HLQ Data: CMMI_HA_022

Participant Information

CMMI ID:
CMMI_HA_022

Study ID:
MMS000189

Questionnaire Date:
2025-01-05 11:20

Upload:
Manual Import

Age:
79

Sex:
Female

Lives Alone:
Yes

General Health:
Good

Takes Supplements:
Yes (45)

Demographics & Household3
Sex
2
Age Calc
79
Live Alone
1
Pets1
Pets Hh
0
General Health & Supplements9
Amemia
0
Gluten
9
Behav Chg
0
Gen Health
3
Food Allergies
1
Reg Supplement
1
Food Allergies Sp
EGGPLANT, AVOCADO
Reg Supplement Sp
HEALTH BALANCE
Reg Supplement Num
45
Bowel Habits & Digestion17
Bowel 1
0
Bowel 2
2
Bowel 3
1
Bowel 4
1
Bowel 6
2
Bowel 7
2
Bowel 8
2
Bowel 9
1
Stool 1
2
Stool 2
0
Stool 3
0
Stool 4
3
Stool 5
0
Stool 6
0
Bloating
3
Laxatives
0
Constipation Symp 6 Mo
0
IBS Symptoms3
Pain Abs 3 Mos
3
Pain Abs 6 Mos
0
Pain Abs Menstru
2
Health-Related Medications3
Med Acid Reflux
1
Med Antibiotics
0
Med Constipation
0
Current Medications16
Med 1
SYMBICORT 200
Med 2
JAMP-TELMISARTAN 60MG
Med 3
AMITRIPTYLINE HCL 10MG
Med 4
PREGABALIN 50MG
Med 5
PANTOPRAZOLE MAGNESIUM 40MG
Med 6
SANDOZ PREDNISOLONE 1%
Med 7
PROLENSA
Med Num
7
Med Type 1
ASTHMA
Med Type 2
HIGH BLOOD PRESSURE MEDICATION
Med Type 3
LOWER BACK AND RIGHT LEG NERVE PAIN, ASSIST WITH SLEEP
Med Type 4
LOWER BACK AND LEGS NERVE PAIN POST SURGERY, FUSION L5-S1
Med Type 5
ACID REFLUX
Med Type 6
INFLAMED RETINA RIGHT EYE
Med Type 7
INFLAMED RETINA RIGHT EYE
Med Current
1
Disease History - Cardiovascular11
Hf Ever
0
Mi Ever
0
Chd Ever
0
Hbp Ever
0
Vhd Ever
0
Angina Ever
0
Atrial Ever
0
Cardio Ever
0
Thrombo Ever
0
High Chol Ever
0
Arrhythmia Ever
0
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
1
Asthma Ever
1
Emphysema Ever
0
Cystic Fib Ever
0
Disease History - Digestive & GI10
Lc Ever
0
Uc Ever
0
Ibs Ever
0
Gerd Ever
0
Crohn Ever
0
Fatty Ever
0
Celiac Ever
0
Gastro Ever
0
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
1
Bones Ever
0
Disease History - Skin4
Ps Ever
0
Skin Ever
1
Eczema Ever
1
Rosacea Ever
0
Disease History - Kidney & Liver5
Hemo Ever
0
Liver Ever
0
Acute Fail Ever
0
Chronic Fail Ever
1
Kidney Stones Ever
0
Disease History - Other Conditions7
Ch Ever
0
Hm Ever
0
Hiv Ever
0
Infec Ever
0
Other Cond Ever
9
Infec Type Other
0
Sleep Apnea Ever
1
Mental Health - Depression & Anxiety22
Mh Ever
0
Dep Ever
0
Minor Dep Ever
0
Mh 5 Eating Prob
1
Anxiety Dis Ever
0
Mh 5 Too Restless
3
Mh 3 Sleeping Prob
2
Mh 4 Feeling Tired
1
Mh 6 Easily Annoyed
0
Mh 6 Self Conf Prob
0
Mh 7 Feeling Afraid
0
Mh 8 Impact Anxious
1
Mh 8 Slow Fast Prob
0
Mh 1 Feeling Nervous
1
Mh 1 Little Interest
0
Mh 4 Trouble Relaxing
1
Mh 7 Concentrate Prob
0
Mh 2 Constant Worrying
0
Mh 2 Feeling Depressed
0
Mh 9 Suicidal Thoughts
0
Mh 10 Impact Depressive
1
Mh 3 Excessive Worrying
1
Mental Health - Other Conditions6
Ocd Ever
0
Ptsd Ever
0
Eating Dis Ever
0
Bipolar Dis Ever
0
Schizophrenia Ever
0
Addiction Disorder Ever
0
Sleep - Duration & Quality7
Sleep Hr
7.5
Awake Time
12:00:00
Sleep Time
2:00:00
Bed Partner
0
Sleep Quality
3
Enthusiam Prob
1
Fall Asleep Time
30
Sleep - Trouble & Disturbances11
Trouble A
1
Trouble B
2
Trouble C
3
Trouble D
1
Trouble E
1
Trouble F
1
Trouble G
2
Trouble H
0
Trouble I
3
Trouble J
0
Trouble Awake Freq
0
Sleep - Medication & Treatment1
Med
3
Physical Activity8
Mod Freq
5
Mod Time
105
Vig Freq
1
Vig Time
60
Walk Freq
7
Walk Time
240
Sit Time Wkday
300
Sit Time Wkend
300
Physical Measurements3
Height Ft
5
Height In
1
Weight Lb
138
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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