HLQ Data: CMMI_HA_003
Participant Information
CMMI ID:
CMMI_HA_003
Study ID:
MMS000039
Questionnaire Date:
2025-10-04 09:37
Upload:
Manual Import
Age:
80
Sex:
Female
Lives Alone:
No
General Health:
Excellent
Takes Supplements:
No
Demographics & Household7
Sex
2
2
Age Calc
80
80
Child Hh
0
0
Other Hh
0
0
Live Alone
0
0
Partner Hh
1
1
Multi Child Hh
0
0
Pets1
Pets Hh
0
0
General Health & Supplements6
Amemia
0
0
Gluten
2
2
Behav Chg
0
0
Gen Health
5
5
Food Allergies
2
2
Reg Supplement
0
0
Bowel Habits & Digestion17
Bowel 1
0
0
Bowel 2
1
1
Bowel 3
1
1
Bowel 4
0
0
Bowel 6
1
1
Bowel 7
0
0
Bowel 8
0
0
Bowel 9
2
2
Stool 1
0
0
Stool 2
0
0
Stool 3
0
0
Stool 4
0
0
Stool 5
0
0
Stool 6
0
0
Bloating
0
0
Laxatives
0
0
Constipation Symp 6 Mo
1
1
IBS Symptoms3
Pain Abs 3 Mos
0
0
Pain Abs 6 Mos
0
0
Pain Abs Menstru
0
0
Health-Related Medications3
Med Acid Reflux
0
0
Med Antibiotics
0
0
Med Constipation
0
0
Current Medications6
Med 1
ZENHALE
ZENHALE
Med 2
NASONEX
NASONEX
Med Num
2
2
Med Type 1
INHALER
INHALER
Med Type 2
NASAL SPRAY
NASAL SPRAY
Med Current
1
1
Disease History - Cardiovascular11
Hf Ever
0
0
Mi Ever
0
0
Chd Ever
0
0
Hbp Ever
0
0
Vhd Ever
0
0
Angina Ever
0
0
Atrial Ever
0
0
Cardio Ever
0
0
Thrombo Ever
0
0
High Chol Ever
0
0
Arrhythmia Ever
0
0
Disease History - Diabetes4
Diab Ever
0
0
Diab Gest
0
0
Diab Type1
0
0
Diab Type2
0
0
Disease History - Respiratory7
Cb Ever
0
0
Ild Ever
0
0
Copd Ever
0
0
Resp Ever
1
1
Asthma Ever
1
1
Emphysema Ever
0
0
Cystic Fib Ever
0
0
Disease History - Digestive & GI10
Lc Ever
0
0
Uc Ever
0
0
Ibs Ever
0
0
Gerd Ever
0
0
Crohn Ever
0
0
Fatty Ever
0
0
Celiac Ever
0
0
Gastro Ever
0
0
Ulcers Ever
0
0
Gallstones Ever
0
0
Disease History - Neurological5
Ms Ever
0
0
Neuro Ever
0
0
Dement Ever
0
0
Migraine Ever
0
0
Alzheimer Ever
0
0
Disease History - Autoimmune & Inflammatory8
Sle Ever
0
0
Arthritis Ever
0
0
Fibromyal Ever
0
0
Scleroderma Ever
0
0
Weak Immune Ever
0
0
Sjogren Syndrome Ever
0
0
Hashimoto Thyroid Ever
0
0
Ankylosing Spondylitis Ever
0
0
Disease History - Bone & Muscle3
Op Ever
0
0
Rd Ever
0
0
Bones Ever
0
0
Disease History - Skin4
Ps Ever
0
0
Skin Ever
0
0
Eczema Ever
0
0
Rosacea Ever
0
0
Disease History - Kidney & Liver5
Hemo Ever
0
0
Liver Ever
0
0
Acute Fail Ever
0
0
Chronic Fail Ever
0
0
Kidney Stones Ever
0
0
Disease History - Other Conditions8
Ch Ever
0
0
Hm Ever
0
0
Hiv Ever
0
0
Infec Ever
0
0
Other Cond Ever
1
1
Other Cond Otsp
SINUSITIS
SINUSITIS
Infec Type Other
0
0
Sleep Apnea Ever
1
1
Mental Health - Depression & Anxiety21
Mh Ever
0
0
Dep Ever
0
0
Minor Dep Ever
0
0
Mh 5 Eating Prob
0
0
Anxiety Dis Ever
0
0
Mh 5 Too Restless
0
0
Mh 3 Sleeping Prob
1
1
Mh 4 Feeling Tired
0
0
Mh 6 Easily Annoyed
0
0
Mh 6 Self Conf Prob
0
0
Mh 7 Feeling Afraid
0
0
Mh 8 Slow Fast Prob
0
0
Mh 1 Feeling Nervous
0
0
Mh 1 Little Interest
0
0
Mh 4 Trouble Relaxing
0
0
Mh 7 Concentrate Prob
0
0
Mh 2 Constant Worrying
0
0
Mh 2 Feeling Depressed
0
0
Mh 9 Suicidal Thoughts
0
0
Mh 10 Impact Depressive
0
0
Mh 3 Excessive Worrying
0
0
Mental Health - Other Conditions6
Ocd Ever
0
0
Ptsd Ever
0
0
Eating Dis Ever
0
0
Bipolar Dis Ever
0
0
Schizophrenia Ever
0
0
Addiction Disorder Ever
0
0
Sleep - Duration & Quality12
Sleep Hr
7
7
Awake Time
7:30:00
7:30:00
Sleep Time
21:30:24
21:30:24
Bed Partner
3
3
Sleep Behav A
0
0
Sleep Behav B
0
0
Sleep Behav C
0
0
Sleep Behav D
0
0
Sleep Behav E
0
0
Sleep Quality
3
3
Enthusiam Prob
0
0
Fall Asleep Time
30
30
Sleep - Trouble & Disturbances11
Trouble A
2
2
Trouble B
3
3
Trouble C
3
3
Trouble D
1
1
Trouble E
1
1
Trouble F
1
1
Trouble G
0
0
Trouble H
1
1
Trouble I
0
0
Trouble J
0
0
Trouble Awake Freq
0
0
Sleep - Medication & Treatment1
Med
2
2
Physical Activity7
Mod Freq
4
4
Mod Time
75
75
Vig Freq
0
0
Walk Freq
2
2
Walk Time
10
10
Sit Time Wkday
360
360
Sit Time Wkend
300
300
Physical Measurements3
Height Ft
5
5
Height In
5
5
Weight Lb
176
176
Smoking & Tobacco2
Ecig 30 Days
0
0
Cig Cur Freq
0
0
Drug Use4
Wrk Freq
0
0
Home Freq
0
0
Mj Use Cur
0
0
Illicit Drugs Cur
0
0