HLQ Data: CMMI_HA_016

Participant Information

CMMI ID:
CMMI_HA_016

Study ID:
MMS000121

Questionnaire Date:
2025-11-04 07:30

Upload:
Manual Import

Age:
79

Sex:
Female

Lives Alone:
Yes

General Health:
Fair

Takes Supplements:
No

Demographics & Household3
Sex
2
Age Calc
79
Live Alone
1
Pets1
Pets Hh
0
General Health & Supplements7
Amemia
0
Gluten
2
Behav Chg
1
Gen Health
2
Behav Chg Sp
MY MOBILITY IS CHANGED BY MY HAVING SCIATICA. I NEED A WALKER OR CANE TO GET AROUND.
Food Allergies
2
Reg Supplement
0
Bowel Habits & Digestion17
Bowel 1
0
Bowel 2
1
Bowel 3
1
Bowel 4
1
Bowel 6
0
Bowel 7
1
Bowel 8
1
Bowel 9
2
Stool 1
1
Stool 2
0
Stool 3
2
Stool 4
2
Stool 5
0
Stool 6
0
Bloating
3
Laxatives
0
Constipation Symp 6 Mo
1
IBS Symptoms3
Pain Abs 3 Mos
0
Pain Abs 6 Mos
0
Pain Abs Menstru
0
Health-Related Medications3
Med Acid Reflux
1
Med Antibiotics
0
Med Constipation
0
Current Medications12
Med 1
PANTOPRAZOLE 40MG
Med 2
AMLODIPINE 5MG
Med 3
BISOPROLOL 10MG
Med 4
CANDESARTAN 32MG
Med 5
GABAPENTIN 1800MG/DAY
Med Num
5
Med Type 1
PPI
Med Type 2
BLOOD PRESSURE MEDICATION
Med Type 3
BLOOD PRESSURE MEDICATION
Med Type 4
BLOOD PRESSURE MEDICATION
Med Type 5
NERVE BLOCKER
Med Current
1
Disease History - Cardiovascular11
Hf Ever
0
Mi Ever
0
Chd Ever
0
Hbp Ever
1
Vhd Ever
1
Angina Ever
0
Atrial Ever
0
Cardio Ever
1
Thrombo Ever
0
High Chol Ever
0
Arrhythmia Ever
1
Disease History - Diabetes4
Diab Ever
0
Diab Gest
0
Diab Type1
0
Diab Type2
0
Disease History - Respiratory7
Cb Ever
0
Ild Ever
0
Copd Ever
0
Resp Ever
0
Asthma Ever
0
Emphysema Ever
0
Cystic Fib Ever
0
Disease History - Digestive & GI10
Lc Ever
0
Uc Ever
1
Ibs Ever
0
Gerd Ever
1
Crohn Ever
0
Fatty Ever
1
Celiac Ever
0
Gastro Ever
1
Ulcers Ever
0
Gallstones Ever
0
Disease History - Neurological5
Ms Ever
0
Neuro Ever
0
Dement Ever
0
Migraine Ever
0
Alzheimer Ever
0
Disease History - Autoimmune & Inflammatory8
Sle Ever
0
Arthritis Ever
0
Fibromyal Ever
0
Scleroderma Ever
0
Weak Immune Ever
0
Sjogren Syndrome Ever
0
Hashimoto Thyroid Ever
0
Ankylosing Spondylitis Ever
0
Disease History - Bone & Muscle3
Op Ever
0
Rd Ever
0
Bones Ever
0
Disease History - Skin4
Ps Ever
0
Skin Ever
0
Eczema Ever
0
Rosacea Ever
0
Disease History - Kidney & Liver5
Hemo Ever
0
Liver Ever
1
Acute Fail Ever
0
Chronic Fail Ever
0
Kidney Stones Ever
0
Disease History - Other Conditions7
Ch Ever
0
Hm Ever
0
Hiv Ever
0
Infec Ever
0
Other Cond Ever
0
Infec Type Other
0
Sleep Apnea Ever
0
Mental Health - Depression & Anxiety22
Mh Ever
1
Dep Ever
0
Minor Dep Ever
0
Mh 5 Eating Prob
3
Anxiety Dis Ever
1
Mh 5 Too Restless
3
Mh 3 Sleeping Prob
2
Mh 4 Feeling Tired
3
Mh 6 Easily Annoyed
3
Mh 6 Self Conf Prob
2
Mh 7 Feeling Afraid
3
Mh 8 Impact Anxious
1
Mh 8 Slow Fast Prob
0
Mh 1 Feeling Nervous
3
Mh 1 Little Interest
3
Mh 4 Trouble Relaxing
3
Mh 7 Concentrate Prob
2
Mh 2 Constant Worrying
3
Mh 2 Feeling Depressed
3
Mh 9 Suicidal Thoughts
3
Mh 10 Impact Depressive
1
Mh 3 Excessive Worrying
3
Mental Health - Other Conditions6
Ocd Ever
1
Ptsd Ever
1
Eating Dis Ever
0
Bipolar Dis Ever
0
Schizophrenia Ever
0
Addiction Disorder Ever
0
Sleep - Duration & Quality7
Sleep Hr
8
Awake Time
10:00:00
Sleep Time
1:00:00
Bed Partner
0
Sleep Quality
2
Enthusiam Prob
3
Fall Asleep Time
30
Sleep - Trouble & Disturbances11
Trouble A
3
Trouble B
3
Trouble C
1
Trouble D
0
Trouble E
0
Trouble F
0
Trouble G
0
Trouble H
1
Trouble I
3
Trouble J
1
Trouble Awake Freq
3
Sleep - Medication & Treatment1
Med
2
Physical Activity5
Mod Freq
0
Vig Freq
0
Walk Freq
0
Sit Time Wkday
900
Sit Time Wkend
900
Physical Measurements3
Height Ft
4
Height In
7
Weight Lb
163
Smoking & Tobacco2
Ecig 30 Days
0
Cig Cur Freq
0
Drug Use4
Wrk Freq
0
Home Freq
0
Mj Use Cur
0
Illicit Drugs Cur
0
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