HLQ Data: CMMI_HA_025

Participant Information

CMMI ID:
CMMI_HA_025

Study ID:
MMS000208

Questionnaire Date:

Upload:
Manual Import

Age:
81

Sex:
Female

Lives Alone:
No

General Health:
Good

Takes Supplements:
No

Demographics & Household7
Sex
2
Age Calc
81
Child Hh
0
Other Hh
0
Live Alone
0
Partner Hh
1
Multi Child Hh
0
Pets7
Pets Hh
1
Pets Type Cat
0
Pets Type Dog
1
Pets Type Other
0
Pets Type Cat Num
0
Pets Type Dog Num
1
Pets Type Other Num
0
General Health & Supplements7
Amemia
0
Gluten
2
Behav Chg
0
Gen Health
3
Food Allergies
1
Reg Supplement
0
Food Allergies Sp
SHELLFISH
Bowel Habits & Digestion17
Bowel 1
0
Bowel 2
0
Bowel 3
1
Bowel 4
0
Bowel 6
0
Bowel 7
1
Bowel 8
0
Bowel 9
2
Stool 1
0
Stool 2
0
Stool 3
0
Stool 4
1
Stool 5
1
Stool 6
0
Bloating
1
Laxatives
0
Constipation Symp 6 Mo
0
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 Medications16
Med 1
BISOPROLOL
Med 2
CANDESARTAN
Med 3
DEXILANT
Med 4
DICLOFENAC / MISOPROLOL
Med 5
METFORMIN
Med 6
PAROXETINE
Med 7
ROSUVASTATIN
Med Num
7
Med Type 1
HYPERTENSION
Med Type 2
HYPERTENSION
Med Type 3
GERD
Med Type 4
NSAID
Med Type 5
ANTIDIABETIC
Med Type 6
ANTI-DEPRESSANT
Med Type 7
STATIN ( CHOLESTEROL)
Med Current
1
Disease History - Cardiovascular11
Hf Ever
0
Mi Ever
0
Chd Ever
0
Hbp Ever
1
Vhd Ever
0
Angina Ever
0
Atrial Ever
0
Cardio Ever
1
Thrombo Ever
0
High Chol Ever
1
Arrhythmia Ever
1
Disease History - Diabetes4
Diab Ever
1
Diab Gest
0
Diab Type1
0
Diab Type2
1
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
0
Ibs Ever
0
Gerd Ever
0
Crohn Ever
0
Fatty Ever
1
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 & Inflammatory12
Sle Ever
0
Arthritis Ever
1
Fibromyal Ever
0
Scleroderma Ever
0
Weak Immune Ever
0
Arthritis Oa Ever
0
Arthritis Ra Ever
0
Arthritis Type Otsp
ANKYLOSING SPONDYLITIS
Arthritis Other Ever
1
Sjogren Syndrome Ever
0
Hashimoto Thyroid Ever
0
Ankylosing Spondylitis Ever
0
Disease History - Bone & Muscle3
Op Ever
0
Rd Ever
0
Bones Ever
1
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
1
Hiv Ever
0
Infec Ever
0
Other Cond Ever
9
Infec Type Other
0
Sleep Apnea Ever
0
Mental Health - Depression & Anxiety21
Mh Ever
1
Dep Ever
0
Minor Dep Ever
0
Mh 5 Eating Prob
0
Anxiety Dis Ever
1
Mh 5 Too Restless
0
Mh 3 Sleeping Prob
1
Mh 4 Feeling Tired
0
Mh 6 Easily Annoyed
0
Mh 6 Self Conf Prob
0
Mh 7 Feeling Afraid
0
Mh 8 Slow Fast Prob
0
Mh 1 Feeling Nervous
0
Mh 1 Little Interest
0
Mh 4 Trouble Relaxing
0
Mh 7 Concentrate Prob
0
Mh 2 Constant Worrying
0
Mh 2 Feeling Depressed
0
Mh 9 Suicidal Thoughts
0
Mh 10 Impact Depressive
0
Mh 3 Excessive Worrying
0
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 & Quality12
Sleep Hr
7
Awake Time
8:30:00
Sleep Time
23:30:24
Bed Partner
3
Sleep Behav A
2
Sleep Behav B
0
Sleep Behav C
3
Sleep Behav D
0
Sleep Behav E
2
Sleep Quality
3
Enthusiam Prob
1
Fall Asleep Time
10
Sleep - Trouble & Disturbances11
Trouble A
0
Trouble B
3
Trouble C
3
Trouble D
0
Trouble E
2
Trouble F
0
Trouble G
1
Trouble H
2
Trouble I
0
Trouble J
0
Trouble Awake Freq
0
Sleep - Medication & Treatment1
Med
0
Physical Activity6
Mod Freq
0
Vig Freq
0
Walk Freq
7
Walk Time
45
Sit Time Wkday
300
Sit Time Wkend
300
Physical Measurements3
Height Ft
5
Height In
1
Weight Lb
115
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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