpFormDimensionPain_Interfere_Day_To_Daynvarchar100In the past 7 days how much did pain interfere with your day to day activities?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionPain_Interfere_Socialnvarchar100In the past 7 days how much did pain interfere with your ability to participate in social activities?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionPain_Interfere_Enjoyment_Lifenvarchar100In the past 7 days how much did pain interfere with your enjoyment of life?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionPain_Interfere_Work_At_Homenvarchar100In the past 7 days how much did pain interfere with work around the home?• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionSatisfied_Sleepnvarchar100In the past 7 days I was satisfied with my sleep.• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionFelt_Angrynvarchar100In the past 7 days I felt angry.• Never
• Rarely
• Sometimes
• Often
• Always
• No Response
• Multiple Responses
FollowUpFormDimensionSatisfied_With_Daily_Routinesnvarchar100In the past 7 days I am satisfied with my ability to perform my daily routines.• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionSatisfied_Leisure_Activitiesnvarchar100In the past 7 days I am satisfied with my ability to do leisure activities.• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much
• No Response
• Multiple Responses
FollowUpFormDimensionAble_To_Shampoo_Hairnvarchar100Are you able to shampoo your hair?• Without any difficulty
• With a little difficulty
• With some difficulty
• With much difficulty
• Unable to do
• No Response
• Multiple Responses