| PC9-001 [] | Section: Child Health |
Now I'd like to ask you some questions about [name of youth()]'s general state of health.
In general, how is [youth his/her()] health?
| | 1 Excellent |
| | 2 Very good |
| | 3 Good |
| | 4 Fair |
| | 5 Poor |
| PC9-002 [] | Section: Child Health |
(Excluding pregnancy), does [name of youth()] have or has [he/she youth()] ever had any physical, emotional, or mental condition that limits or has limited [youth his/her()] ability to attend school regularly, do regular school work, or work at a job for pay?
| PC9-003 [] | Section: Child Health |
Does [name of youth()] regularly take any medicine or prescription drugs related to a chronic condition?
| PC9-004 [] | Section: Child Health |
Does [name of youth()] now have or has [he/she youth()] ever had a learning or emotional problem that limits or has limited the kind of schoolwork or other daily activities [he/she youth()] can perform, the amount of time [he/she youth()] can spend on these activities or [youth his/her()] performance in these activities?
| PC9-005 [] | Section: Child Health |
([PC9-002()] = 1) OR ([PC9-004()] = 1)
COMMENT: was yes answered to either question 2 or 4?
| | 1 CONDITION APPLIES ...(Go To PC9-006) |
| | 0 CONDITION DOES NOT APPLY |
| PC9-006 [] | Section: Child Health |
What (is/are) the condition(s)?
(SELECT ALL THAT APPLY.)
| | 1 Learning disability (i.e., dyslexia) or attention disorder |
| | 2 Emotional/mental problem or behavior problem |
| | 3 Eating disorder like anorexia or bulemia |
| | 4 Mental retardation |
| | 6 Physical problem |
| | 5 Other (SPECIFY) |
| PC9-007-LOOP-BEGIN [] | Section: Child Health |
REPEAT ([loop number 1])
COMMENT: go through conditions selected
| PC9-008 [] | Section: Child Health |
INLIST ([PC9-006([parent calendar loop])],[loop number 1])
COMMENT: was this choice selected?
| | 1 CONDITION APPLIES ...(Go To PC9-011) |
| | 0 CONDITION DOES NOT APPLY |
| PC9-011 [] | Section: Child Health |
How old was [name of youth([parent calendar loop])] when the [learning, emotional, eating, mental disorder text substitution for youth()] was first noticed?
(INTERVIEWER: ENTER "0" IF [name of youth([parent calendar loop])] HAS HAD THIS
CONDITION SINCE BIRTH.)
| PC9-012 [] | Section: Child Health |
Does the [learning, emotional, eating, mental disorder text substitution for youth()] currently limit [name of youth([parent calendar loop])]?
| | 0 No, not currently limited by this condition |
| | 1 Yes, limited a little |
| | 2 Yes, limited a lot |
| PC9-013-LOOP-END [] | Section: Child Health |
UNTIL ([loop number 1], ([loop number 1] = 5))
COMMENT: repeat loops until all selections checked
| PC9-014 [] | Section: Child Health |
Does [name of youth()] now have or has [he/she youth()] ever had trouble seeing, hearing or speaking?
| PC9-015 [] | Section: Child Health |
What (is/are) the condition(s)?
(SELECT ALL THAT APPLY.)
| | 1 Blindness in one eye |
| | 2 Blindness in both eyes |
| | 3 Other vision difficulty |
| | 4 Hearing difficulty |
| | 5 Deaf |
| | 6 Speech impairment (e.g., lisp, stammering, or stuttering) |
| | 7 Other (SPECIFY) |
| PC9-016-LOOP-BEGIN [] | Section: Child Health |
REPEAT ([loop number 2])
COMMENT: loop through the conditions selected
| PC9-017 [] | Section: Child Health |
INLIST ([PC9-015([parent calendar loop])],[loop number 2])
COMMENT: was this condition selected?
| | 1 CONDITION APPLIES ...(Go To PC9-020) |
| | 0 CONDITION DOES NOT APPLY |
| PC9-020 [] | Section: Child Health |
How old was [name of youth([parent calendar loop])] when the [text substitution for sight, hearing, speach problem for youth()] was first noticed?
(INTERVIEWER: ENTER "0" IF [name of youth([parent calendar loop])] HAS HAD THIS
CONDITION SINCE BIRTH.)
| PC9-021 [] | Section: Child Health |
Does the [text substitution for sight, hearing, speach problem for youth()] currently limit [name of youth([parent calendar loop])]?
| | 0 No, not currently limited by this condition |
| | 1 Yes, limited a little |
| | 2 Yes, limited a lot |
| PC9-022-LOOP-END [] | Section: Child Health |
UNTIL ([loop number 2], ([loop number 2] = 7))
COMMENT: repeat loops until all selections checked
| PC9-023 [] | Section: Child Health |
Does [name of youth()] now have or has [he/she youth()] ever had a part of [youth his/her()] body that (is/was) deformed or missing?
| PC9-024 [] | Section: Child Health |
What (is/are) the condition(s)?
(SELECT ALL THAT APPLY.)
| | 1 Missing finger, hand, arm, toe, foot, or leg |
| | 2 Permanent stiffness or any deformity of the back, foot, or leg |
| | 3 Permanent stiffness or any deformity of the fingers, hand, or arm |
| | 4 Other (SPECIFY) |
| PC9-025-LOOP-BEGIN [] | Section: Child Health |
REPEAT ([loop number 3])
COMMENT: loop through conditions selected
| PC9-026 [] | Section: Child Health |
INLIST ([PC9-024([parent calendar loop])],[loop number 3])
COMMENT: was this condition selected?
| | 1 CONDITION APPLIES ...(Go To PC9-029) |
| | 0 CONDITION DOES NOT APPLY |
| PC9-029 [] | Section: Child Health |
How old was [name of youth([parent calendar loop])] when the [text substitution for missing/deformed body part on youth()] was first noticed?
(INTERVIEWER: ENTER "0" IF [name of youth([parent calendar loop])] HAS HAD THIS
CONDITION SINCE BIRTH.)
| PC9-030 [] | Section: Child Health |
Does the [text substitution for missing/deformed body part on youth()] currently limit [name of youth([parent calendar loop])]?
| | 0 No, not currently limited by this condition |
| | 1 Yes, limited a little |
| | 2 Yes, limited a lot |
| PC9-031-LOOP-END [] | Section: Child Health |
UNTIL ([loop number 3], ([loop number 3] = 4))
COMMENT: repeat loops until all selections checked
| PC9-032 [] | Section: Child Health |
Does [name of youth()] now have or has [he/she youth()] ever had any other chronic health condition or life threatening disease such as asthma, heart condition, anemia, diabetes or cancer?
| PC9-033 [] | Section: Child Health |
What (is/are) the condition(s)?
(SELECT ALL THAT APPLY.)
| | 1 Asthma |
| | 2 Heart condition |
| | 3 Anemia |
| | 4 Diabetes |
| | 5 Cancer |
| | 6 Epilepsy |
| | 7 Other (SPECIFY) |
| PC9-034-LOOP-BEGIN [] | Section: Child Health |
REPEAT ([loop number 4])
COMMENT: loop through conditions selected
| PC9-035 [] | Section: Child Health |
INLIST ([PC9-033([parent calendar loop])],[loop number 4])
COMMENT: was this condition selected?
| | 1 CONDITION APPLIES ...(Go To PC9-038) |
| | 0 CONDITION DOES NOT APPLY |
| PC9-038 [] | Section: Child Health |
How old was [name of youth([parent calendar loop])] when the [text substitution for youth's chronic health problem or threatening disease()] was first noticed?
(INTERVIEWER: ENTER "0" IF [name of youth([parent calendar loop])] HAS HAD THIS
CONDITION SINCE BIRTH.)
| PC9-039 [] | Section: Child Health |
Does the [text substitution for youth's chronic health problem or threatening disease()] currently limit [name of youth([parent calendar loop])]?
| | 0 No, not currently limited by this condition |
| | 1 Yes, limited a little |
| | 2 Yes, limited a lot |
| PC9-040-LOOP-END [] | Section: Child Health |
UNTIL ([loop number 4], ([loop number 4] = 6))
COMMENT: repeat loops until all selections checked
| PC9-050 [] | Section: Child Health |
(HAND CARD L)
Is [name of youth()] covered by health insurance that includes physician or hospital care through any of the following?
| | 1 1. Your or someone else's job, union or business? |
| | 2 2. A direct purchase from an insurance company or through a professional association or retirement association? |
| | 3 3. MediCAID (OR STATE NAME FOR MEDICAID), the state-sponsored program to provide health care to low income people? |
| | 4 4. MediCare, the plan for people 65 or older and some younger disabled people that is sponsored by the federal government? |
| | 5 5. A military-related health plan such as CHAMPUS (which covers both active duty retired military personnel, their dependents and survivors), CHAMPVA (which covers disabled veterans, their dependents and survivors), or are you eligible for VA hospital care? |
| | 6 6. Anything else or are you not covered? |
| | 0 NONE |