Variable / Field Name,Form Name,Section Header,Field Type,Field Label,"Choices, Calculations, OR Slider Labels"
participant_id,cam_care_pd_questionnaire,,text,,
consent,cam_care_pd_questionnaire,,yesno,"""I have read the participant information sheet and I do not have any questions about participation. I voluntarily consent to participate in this study. I understand that future questions I may have about the research or about my rights as a participant will be answered by study staff at 425-602-3306 or neuroresearch@bastyr.edu.""



Do you consent to participate?



By consenting online, you no longer need to sign and mail in a paper copy of the consent form.  ",
savetillater,cam_care_pd_questionnaire,,descriptive,"TO SAVE YOUR INFORMATION & RETURN AT A LATER TIME:



Scroll to the end of the survey and click on the ""Save Record"" button.  Unsaved data will be lost! ",
whosays,cam_care_pd_questionnaire,,radio,Who is completing this survey? ,"1, 1. Person with Parkinsonism/ Parkinson's disease  (PWP) | 2, 2. Friend/ caregiver, in the presence of PWP (for instance, if motor symptoms make keyboard use difficult, or if PWP is not comfortable on computer.) | 3, 3. Other"
otherhelp,cam_care_pd_questionnaire,,text,Please describe who is completing this form and your relationship to the PWP:,
record_id,cam_care_pd_questionnaire,,text,"Create a PATIENT RECORD ID:

In the box to the RIGHT, please fill in as follows (example: ABCD84):

1st letter of your first name:  A

1st letter of your surname or last name:  B

1st letter of your mother's maiden name:  C

1st letter of your city of birth:  D

Last two digits of your birth year: 84",
firstname,cam_care_pd_questionnaire,,text,First Name,
lastname,cam_care_pd_questionnaire,,text,Last Name,
country,cam_care_pd_questionnaire,,dropdown,Country,"1, United States | 2, Afghanistan | 3, Albania | 4, Algeria | 5, Andorra | 6, Angola | 7, Antigua and Barbuda | 8, Argentina | 9, Armenia | 10, Aruba | 11, Australia | 12, Austria | 13, Azerbaijan | 14, Bahamas | 15, Bahrain | 16, Bangladesh | 17, Barbados | 18, Belarus | 19, Belgium | 20, Belize | 21, Benin | 22, Bhutan | 23, Bolivia | 24, Bosnia and Herzegovina | 25, Botswana | 26, Brazil | 27, Brunei | 28, Bulgaria | 29, Burkina Faso | 30, Burundi | 31, Cabo Verde | 32, Cambodia | 33, Cameroon | 34, Canada | 35, Central African Republic | 36, Chad | 37, Chile | 38, China | 39, Colombia | 40, Comoros | 41, Congo -  Democratic Republic of the | 42, Congo -  Republic of the | 43, Costa Rica | 44, Cote d'Ivoire | 45, Croatia | 46, Cuba | 47, Curacao | 48, Cyprus | 49, Czechia | 50, Denmark | 51, Djibouti | 52, Dominica | 53, Dominican Republic | 54, East Timor | 55, Ecuador | 56, Egypt | 57, El Salvador | 58, Equatorial Guinea | 59, Eritrea | 60, Estonia | 61, Ethiopia | 62, Fiji | 63, Finland | 64, France | 65, Gabon | 66, Gambia | 67, Georgia | 68, Germany | 69, Ghana | 70, Greece | 71, Grenada | 72, Guatemala | 73, Guinea | 74, Guinea-Bissau | 75, Guyana | 76, Haiti | 77, Honduras | 78, Hong Kong | 79, Hungary | 80, Iceland | 81, India | 82, Indonesia | 83, Iran | 84, Iraq | 85, Ireland | 86, Israel | 87, Italy | 88, Jamaica | 89, Japan | 90, Jordan | 91, Kazakhstan | 92, Kenya | 93, Kiribati | 94, Kosovo | 95, Kuwait | 96, Kyrgyzstan | 97, Laos | 98, Latvia | 99, Lebanon | 100, Lesotho | 101, Liberia | 102, Libya | 103, Liechtenstein | 104, Lithuania | 105, Luxembourg | 106, Macau | 107, Macedonia | 108, Madagascar | 109, Malawi | 110, Malaysia | 111, Maldives | 112, Mali | 113, Malta | 114, Marshall Islands | 115, Mauritania | 116, Mauritius | 117, Mexico | 118, Micronesia | 119, Moldova | 120, Monaco | 121, Mongolia | 122, Montenegro | 123, Morocco | 124, Mozambique | 125, Myanmar | 126, Namibia | 127, Nauru | 128, Nepal | 129, Netherlands | 130, New Zealand | 131, Nicaragua | 132, Niger | 133, Nigeria | 134, North Korea | 135, Norway | 136, Oman | 137, Pakistan | 138, Palau | 139, Palestinian Territories | 140, Panama | 141, Papua New Guinea | 142, Paraguay | 143, Peru | 144, Philippines | 145, Poland | 146, Portugal | 147, Qatar | 148, Romania | 149, Russia | 150, Rwanda | 151, Saint Kitts and Nevis | 152, Saint Lucia | 153, Saint Vincent and the Grenadines | 154, Samoa | 155, San Marino | 156, Sao Tome and Principe | 157, Saudi Arabia | 158, Senegal | 159, Serbia | 160, Seychelles | 161, Sierra Leone | 162, Singapore | 163, Sint Maarten | 164, Slovakia | 165, Slovenia | 166, Solomon Islands | 167, Somalia | 168, South Africa | 169, South Korea | 170, South Sudan | 171, Spain | 172, Sri Lanka | 173, Sudan | 174, Suriname | 175, Swaziland | 176, Sweden | 177, Switzerland | 178, Syria | 179, Taiwan | 180, Tajikistan | 181, Tanzania | 182, Thailand | 183, Togo | 184, Tonga | 185, Trinidad and Tobago | 186, Tunisia | 187, Turkey | 188, Turkmenistan | 189, Tuvalu | 190, Uganda | 191, Ukraine | 192, United Arab Emirates | 193, United Kingdom | 194, Uruguay | 195, Uzbekistan | 196, Vanuatu | 197, Vatican | 198, Venezuela | 199, Vietnam | 200, Yemen | 201, Zambia | 202, Zimbabwe"
uk_country,cam_care_pd_questionnaire,,dropdown,Country within the United Kingdom,"1, England | 2, Northern Ireland | 3, Scotland | 4, Wales"
street,cam_care_pd_questionnaire,,text,Street address,
city,cam_care_pd_questionnaire,,text,City,
state_list,cam_care_pd_questionnaire,,dropdown,State or territory,"1, Alabama | 2, Alaska | 3, American Samoa | 4, Arizona | 5, Arkansas | 6, California | 7, Colorado | 8, Connecticut | 9, District of Columbia | 10, Delaware | 11, Florida | 12, Georgia | 13, Guam | 14, Hawaii | 15, Idaho | 16, Illinois | 17, Indiana | 18, Iowa | 19, Kansas | 20, Kentucky | 21, Louisiana | 22, Maine | 23, Maryland | 24, Massachusetts | 25, Michigan | 26, Minnesota | 27, Mississippi | 28, Missouri | 29, Montana | 30, Nebraska | 31, Nevada | 32, New Hampshire | 33, New Jersey | 34, New Mexico | 35, New York | 36, North Carolina | 37, North Marianas Islands | 38, North Dakota | 39, Ohio | 40, Oklahoma | 41, Oregon | 42, Pennsylvania | 43, Puerto Rico | 44, Rhode Island | 45, South Carolina | 46, South Dakota | 47, Tennessee | 48, Texas | 49, Utah | 50, Vermont | 51, Virginia | 52, Virgin Islands | 53, Washington | 54, West Virginia | 55, Wisconsin | 56, Wyoming"
state,cam_care_pd_questionnaire,,text,State,
province_ca,cam_care_pd_questionnaire,,dropdown,Province,"1, Alberta (AB) | 2, British Columbia (BC) | 3, Manitoba (MB) | 4, New Brunswick (NB) | 5, Newfoundland and Labrador (NL) | 6, Northwest Territories (NT) | 7, Nova Scotia (NS) | 8, Nunavut (NU) | 9, Ontario (ON) | 10, Prince Edward Island (PE) | 11, Quebec (QC) | 12, Saskatchewan (SK) | 13, Yukon (YT)"
province_other,cam_care_pd_questionnaire,,text,"State , province, or region",
zip,cam_care_pd_questionnaire,,text,Postal (ZIP) code,
email,cam_care_pd_questionnaire,,text,Email,
phone,cam_care_pd_questionnaire,,text,Phone,
todaydate,cam_care_pd_questionnaire,,text,Today's Date,
dxpd,cam_care_pd_questionnaire,,text,Date of Parkinson's diagnosis?,
firstpdsx,cam_care_pd_questionnaire,,text,"What is the approximate month, day, and year that you first began having motor symptoms related to PD, even before your diagnosis? 

(If you don't know the date, choose the 15th of the month.)",
diagnosis,cam_care_pd_questionnaire,,radio,What is your diagnosis?,"1, Parkinson's disease/ Idiopathic Parkinson's disease (PD) | 2, Parkinsonism | 3, Multiple system atrophy (MSA)/ Shy-Drager syndrome | 4, Progressive supranuclear palsy (PSP) | 5, Corticobasal degeneration (CBD) | 6, Dementia with Lewy bodies (DLB) | 7, Pick's disease | 8, Olivopontocerebellar atrophy (OPCA) | 9, Other"
otherdiagnosis,cam_care_pd_questionnaire,,text,"If other, please describe:",
dxmadeby,cam_care_pd_questionnaire,,radio,Was your diagnosis made by:,"1, Primary care provider / general medicine practitioner | 2, Neurologist, general | 3, Neurologist, movement disorders specialist | 4, Other"
dxmadebyother,cam_care_pd_questionnaire,,notes,"If other, who made your diagnosis?",
dxright,cam_care_pd_questionnaire,,truefalse,I believe my diagnosis is correct / accurate.,
dxwrong,cam_care_pd_questionnaire,,truefalse,I question my diagnosis.,
dx_delay,cam_care_pd_questionnaire,,yesno,Was there a delay in your diagnosis?,
originaldx,cam_care_pd_questionnaire,,text,What were you originally diagnosed with?,
sx_allhead,cam_care_pd_questionnaire,,yesno,"Did people think your symptoms were ""all in your head""?",
progression6mo,cam_care_pd_questionnaire,,dropdown,"Over the past 6 months, would you say your disease has:","1, Improved | 2, Been stable | 3, Worsened"
pd_stage,cam_care_pd_questionnaire,,dropdown,Which stage best represents your disease?,"1, 1-sided symptoms only, minimal disability | 2, Both sides affected, balance is stable | 3, Mild to moderate disability, balance affected | 4, Severe disability, able to walk and stand without help | 5, Confinement to bed or wheelchair unless aided | 6, Don't know"
dopaeffect,cam_care_pd_questionnaire,,radio,Have you had a clear and dramatic beneficial response to dopaminergic therapy?,"1, Yes, during initial treatment with dopamine (e.g., levodopa), my function returned to near-normal or normal. (Mild changes do not qualify) | 0, No | 2, I have never done a therapeutic trial of dopaminergic therapies (e.g., levodopa)."
dopaeffect2,cam_care_pd_questionnaire,,radio,"I can feel my dopaminergic medicines ""kick in"" and/or ""wear off.""","1, True | 0, False | 2, Not applicable / do not take dopamine (e.g., levodopa)"
slow,cam_care_pd_questionnaire,"DISEASE STATUS    The more severe the symptom, move slider right.  If you don't have the symptom, move slider left.",slider,Slowness,Move with ease | Severe
tremor,cam_care_pd_questionnaire,,slider,Tremor,None | Severe & debilitating
balance,cam_care_pd_questionnaire,,slider,Sense of balance,Sturdy & steady | Occasional falls | Lose balance spontaneously
fatigue,cam_care_pd_questionnaire,,slider,Fatigue,None | Severe
sleepy,cam_care_pd_questionnaire,,slider,Daytime Sleepiness,None | Severe
motivation,cam_care_pd_questionnaire,,slider,Motivation & Initiative,"Engaged, active | Withdrawn, detached"
constipation,cam_care_pd_questionnaire,,slider,Constipation (incomplete bowel empyting),Daily bowel movement | require medication | Severe constipation
walk,cam_care_pd_questionnaire,,slider,Walking,"I move freely, with ease | Unable to move"
rising,cam_care_pd_questionnaire,,slider,Rising from seated position,With ease | With effort | Require assistance
dressing,cam_care_pd_questionnaire,,slider,"Dressing, Eating, Grooming",With ease | With effort | Require assistance
freezing,cam_care_pd_questionnaire,,slider,Freezing,"None | Severe, debilitating"
falls,cam_care_pd_questionnaire,,slider,Falling,Never | Occassionally | Daily
handwriting,cam_care_pd_questionnaire,,slider,Handwriting & Typing,With ease | Slow or small | Illegible
drool,cam_care_pd_questionnaire,,slider,Drooling,None | Nightime only | Severe
speech,cam_care_pd_questionnaire,,slider,Speech,Normal | Asked to repeat statements | Not understandable
visual,cam_care_pd_questionnaire,,slider,Visual disturbance,None | Severe
musclepain,cam_care_pd_questionnaire,,slider,"Muscle cramping, pain, or aching",None | Severe
restlesslegs,cam_care_pd_questionnaire,,slider,Restless Legs- Urge to move legs in order to stop unpleasant sensations,None | Severe
rbd,cam_care_pd_questionnaire,,slider,Sleep behavior disorder (e.g. acting out dreams),"None | Vivid dreams | Yelling, kicking, interferes with sleep"
insomnia,cam_care_pd_questionnaire,,slider,Insomnia (inability to sleep),Not a problem | Severe problem
smell,cam_care_pd_questionnaire,,slider,Sense of smell,Excellent | Completely absent
nausea,cam_care_pd_questionnaire,,slider,Nausea,None | Severe
depression,cam_care_pd_questionnaire,,slider,"Depression (feeling sad, blues)",Mentally healthy | Persistent sorrow | Severe
anxiety,cam_care_pd_questionnaire,,slider,Anxiety,None | Severe
withdrawn,cam_care_pd_questionnaire,,slider,Loss of Interest ,"Active, engaged | Severely withdrawn"
dizzy,cam_care_pd_questionnaire,,slider,Dizzy on standing,None | Severe
stoop,cam_care_pd_questionnaire,,slider,Stooped posture,Stand tall | Rounded shoulders | Severely stooped
memory,cam_care_pd_questionnaire,,slider,Memory/ Forgetfulness,Sharp | Occasional forgetfulness | Severe lapses
comprehension,cam_care_pd_questionnaire,,slider,Comprehension,Sharp | Frequent confusion
sexual,cam_care_pd_questionnaire,,slider,"Sexual dysfunction 

(loss of libido, erectile dysfunction, difficulty with orgasm)",Healthy | Severe
urinary,cam_care_pd_questionnaire,,slider,"Urinary symptoms

(dribbling, urgency, incontinence)",None | Incontinent
dyskinesia,cam_care_pd_questionnaire,,slider,"Dyskinesia

(Rocking, writhing, twisting, squirming movements associated with medication)","None | Sometimes, mild | Severe, debilitating"
hallucinations,cam_care_pd_questionnaire,,slider,"Hallucinations or Delusions

(seeing things that aren't there)",None | Mild | Severe
propd,cam_care_pd_questionnaire,,calc,PRO-PD Score,([slow] + [tremor] + [balance] + [fatigue] + [sleepy] + [motivation] + [constipation]  + [walk] + [rising] + [dressing] + [freezing] + [falls] + [handwriting] + [drool] + [speech] + [visual] + [musclepain] + [restlesslegs] + [rbd] + [insomnia] + [smell] + [nausea] + [depression] + [anxiety] + [withdrawn] + [dizzy] + [stoop] + [memory] + [comprehension] + [sexual] + [urinary] + [dyskinesia] + [hallucinations])
medsubs,cam_care_pd_questionnaire,,checkbox,Please mark box if you have taken any of the following consistently over the past 6 months.,"1, Alpha-Lipoic acid | 2, Coconut oil | 3, Vitamin B12 (methylcobalamin, cyanocobalamin) | 4, Vitamin C | 5, Calcium | 6, Vitamin D | 7, CoQ10 | 8, DHEA | 9, Estrogen | 10, Fish Oil | 11, NADH | 12, Gingko biloba | 13, Glutathione, oral | 14, Glutathione, intranasal | 15, Inosine | 16, Iron (Fe) | 17, Lithium, low dose | 18, Marijuana (edible) | 19, Marijuana (inhaled) | 20, Melatonin | 21, Probiotics | 22, Quercetin | 23, Resveratrol | 25, Homocysteine Factors (B6, B12, folic acid, betaine) | 26, Turmeric/ curcumin | 27, 5 methyltetrahydrofolate (5-MTHF) | 28, Multivitamin/ Mineral | 29, N-acetyl cysteine (NAC) | 30, Low dose naltrexone | 31, Mucuna | 32, Fava beans | 34, Dance for PD | 35, Tremble Clefs program | 36, Lee Silverman Voice Treatment | 38, High Dose Thiamine (Vitamin B1), Oral | 39, High Dose Thiamine (Vitamin B1), Intramuscular | 40, Lion's Mane mushroom | 41, Other medicinal mushrooms (reishi, cordyceps, chaga, agaricus, etc.) | 42, Testosterone, Intramuscular | 43, Testosterone, Topical | 44, Zandopa | 45, Mannitol | 46, NAD+ | 47, Intravenous micronutrient therapy (e.g., IV vitamins) | 48, Intramuscular micronutrient therapy (e.g., B12 injections) | 49, Intravenous exosome therapy"
glutathioneoraltype,cam_care_pd_questionnaire,,dropdown,What type of oral glutathione do you take?,"1, Capsules or tablets (e.g., Jarrow brand) | 2, Liposomal glutathione (e.g., Quicksilver brand)"
specialdiet,cam_care_pd_questionnaire,,checkbox,Have you followed any of these diets consistently in the last 6 months? (check all that apply),"9, Anti-inflammatory diet | 1, Calorie restriction | 2, Ketogenic | 12, Paleo diet | 5, Low-carbohydrate | 3, Low-fat | 4, Low-protein | 6, Vegan (no dairy, eggs, or meat) | 7, Vegetarian | 8, Wahls diet | 13, Allergy Avoidance (avoid foods you've been shown to make antibodies to) | 10, No dietary restrictions | 11, Other"
veg_type,cam_care_pd_questionnaire,,dropdown,What type of vegetarianism?,"1, Vegetarian, lacto-ovo (dairy and eggs, no meat) | 2, Vegetarian, ovo (eggs, no dairy or meat)"
otherdiet,cam_care_pd_questionnaire,,text,What diet do you follow? ,
music,cam_care_pd_questionnaire,,checkbox,"Music


Please mark box if you have consistently engaged in the activity over the past 6 months","0, Listen to music | 1, Play an instrument | 2, Singing | 3, Dancing | 4, Writing music | 5, Reading music"
activity,cam_care_pd_questionnaire,,dropdown,On how many of the last seven days did you participate in at least 30 minutes of physical activity?,"0, 0 | 1, 1 | 2, 2 | 3, 3 | 4, 4 | 5, 5 | 6, 6|7,7"
specific_exercise,cam_care_pd_questionnaire,,checkbox,What kind of physical activity? (check all that apply),"1, Swimming | 2, Running | 3, Biking | 4, Hiking | 5, Yoga | 6, Dance | 7, Walking | 8, Climbing | 9, Tai chi | 11, Brian Grant Foundation Powering Forward Boot Camp | 12, Silver Sneakers FLEX Parkinson's Cycling Program | 13, Rock Steady Boxing | 10, Other | 14, The Daily Dose ™ | 15, The Parkinson's Fitness Project ™"
otheract,cam_care_pd_questionnaire,,text,"What ""Other"" activity do you do?",
minofexercise,cam_care_pd_questionnaire,,text,"For how long did you participate? 
(number of minutes per week, total)
",
intensity,cam_care_pd_questionnaire,,radio,"At what intensity level did you engage, on average, while doing the activity? ","5, 1- barely moving | 2, 2 | 6, 3 - increased heart rate, breaking a sweat | 7, 4 | 8, 5- maximum effort"
livefitness,cam_care_pd_questionnaire,,truefalse,"I regularly take live, in-person fitness classes.",
onlinefitness,cam_care_pd_questionnaire,,truefalse,"I regularly take online, virtual fitness classes.",
onlinepdworkout,cam_care_pd_questionnaire,,checkbox,Do you participate in any of the following online workout programs with a PD-specialized physical therapist or fitness professional?? (please select all that apply),"1, PWR! | 2, LSVT | 3, Rogue In Motion | 4, DailyDose | 5, Other"
otheronlinepdworkout,cam_care_pd_questionnaire,,text,Please type the name of the online workout program that you participate in:,
physicaltherapist,cam_care_pd_questionnaire,,truefalse,I regularly see a physical therapist (in person or online).,
sixmonthweight,cam_care_pd_questionnaire,,radio,Please select which of the following describes your weight over the last 6 months:,"1, My weight has remained stable | 2, I've gained weight - intentionally | 3, I've gained weight - unintentionally | 4, I've lost weight - intentionally | 5, I've lost weight - unintentionally"
champs_intro,cam_care_pd_questionnaire,"The next section of questions is from a validated instrument to help us better understand your level of physical activity.

CHAMPS: Community Healthy Activities Model Program for Seniors
Institute for Health & Aging, University of California San Francisco
Stanford Center for Research i Disease Prevention, Stanford University

",descriptive,"This questionnaire is about activities that you may have done in the past 4 weeks.  

The questions that follow are similar to the example shown below.

INSTRUCTIONS
If you DID the activity in the past 4 weeks:</center>
Step #1  -  Check the YES box.

Step #2  -  Think about <u>how many</u> TIMES <u>a week</u> you usually did it, and write your response in the space provided.

Step #3  -  Select the button for how many TOTAL HOURS <u>in a typical week</u> you did the activity.

If you DID NOT do the activity:</center>
* Check the NO box and move to the next question

<u>Here is an example of how Mrs. Jones would answer question #1:</u>  
Mrs. Jones usually visits her friends Maria and Olga <u>twice a week.</u>  She usually spends <u>one</u> hour on Monday with Maria and <u>two</u> hours on Wednesday with Olga.  Therefore, the total hours a week that she visits with friends is <u>3</u> hours a week.",
champs_setup_grp1,cam_care_pd_questionnaire,CHAMPS Activities Questionnaire for Older Adults,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_friends_yn,cam_care_pd_questionnaire,,yesno,1.  Visit with friends or family (other than those you live with) ?,
champs_friends_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_friends_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_center_yn,cam_care_pd_questionnaire,,yesno,2.  Go to the senior center ?,
champs_center_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_center_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_vol_yn,cam_care_pd_questionnaire,,yesno,3.  Do volunteer work ?,
champs_vol_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_vol_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_church_yn,cam_care_pd_questionnaire,,yesno,4.  Attend church or take part in church activities ?,
champs_church_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_church_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_clubs_yn,cam_care_pd_questionnaire,,yesno,5.  Attend other club or group meetings ?,
champs_clubs_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_clubs_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_comp_yn,cam_care_pd_questionnaire,,yesno,6.  Use a computer?,
champs_comp_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_comp_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp2,cam_care_pd_questionnaire,,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_dance_yn,cam_care_pd_questionnaire,,yesno,"7.  Dance (such as square, folk, line, ballroom)(do <u>not</u> count aerobic dance here) ?",
champs_dance_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_dance_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_crafts_yn,cam_care_pd_questionnaire,,yesno,"8.  Do woodworking, needlework, drawing, or other arts or crafts?",
champs_crafts_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_crafts_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_golfequip_yn,cam_care_pd_questionnaire,,yesno,"9.  Play golf, carrying or pulling your equipment (count <u>walking time</u> only)?",
champs_golfequip_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_golfequip_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_golfcart_yn,cam_care_pd_questionnaire,,yesno,"10.  Play golf, riding a cart (count <u>walking time</u> only)?",
champs_golfcart_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_golfcart_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_event_yn,cam_care_pd_questionnaire,,yesno,"11.  Attend a concert, movie, lecture, or sport event ?",
champs_event_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_event_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_games_yn,cam_care_pd_questionnaire,,yesno,"12. Play cards, bingo, or board games with other people ?",
champs_games_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_games_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp3,cam_care_pd_questionnaire,,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_pool_yn,cam_care_pd_questionnaire,,yesno,13. Shoot pool or billiards ?,
champs_pool_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_pool_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_tennis1_yn,cam_care_pd_questionnaire,,yesno,14. Play singles tennis (do <u>not</u> count doubles) ?,
champs_tennis1_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_tennis1_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_tennis2_yn,cam_care_pd_questionnaire,,yesno,15. Play doubles tennis (do <u>not</u> count singles) ?,
champs_tennis2_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_tennis2_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_skate_yn,cam_care_pd_questionnaire,,yesno,"16. Skate (ice, roller, in-line)?",
champs_skate_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_skate_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_music_yn,cam_care_pd_questionnaire,,yesno,17. Play a musical instrument?,
champs_music_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_music_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_read_yn,cam_care_pd_questionnaire,,yesno,18. Read?,
champs_read_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_read_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_house_hvy_yn,cam_care_pd_questionnaire,,yesno,"19. Do heavy work around the house (such as washing windows, cleaning gutters)?",
champs_house_hvy_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_house_hvy_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp4,cam_care_pd_questionnaire,,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_house_lte_yn,cam_care_pd_questionnaire,,yesno,20. Do light work around the house (such as sweeping or vacuuming)?,
champs_house_lte_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_house_lte_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_garden_hvy_yn,cam_care_pd_questionnaire,,yesno,"21. Do heavy gardening (such as spading, raking)?",
champs_garden_hvy_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_garden_hvy_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_garden_lte_yn,cam_care_pd_questionnaire,,yesno,22. Do light gardening (such as watering plants) ?,
champs_garden_lte_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_garden_lte_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_machine_yn,cam_care_pd_questionnaire,,yesno,"23. Work on your car, truck, lawn mower or other machinery?",
champs_machine_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_machine_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_note_tread,cam_care_pd_questionnaire,,descriptive,"<i><center>** Please note: For the following questions about running and walking, include use of a treadmill.</i></center>",
champs_jog_yn,cam_care_pd_questionnaire,,yesno,24.  Jog or run?,
champs_jog_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_jog_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_uphill_yn,cam_care_pd_questionnaire,,yesno,25. Walk uphill or hike uphill (count only uphill part)?,
champs_uphill_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_uphill_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp5,cam_care_pd_questionnaire,,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_brisk_yn,cam_care_pd_questionnaire,,yesno,26. Walk <u>fast or briskly</u> for exercise (do <u>not</u> count walking leisurely or uphill)?,
champs_brisk_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_brisk_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_errands_yn,cam_care_pd_questionnaire,,yesno,27. Walk <u>to do errands</u> (such as to/from a store or to take children to school) (<u>count walk time only</u>)?,
champs_errands_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_errands_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_leisure_yn,cam_care_pd_questionnaire,,yesno,28. Walk <u>leisurely</u> for exercise or pleasure?,
champs_leisure_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_leisure_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_bike_yn,cam_care_pd_questionnaire,,yesno,29. Ride a bicycle or stationary cycle?,
champs_bike_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_bike_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_aero_mach_yn,cam_care_pd_questionnaire,,yesno,"30. Do other aerobic machines such as rowing, or step machines (do <u>not</u> count treadmill or stationary cycle) ?",
champs_aero_mach_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_aero_mach_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_h2oex_yn,cam_care_pd_questionnaire,,yesno,31. Do water exercises (do <u>not</u> count other swimming) ?,
champs_h2oex_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_h2oex_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp6,cam_care_pd_questionnaire,,descriptive,"<i><center>In a typical week during the past 4 weeks, did you...</i></center>",
champs_swim_fst_yn,cam_care_pd_questionnaire,,yesno,32. Swim moderately or fast ?,
champs_swim_fst_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_swim_fst_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_swim_easy_yn,cam_care_pd_questionnaire,,yesno,33. Swim gently ?,
champs_swim_easy_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_swim_easy_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_stretch_yn,cam_care_pd_questionnaire,,yesno,34. Do stretching or flexibility exercises (do <u>not</u> count yoga or Tai-chi) ?,
champs_stretch_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_stretch_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_yoga_yn,cam_care_pd_questionnaire,,yesno,35. Do yoga or Tai-chi ?,
champs_yoga_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_yoga_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_aerobics_yn,cam_care_pd_questionnaire,,yesno,36. Do aerobics or aerobic dancing ?,
champs_aerobics_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_aerobics_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_strength_hvy_yn,cam_care_pd_questionnaire,,yesno,"37. Do moderate to heavy strength training (such as hand-held weights of <u>more than 5 lbs.</u>, weight machines, or push-ups) ?",
champs_strength_hvy_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_strength_hvy_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_setup_grp7,cam_care_pd_questionnaire,,descriptive,"<i>In a typical week during the past 4 weeks, did you...</i>",
champs_strength_lte_yn,cam_care_pd_questionnaire,,yesno,38. Do light strength training (such as hand-held weights of <u> 5 lbs. or less</u>  or elastic bands) ?,
champs_strength_lte_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_strength_lte_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_gen_con_yn,cam_care_pd_questionnaire,,yesno,"39. Do general conditioning exercises, such as light calisthenics or chair exercises (do <u> not</u>  count strength training) ?",
champs_gen_con_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_gen_con_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_ball_yn,cam_care_pd_questionnaire,,yesno,"40. Play basketball, soccer, or racquetball (do <u>not</u> count time on sidelines) ?",
champs_ball_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_ball_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_other_yn,cam_care_pd_questionnaire,,yesno,41. Do other types of physical activity not previously mentioned ?,
champs_other_specify,cam_care_pd_questionnaire,,text,Please specify,
champs_other_freq,cam_care_pd_questionnaire,,text,How many TIMES a week?,
champs_other_total,cam_care_pd_questionnaire,,radio,How many TOTAL <u>hours a week</u> did you usually do it?,"1, Less than 1 hour | 2, 1 - 2-1/2 hours | 3, 3 - 4-1/2 hours | 4, 5 - 6-1/2 hours | 5, 7 - 8-1/2 hours | 6, 9 or more hours"
champs_thanks,cam_care_pd_questionnaire,,descriptive,"THANK YOU FOR COMPLETING THE CHAMPS PHYSICAL ACTIVITY QUESTIONS, PLEASE CONTINUE WITH THE REST OF THE SURVEY BELOW.",
global01,cam_care_pd_questionnaire,This next section is about quality of life. Please respond to each item by marking one answer per question.,radio,"In general, would you say your health is:...","5, Excellent | 4, Very good | 3, Good | 2, Fair | 1, Poor"
global02,cam_care_pd_questionnaire,,radio,"In general, would you say your quality of life is:...","5, Excellent | 4, Very Good | 3, Good | 2, Fair | 1, Poor"
global03,cam_care_pd_questionnaire,,radio,"In general, how would you rate your physical health?...","5, Excellent | 4, Very Good | 3, Good | 2, Fair | 1, Poor"
global04,cam_care_pd_questionnaire,,radio,"In general, how would you rate your mental health, including your mood and your ability to think?...","5, Excellent | 4, Very Good | 3, Good | 2, Fair | 1, Poor"
global05,cam_care_pd_questionnaire,,radio,"In general, how would you rate your satisfaction with your social activities and relationships?...","5, Excellent | 4, Very Good | 3, Good | 2, Fair | 1, Poor"
global09,cam_care_pd_questionnaire,,radio,"In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)...","5, Excellent | 4, Very Good | 3, Good | 2, Fair | 1, Poor"
global06,cam_care_pd_questionnaire,,radio,"To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?...","5, Completely | 4, Mostly | 3, Moderately | 2, A little | 1, Not at all"
global10,cam_care_pd_questionnaire,In the past 7 days....,radio,"How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?...","1, Never | 2, Rarely | 3, Sometimes | 4, Often | 5, Always"
global08,cam_care_pd_questionnaire,,radio,How would you rate your fatigue on average?...,"1, None | 2, Mild | 3, Moderate | 4, Severe | 5, Very Severe"
global07,cam_care_pd_questionnaire,,radio,How would you rate your pain on average?...,"1, 1 No pain | 2, 2 | 3, 3 | 4, 4 | 5, 5 | 6, 6 | 7, 7 | 8, 8 | 9, 9 | 10, 10 Worst imaginable pain"
smokeever,cam_care_pd_questionnaire,Lifetime Tobacco Use,yesno,Have you smoked at least 100 cigarettes in your ENTIRE LIFE?,
smkreg,cam_care_pd_questionnaire,,text,How old were you when you FIRST started to smoke fairly regularly? ,
smknow,cam_care_pd_questionnaire,,dropdown,"Do you NOW smoke cigarettes every day, some days, or not at all?","1, Every day | 2, Some days | 3, Not at all | 4, Don't know"
smkqtno,cam_care_pd_questionnaire,,text,How long has it been since you quit smoking cigarettes? (enter number here and unit of time below),
smkqttp,cam_care_pd_questionnaire,,radio,How long has it been since you quit smoking cigarettes? (Time period),"1, Days | 2, Weeks | 3, Months | 4, Years | 5, Don't know"
cigsda1,cam_care_pd_questionnaire,,text,"On the average, how many cigarettes do you now smoke a day?",
cigsdamo,cam_care_pd_questionnaire,,text,On how many of the PAST 30 DAYS did you smoke a cigarette?,
cigsda2,cam_care_pd_questionnaire,,text,"On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day? ",
cigqtyr,cam_care_pd_questionnaire,,dropdown,"During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?","1, Yes | 2, No | 3, Don't know"
occupation,cam_care_pd_questionnaire,Occupational History,notes,"To the best of your ability, please describe the jobs you have held, the work required during your employment, and any potential environmental exposures encountered as part of your work? 

(If you have answered this question before, only answer this question if your employment history has changed.)",
meals,cam_care_pd_questionnaire,"Diet, Lifestyle & Social Health - Please mark all boxes you consider TRUE or FALSE over the past six months. ",truefalse,I eat most meals at home.,
cook,cam_care_pd_questionnaire,,truefalse,I cook most of my meals.,
preparemeal,cam_care_pd_questionnaire,,truefalse,I routinely prepare meals for others.,
grocery,cam_care_pd_questionnaire,,truefalse,It is difficult to afford groceries.,
affordfood,cam_care_pd_questionnaire,,truefalse,I find it difficult to afford healthy food.,
localfood,cam_care_pd_questionnaire,,truefalse,"I buy food from local farmers (co-op, farmer's markets).",
organic,cam_care_pd_questionnaire,,truefalse,I try to eat organically grown foods when possilbe.,
vegetarian,cam_care_pd_questionnaire,,truefalse,I am a vegetarian.,
beef,cam_care_pd_questionnaire,,truefalse,I avoid beef.,
pork,cam_care_pd_questionnaire,,truefalse,I avoid pork.,
dairy,cam_care_pd_questionnaire,,truefalse,I avoid dairy.,
soda,cam_care_pd_questionnaire,,truefalse,I avoid soda.,
sweetner,cam_care_pd_questionnaire,,truefalse,I avoid artificial sweeteners.,
sugar,cam_care_pd_questionnaire,,truefalse,I avoid sugar.,
colors,cam_care_pd_questionnaire,,truefalse,"I avoid artificial colors, flavors, etc.",
church,cam_care_pd_questionnaire,,truefalse,I go to church.,
pray,cam_care_pd_questionnaire,,truefalse,I pray.,
friends,cam_care_pd_questionnaire,,truefalse,I have lots of friends.,
lonely,cam_care_pd_questionnaire,,truefalse,I am lonely.,
companionship,cam_care_pd_questionnaire,,radio,How often do you feel that you lack companionship?,"1, Hardly ever | 2, Some of the time | 3, Often"
leftout,cam_care_pd_questionnaire,,radio,How often do you feel left out?,"1, Hardly ever | 2, Some of the time | 3, Often"
isolated,cam_care_pd_questionnaire,,radio,How often do you feel isolated from others?,"1, Hardly ever | 2, Some of the time | 3, Often"
oversched,cam_care_pd_questionnaire,,truefalse,I feel over-scheduled.,
guilt,cam_care_pd_questionnaire,,truefalse,I regularly experience feelings of guilt.,
selfesteem,cam_care_pd_questionnaire,,truefalse,I have low self-esteem.,
stigma,cam_care_pd_questionnaire,,checkbox,Do you experience any feelings of discomfort or discrimination due to your Parkinson's disease as a result of the following? (check all that apply),"1, Visible physical symptoms | 2, Progressive loss of functionality | 3, Impaired ability to communicate verbally | 4, Impaired ability to communicate with facial expressions and body language | 5, Others perceiving me as frail or unable to complete tasks | 6, Being a burden on others | 7, Other"
stigma_other,cam_care_pd_questionnaire,,text,"If other, please specify:",
livesupport,cam_care_pd_questionnaire,,truefalse,"I regularly attend a live, in-person support group.",
onlinesupport,cam_care_pd_questionnaire,,truefalse,"I regularly attend an online, virtual support group.",
onlinehappyhour,cam_care_pd_questionnaire,,truefalse,"I regularly attend online, virtual happy hours.",
dailyvideophone,cam_care_pd_questionnaire,,truefalse,I speak with someone on the phone or through video conferencing daily.,
therapy,cam_care_pd_questionnaire,,truefalse,"I regularly see a psychotherapist, counselor, or coach (in person on online).",
therapytype,cam_care_pd_questionnaire,,notes,Please describe the type of therapy / coaching / counseling that you participate in:,
grandchildren,cam_care_pd_questionnaire,,truefalse,I have grandchildren.,
babysit,cam_care_pd_questionnaire,,truefalse,I frequently babysit or spend time with my grandchildren.,
caregiver,cam_care_pd_questionnaire,,yesno,Are you currently the primary caregiver of others (is it your responsibility that their needs are met)?,
caregiver_years,cam_care_pd_questionnaire,,text,How many years have you been a caregiver?,
caregiver_to,cam_care_pd_questionnaire,,checkbox,For whom do you provide care? (please check all that apply),"1, Children | 2, Grandchildren | 3, Partner | 4, Parent | 5, Other"
single_parent,cam_care_pd_questionnaire,,yesno,Are you currently a single parent?,
single_parent_number,cam_care_pd_questionnaire,,text,For how many children are you a single parent?,
calorierestr,cam_care_pd_questionnaire,,truefalse,I practice calorie restriction.,
overweight,cam_care_pd_questionnaire,,truefalse,I am overweight.,
spices,cam_care_pd_questionnaire,,truefalse,I use spices liberally.,
meditate,cam_care_pd_questionnaire,,truefalse,I meditate.,
meditationapp,cam_care_pd_questionnaire,,truefalse,I use an app for meditation and/or relaxation.,
meditationappname,cam_care_pd_questionnaire,,notes,Please type the name of the app(s) that you use for meditation and/or relaxation:,
livemusic,cam_care_pd_questionnaire,,truefalse,I regularly listen to live music.,
recordedmusic,cam_care_pd_questionnaire,,truefalse,I regularly listen to recorded music.,
solomusic,cam_care_pd_questionnaire,,truefalse,I regularly sing or play an instrument by myself.,
othersmusic,cam_care_pd_questionnaire,,truefalse,I regularly sing or play an instrument with others.,
tobacco,cam_care_pd_questionnaire,,truefalse,I smoke tobacco.,
cannabis,cam_care_pd_questionnaire,,truefalse,"I use marijunana.  

(You may skip this question if you don't feel comfortable answering.)",
stress,cam_care_pd_questionnaire,,truefalse,I have a lot of stress.,
dirtyd,cam_care_pd_questionnaire,,truefalse,I can name 6 foods on the dirty dozen.,
stressmang,cam_care_pd_questionnaire,,truefalse,I practice stress management.,
amalgam,cam_care_pd_questionnaire,,truefalse,I have amalgam (silver) fillings.,
gold,cam_care_pd_questionnaire,,truefalse,I have gold crowns.,
root,cam_care_pd_questionnaire,,truefalse,I have had root canals.,
veteran,cam_care_pd_questionnaire,,truefalse,I am a veteran,
yearsservice,cam_care_pd_questionnaire,,text,How many years were you in the service?,
servicebranch,cam_care_pd_questionnaire,,checkbox,In which armed service did your serve?,"1, Air Force |2, Army |3, Coast Guard |4, Marines |5, Navy"
combat,cam_care_pd_questionnaire,,yesno,Were you in combat?,
combat_intensity,cam_care_pd_questionnaire,,radio,"In combat, would you consider your involvement: ","1, Mild |2, Moderate|3, Intense"
camplejeune,cam_care_pd_questionnaire,,yesno,Did you spend time at Camp Lejeune? ,
timeatlejeune,cam_care_pd_questionnaire,,radio,How much time did you spend at Camp Lejeune?,"1, Less than 1 month | 2, 1-3 months | 3, 3 months- 1 year | 4, More than 1 year"
agentorange,cam_care_pd_questionnaire,,radio,Were you exposed to Agent Orange?,"1, Yes |2, No |3, I don't know"
agentorangeintensity,cam_care_pd_questionnaire,,radio,"If you were exposed to Agent Orange, would you consider your exposure to be: ","1, Mild |2, Moderate|3, Severe"
pets,cam_care_pd_questionnaire,,truefalse,I have pets.,
petstype,cam_care_pd_questionnaire,,checkbox,What type of pet(s) do you have?,"1, Dog | 2, Cat | 3, Other"
support,cam_care_pd_questionnaire,,truefalse,I am in a support group.,
book,cam_care_pd_questionnaire,,truefalse,I read a fictional book.,
education,cam_care_pd_questionnaire,,truefalse,I read an educational book.,
selfcare,cam_care_pd_questionnaire,,truefalse,I find it difficult to care for myself.,
dbs,cam_care_pd_questionnaire,,truefalse,I have had deep brain stimulation surgery (DBS).,
fallingasleep,cam_care_pd_questionnaire,,truefalse,I have difficulty falling asleep.,
stayingasleep,cam_care_pd_questionnaire,,truefalse,I have difficulty staying asleep.,
hourssleep,cam_care_pd_questionnaire,,dropdown,"Over the past month, estimate the average number of hours you sleep per night:","0, Less than 1 hour or no sleep | 1, 1 hour | 2, 2 hours | 3, 3 hours | 4, 4 hours | 5, 5 hours | 6, 6 hours | 7, 7 hours | 8, 8 hours | 9, 9 hours | 10, 10 hours | 11, 11 hours | 12, 12 hours | 13, 13 hours | 14, 14 hours | 15, 15 or more hours"
wakerested,cam_care_pd_questionnaire,,slider,"Over the past month, what percentage of the time do you wake feeling rested? (Please click and drag the slider bar.)",0% | 50% | 100%
rbd1q,cam_care_pd_questionnaire,,yesno,"Have you ever been told, or suspected yourself, that you seem to 'act out your dreams' while asleep (for example, punching, flailing your arms in the air, making running movements, etc.)?",
unfilteredtap,cam_care_pd_questionnaire,,truefalse,I drink mostly unfiltered tap water.,
filteredtap,cam_care_pd_questionnaire,,truefalse,I drink mostly filtered tap water.,
plasticbottledwater,cam_care_pd_questionnaire,,truefalse,I drink mostly plastic bottled water.,
glassbottledwater,cam_care_pd_questionnaire,,truefalse,I drink mostly glass bottled water.,
cannedwater,cam_care_pd_questionnaire,,truefalse,"I drink mostly canned water (e.g., flavored fizzy water).",
mineralwater,cam_care_pd_questionnaire,,truefalse,I drink mostly mineral water.,
pastweekwater,cam_care_pd_questionnaire,,radio,"Over the past week, on average, how many ounces of water (excluding tea, soda, juice) did you drink daily? One cup or glass of water is about 8 oz. Please refer to this image to help you with this calculation.
<img src=""https://8oztoml.com/wp-content/uploads/2019/09/8-oz-to-cups.jpg"" alt=""image load error"">","0, Less than 16 oz total per day (less than 2 cups) | 1, Between 16 - 32 oz total per day (2 - 4 cups) | 2, Between 32 - 48 oz total per day (4 - 6 cups) | 3, Between 48 - 64 oz total per day (6 - 8 cups) | 4, Between 64 - 80 oz total per day (8 - 10 cups) | 5, Between 80 - 96 oz total per day (10 - 12 cups) | 6, Between 96 - 112 oz total per day (12 - 14 cups) | 7, Between 112 - 128 oz total per day (14 - 16 cups) | 8, Over 128 oz total per day (more than 16 cups)"
patientbirthdate,cam_care_pd_questionnaire,PERSONAL INFORMATION,text,Your date of birth:,
gender,cam_care_pd_questionnaire,,radio,Gender,"1, Male | 2, Female | 3, Non-binary"
patientzip,cam_care_pd_questionnaire,,text,Zip Code,
wgt,cam_care_pd_questionnaire,,text,Weight (lbs),
hgt,cam_care_pd_questionnaire,,text,Height (inches),
marital,cam_care_pd_questionnaire,,radio,What is your current marital or partnership status?,"1, Married | 2, Divorced | 3, Single | 4, Domestic partnership | 5, Other"
race_ethnicity,cam_care_pd_questionnaire,,radio,Race / Ethnicity:,"1, Caucasian | 2, Black | 3, Hispanic | 4, Native American | 5, Asian / Pacific Islander | 6, Other"
hair_color,cam_care_pd_questionnaire,,radio,What is your natural hair color?,"0, Black | 1, Blond | 2, Brown | 3, Red | 4, Other"
costcam,cam_care_pd_questionnaire,The COST of Health: Please estimate your monthly out-of-pocket expenses for the following:,text,"Complementary & alternative therapies (CAM)

(supplements, vitamins, etc.)",
costconventional,cam_care_pd_questionnaire,,text,"Conventional therapies 

(co-pays, uncovered prescriptions, etc.)",
costactivity,cam_care_pd_questionnaire,,text,"Activity costs 

(gym, classes, memberships, etc.)",
highestedu,cam_care_pd_questionnaire,DEMOGRAPHICS  ,radio,"Highest grade level completed:

","1, Less than 8th grade | 2, Grades 9-11 | 3, Completed High School/GED | 4, Technical school certification | 5, Associate Degree | 6, Bachelors Degree | 7, Graduate / Professional degree"
income,cam_care_pd_questionnaire,,radio,What is your family's income in past 12 months? (Select all that apply.),"1, Less than $20,000 | 2, Between $20-40,000 | 3, Between $40-60,000 | 4, Between $60-80,000 | 5, Between $80-100,000 | 6, Between $100-150,000 | 7, More than $150,000"
working,cam_care_pd_questionnaire, ,yesno,Are you still working?,
working_hours,cam_care_pd_questionnaire,,text,How many hours per week do you work?,
working_not,cam_care_pd_questionnaire,,text,What were the circumstances in which you left your job?,
highway,cam_care_pd_questionnaire,ENVIRONMENTAL HISTORY,text,"How many miles is your home from the

nearest highway?

",
ag,cam_care_pd_questionnaire,,text,"How many miles is your home from the

nearest agricultural area?

",
wellwater,cam_care_pd_questionnaire,,yesno,"Have you ever lived somewhere where you were on a well? (drank well water) 
",
welldrink,cam_care_pd_questionnaire,,yesno,Was the water from the well filtered before drinking and cooking with it? ,
wellshower,cam_care_pd_questionnaire,,yesno,Was the well water used for showering and bathing filtered before use? ,
wellyears,cam_care_pd_questionnaire,,text,For how many years did you live on well water?,
medi_1,cam_care_pd_questionnaire,"
14-Item Questionnaire of Mediterranean Diet Adherence

",yesno,Do you use olive oil as a main culinary fat?,
medi_2,cam_care_pd_questionnaire,,yesno,"Do you consume more than 4 tablespoons of olive oil in a given day (including oil used for frying, salads, out-of-house meals, etc.)?",
medi_3,cam_care_pd_questionnaire,,yesno,"Do you consume more than 2 vegetable servings per day, with at least one of the portions raw or as a salad? (1 serving= 200 g; side dishes should be considered 1/2 a serving)",
medi_4,cam_care_pd_questionnaire,,yesno,Do you consume 3 or more fruit units (including nautral fruit juices) per day?,
medi_5,cam_care_pd_questionnaire,,yesno,"Do you consume less than 1 serving per day of red meat, hamburger, or meat products (ham, sausage, etc.)? (1 serving: 100-150 g)",
medi_6,cam_care_pd_questionnaire,,yesno,"Do you consume less than 1 serving per day of butter, margarine, or cream? (1 serving=12 g)",
medi_7,cam_care_pd_questionnaire,,yesno,Do you consume less than 1 sweet or carbonated beverage drink per day? ,
medi_8,cam_care_pd_questionnaire,,yesno,Do you drink 7 or more glasses of wine per week? ,
medi_9,cam_care_pd_questionnaire,,yesno,Do you consume 3 or more servings of legumes per week? (1 serving =150 g),
medi_10,cam_care_pd_questionnaire,,yesno,Do you consume 3 or more serrvings of fish or shellfish per week? (1 serving 100-150 g of fish or 4-5 units or 200 g of shellfish),
medi_11,cam_care_pd_questionnaire,,yesno,"Do you consume les sthan 3 servings per week of commercial sweets or pastries (not homemade), such as cakes, cookies, biscuits, or custard?",
medi_12,cam_care_pd_questionnaire,,yesno,Do you consume 3 or more servings of nuts (including peanuts) per week? (1 serving = 30 g),
medi_13,cam_care_pd_questionnaire,,yesno,"Do you preferentially consume chicken, turkey, or rabbit meat instead of veal, pork, hamburger, or sausage?",
medi_14,cam_care_pd_questionnaire,,yesno,"Do you consume vegetables, pasta, rice, or other dishes seasoned with sofrito (sauce made with tomato and onion, leek, or garlic and simmered with olive oil) at least 2 times per week? ",
mind_green,cam_care_pd_questionnaire,"
MIND Dietary Assessment

",radio,"How often do you consume green leafy vegetables? (kale, collards, greens, spinach, lettuce)","1, 2 or fewer servings per week |2, 3-5 servings per week | 3, 6 or more servings per week"
mind_veg,cam_care_pd_questionnaire,,radio,"How often do you consume other vegetabels? (green/red peppers, squash, cooked carrots, raw carrots, broccoli, celery, potatoes, peas or lima beans, potatoes, tomatoes, tomato sauce, string beans, beets, corn, zucchini/summer squash/eggplant, coleslaw, potato salad)","1, 4 or fewer servings per week | 2, 4-6 servings per week | 3, 1 or more servings per day"
mind_berries,cam_care_pd_questionnaire,,radio,How often do you consume berries? (strawberries),"1, Less than 1 serving per week  | 2, 1 serving per week | 3, 2 or more servings per week"
mind_nuts,cam_care_pd_questionnaire,,radio,How often do you consume nuts?,"1, Less than once a month | 2, 1x/month to 4x/week | 3, 5 or more times per week"
mind_olive,cam_care_pd_questionnaire,,radio,How often do you consume olive oil?,"0, Not a primary oil | 1, It is the primary oil that I use"
mind_butter,cam_care_pd_questionnaire,,radio,How often do you consume butter or margarine?,"1, More than 2 tablespoons per day | 2, 1-2 tablespoons per day | 3, Less than 1 tablespoon per day"
mind_cheese,cam_care_pd_questionnaire,,radio,How often do you consume cheese?,"1, 7 or more servings per week | 2, 1-6 servings per week | 3, Less than 1 serving per week"
mind_grain,cam_care_pd_questionnaire,,radio,How often do you consume whole grains?,"1, Less than 1 serving per day | 2, 1-2 servings per day | 3, 3 or more servings per week"
mind_fish,cam_care_pd_questionnaire,,radio,"How often do you consume non-fried fish? (tuna sandwich, fresh fish as main dish; not fried fish cakes, sticks, or sandwiches)","1, Rarely | 2, 1-3 meals per month | 3, 1 or more meals per week"
mind_beans,cam_care_pd_questionnaire,,radio,"How often do you consume beans? (beans, lentils, soybeans)","1, Less than 1 meal per week | 2, 1-3 meals per week | 3, 4 or more meals per week"
mind_poultry,cam_care_pd_questionnaire,,radio," How often do you consume non-fried poultry? (chicken or turkey sandwich, chicken or turkey as main dish and never eat fried at home or away from home)","1, Less than 1 meal per week  | 2, 1 meal per week | 3, 2 or more meals per week"
mind_red,cam_care_pd_questionnaire,,radio,"How often do you consume red meat and related products? (cheeseburger, hamburger, beef tacos/burritos, hot dogs/sausages, roast beef or ham sandwich, salami, bologna, or other deli meat sandwich, beef (steak, roast) or lamb as main dish, pork or ham as main dish, meatballs or meatloaf)","1, 7 or more meals per week | 2, 4-6 meals per week | 3, 3 or fewer meals per week"
mind_fried,cam_care_pd_questionnaire,,radio,"How often do you consume fast fried food? (How often do you eat fried food away from home (like French fries, chicken nuggets)","1, 4 or more times per week | 2, 1-3 times per week | 3, Less than 1 time per week"
mind_pastries,cam_care_pd_questionnaire,,radio,"How often do you consume pastries and sweets? (biscuit/roll, poptarts, cake, snack cakes/twinkies, Danish/sweetrolls/pastry, donuts, cookies, brownies, pie, candy bars, other candy, ice cream, pudding, milkshakes/frappes)","1, 7 or more times per week | 2, 5-6 times per week | 3, 4 or fewer times per week"
mind_wine,cam_care_pd_questionnaire,,radio,How often do you consume wine?,"0, Never | 1, 1 glass per month - 6 glasses per week | 2, 1 glass per day | 3, More than 1 glass per day"
chickenfreq,cam_care_pd_questionnaire,Food Frequency Questionnaire -     Please answer the following to the best of your knowledge regarding the frequency that you consume these foods. Estimate your average intake over the past 6 months.,radio,"Chicken 
Serving size: 1 large or two small pieces (4 oz)","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
turkey,cam_care_pd_questionnaire,,radio,"Turkey
Serving size: 1 large or two small pieces (4 oz)","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
beeffreq,cam_care_pd_questionnaire,,radio,Beef - 4 ounces or 1 medium patty,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
portfreq,cam_care_pd_questionnaire,,radio,Pork - 4 ounces or 1 medium patty,"1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
fvegfreq,cam_care_pd_questionnaire,,radio,Fresh Vegetables  - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
cvegfreq,cam_care_pd_questionnaire,,radio,Canned Vegetables - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
frvegfreq,cam_care_pd_questionnaire,,radio,Frozen Vegetables - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
ffruitfreq,cam_care_pd_questionnaire,,radio,"Fresh Fruit - 1 medium, 1/2 cup","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
cfruitfreq,cam_care_pd_questionnaire,,radio,Canned Fruit - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
frfruitfreq,cam_care_pd_questionnaire,,radio,Frozen Fruit - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
organicveg,cam_care_pd_questionnaire,,text,What percentage of the time do you buy organic fruits and vegetables? ,
cheesefreq,cam_care_pd_questionnaire,,radio,"Cheese - 1 slice, 1/2 oz., 1 Tbsp","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
milkfreq,cam_care_pd_questionnaire,,radio,"Milk - 1 cup (from cows, do not include non-dairy milks)","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
creamfreq,cam_care_pd_questionnaire,,radio,Cream - 1/4 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
icecrfrq,cam_care_pd_questionnaire,,radio,"Ice Cream - 1 scoop, ~ 1/2 cup","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
yogurt,cam_care_pd_questionnaire,,radio,Yogurt- 3/4 cup (6 oz) (typical individual container),"1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3 per month | 5, 1 per week | 6, 2-4x per week | 7, 5-6x per week | 8, Once daily | 9, 2-4x per day | 10, 4-6x per day"
buttrfreq,cam_care_pd_questionnaire,,radio,Butter - 1 tsp,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
organicdairy,cam_care_pd_questionnaire,,text,What percentage of the time do you buy organic dairy products?,
beanfreq,cam_care_pd_questionnaire,,radio,Beans - 1/2 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
nutfreq,cam_care_pd_questionnaire,,radio,Nuts and Seeds - 1/4 cup or 2 Tbsp spread (e.g. peanut butter),"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
fishfreq,cam_care_pd_questionnaire,,radio,Fish (non-fried) - 4 ounces,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
farmraised,cam_care_pd_questionnaire,,text,What percentage of the time do you buy farm-raised fish? ,
friedfreq,cam_care_pd_questionnaire,,radio,"Fried foods (fries, chicken, etc) - 4 ounces","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
sodafreq,cam_care_pd_questionnaire,,radio,"Non-diet soda - 12 ounces, 1 can","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
dietsodafreq,cam_care_pd_questionnaire,,radio,"Diet soda - 12 ounces, 1 can","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
spicefreq,cam_care_pd_questionnaire,,radio,"Spices (cinnamon, cloves, etc) - 1/4 teaspoon","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
oatmfreg,cam_care_pd_questionnaire,,radio,Oatmeal - 1 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
eggfreq,cam_care_pd_questionnaire,,radio,Eggs - 1 egg,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
organiceggs,cam_care_pd_questionnaire,,text,What percentage of the time do you buy organic eggs?,
breadfreq,cam_care_pd_questionnaire,,radio,Bread - 1 slice,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
glutenfreebread,cam_care_pd_questionnaire,,truefalse,I only consume gluten-free bread and bread products.,
grains,cam_care_pd_questionnaire,,checkbox,I regularly eat the following grains (please select all that apply):,"1, White rice | 2, Brown rice | 3, Quinoa | 4, Amaranth | 5, Millet | 6, Barley | 7, Teff | 8, Oats | 9, Sorghum | 10, Farro | 11, Buckwheat"
whitericefreq,cam_care_pd_questionnaire,,radio,"White rice 
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
brownricefreq,cam_care_pd_questionnaire,,radio,"Brown rice
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
quinoafreq,cam_care_pd_questionnaire,,radio,"Quinoa
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
amaranthfreq,cam_care_pd_questionnaire,,radio,"Amaranth
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
milletfreq,cam_care_pd_questionnaire,,radio,"Millet
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
barleyfreq,cam_care_pd_questionnaire,,radio,"Barley
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
tefffreq,cam_care_pd_questionnaire,,radio,"Teff
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
oatsfreq,cam_care_pd_questionnaire,,radio,"Oats
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
sorghumfreq,cam_care_pd_questionnaire,,radio,"Sorghum
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
farrofreq,cam_care_pd_questionnaire,,radio,"Farro
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
buckwheatfreq,cam_care_pd_questionnaire,,radio,"Buckwheat
1/2 cup cooked","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
pastafreq,cam_care_pd_questionnaire,,radio,Pasta - 1 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
glutenfree,cam_care_pd_questionnaire,,slider,"What percentage of your bread, pasta and grains are gluten-free?",0% | 50% | 100%
frherbfreq,cam_care_pd_questionnaire,,radio,"Fresh Herbs (Thyme, Basil, etc) - 1 tsp","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
winefreq,cam_care_pd_questionnaire,,radio,"Wine - 1 med glass, 6 oz","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
redwineffq,cam_care_pd_questionnaire,,radio,"Red wine - 1 med glass, 6oz","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
whitewineffq,cam_care_pd_questionnaire,,radio,"White wine - 1 med glass, 6oz","1, Never | 2, < 1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week | 7, Once daily | 8, 2-4x day | 9, 4-6x day"
whitewine,cam_care_pd_questionnaire,,text,What percentage of the time do you drink white wine (or rosé)?,
redwine,cam_care_pd_questionnaire,,text,What percentage of the time do you drink red wine? ,
champagne,cam_care_pd_questionnaire,,text,What percentage of the time do you drink champagne? ,
beerfreq,cam_care_pd_questionnaire,,radio,Beer - 12 ounce can or bottle,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
lager,cam_care_pd_questionnaire,,text,"What percentage of the time do you drink lagers? 
(e.g. Pilsner (Coors, Miller, Bud), Bock, Dunkel, Oktoberfest)
",
ales,cam_care_pd_questionnaire,,text,"What percentage of the time do you drink ales? 
(e.g. Barley wine, Bitter, Brown, India Pale, Pale, Porter, Stout, Wheat)",
caskales,cam_care_pd_questionnaire,,text,"What percentage of the time do you drink cask ales?  (Unfiltered, unpasturized ales)",
liqourfreq,cam_care_pd_questionnaire,,radio,Liquor - 1 oz,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
coffeefreq,cam_care_pd_questionnaire,,radio,"Coffee - 8 oz coffee, 1 shot espresso","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
decaf,cam_care_pd_questionnaire,,truefalse,I only or mostly drink decaf coffee.,
greenteafreq,cam_care_pd_questionnaire,,radio,Green tea -1 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
blackteafreq,cam_care_pd_questionnaire,,radio,Black tea - 1 cup,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
olivefreq,cam_care_pd_questionnaire,,radio,Olive oil - 1 tsp,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
coconutfreq,cam_care_pd_questionnaire,,radio,Coconut oil - 1 tsp,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
safffreq,cam_care_pd_questionnaire,,radio,"Plant-based oils -  1 tsp.

(Safflower, sunflower, canola oil, etc.)","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
soyfreq,cam_care_pd_questionnaire,,radio,"Soy - 3 ounces

(tofu, tempeh, etc.)","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
juicefreq,cam_care_pd_questionnaire,,radio,"Juice -  8 oz., 1 glass","1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
canfreq,cam_care_pd_questionnaire,,radio,Eat food from a can,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
plasticfreq,cam_care_pd_questionnaire,,radio,Drink from plastic bottle,"1, Never | 2, <1 per month | 3, 1 per month | 4, 2-3x month | 5, 1 per week | 6, 2-4x week | 10, 5-6x week |7, Once daily | 8, 2-4x day | 9, 4-6x day"
covid_ref,cam_care_pd_questionnaire,"This next sections of the survey are from the All of Us Research Program and are designed to assess the impact of the COVID-19 pandemic. Please answer each question as honestly as possible. We are looking for your own answers, and not what you think your doctors, family, or friends want you to say. Don't feel like you must spend a long time on each question. The first answer that comes to you is usually the best one. If you aren't sure how to answer a question, choose the best answer from the options given. Some questions also let you say if you don't know an answer or would rather not answer. Some of the questions may be sensitive. You can choose not to answer any question.",descriptive,"Cronin RM, Jerome RN, Mapes B, Andrade R, Johnston R, et al. Development of the Initial Surveys for the All of Us Research Program. Epidemiology. 2019 Jul;30(4):597-608. PMCID: PMC6548672.",
cdc_covid_19_21,cam_care_pd_questionnaire,"COVID-19 Related Social Habits

The next questions ask about your experience with COVID-19 and social habits.",radio,"In the past month, have recommendations for socially distancing caused stress for you?","COPE_A_43, A lot | COPE_A_3, Somewhat | COPE_A_67, A little | COPE_A_168, Not at all"
msds_9,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have stayed home all day.","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_10,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have gone to my workplace or volunteer site that is outside my home.","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_11,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have attended social gatherings outside my home of MORE than 10 people.","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_12,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have attended social gatherings outside my home of LESS than 10 people.","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_13,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have gone on shopping trips or outings that were ""just for fun"".","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_14,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have visited nursing homes or long-term care facilities (outside of work duties).","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day"
msds_15,cam_care_pd_questionnaire,,radio,"Thinking about your current social habits, in the last 5 days:
I have been in close contact with someone who is in a risk group for COVID-19 (adults age 50+, people with chronic medical conditions like heart, lung, liver, or kidney disease, diabetes, high blood pressure, or a suppressed immune system). This includes someone inside or outside of your household.","COPE_A_171, None of the days (0 days) | COPE_A_53, A few days (1-2 days) | COPE_A_127, Most days (3-4 days) | COPE_A_150, Every day | COPE_A_202, I don't know"
msds_16,cam_care_pd_questionnaire,,radio,"Thinking about these activities in the last 5 days, my social interaction with people outside my home was","COPE_A_138, A lot less than normal | COPE_A_78, Somewhat less than normal | COPE_A_146, About the same as normal | COPE_A_64, More than normal | COPE_A_26, A lot more than normal"
msds_18,cam_care_pd_questionnaire,,radio,"Now, thinking about the COVID-19 recommendations and mandates...How often in the past month are you doing the recommended pandemic hygiene, like washing hands frequently, avoiding touching your face, covering coughs, wearing a mask, and avoiding frequently touched surfaces in public places?
","COPE_A_129, All of the time | COPE_A_194, Most of the time | COPE_A_151, Sometimes | COPE_A_41, Rarely"
cdc_covid_19_7_xx22,cam_care_pd_questionnaire,,radio,"In the past month, have you been sick for more than one day with a new illness related to COVID-19 or flu-like symptoms?","COPE_A_44, Yes | COPE_A_13, No"
cdc_covid_19_7_xx22_date,cam_care_pd_questionnaire,,text,Approximate date of onset,
cdc_covid_19_7_xx23,cam_care_pd_questionnaire,,checkbox,Which of the following symptoms did you have? (select all that apply),"COPE_A_54, A fever/feverish | COPE_A_20, Cough | COPE_A_83, Sore or painful throat | COPE_A_40, Runny or stuffy nose | COPE_A_192, Difficulty breathing or shortness of breath | COPE_A_65, Unusual fatigue | COPE_A_49, Unusually strong muscle pains/aches | COPE_A_96, Headache | COPE_A_69, Dizziness or light-headedness | COPE_A_122, Loss of smell or taste | COPE_A_36, Unusual eye soreness or discomfort (e.g., light sensitivity or excessive tears) | COPE_A_183, Unusually hoarse voice | COPE_A_39, Unusual chest pain or tightness in your chest | COPE_A_188, Unusual abdominal pain or stomachache | COPE_A_114, Diarrhea | COPE_A_105, Nausea | COPE_A_185, Skipping meals"
copect_17,cam_care_pd_questionnaire,,radio,"Have you EVER been near someone that you know, or suspect, had COVID-19 (such as co-workers, family members, or others)? Select all that apply.","COPE_A_199, Yes, known COVID-19 | COPE_A_32, Yes, suspected COVID-19 | COPE_A_2, Not that I know of"
copect_40_xx15,cam_care_pd_questionnaire,,radio,Do you think you have had COVID-19?,"COPE_A_44, Yes | COPE_A_13, No | COPE_A_203, Maybe"
cdc_covid_19_9_xx25,cam_care_pd_questionnaire,,radio,Were you tested for COVID-19 in the past month?,"COPE_A_44, Yes | COPE_A_13, No | COPE_A_14, Unknown"
cdc_covid_19_9_xx24,cam_care_pd_questionnaire,,radio,Was the test for COVID-19 positive?,"COPE_A_44, Yes | COPE_A_13, No | COPE_A_14, Unknown | COPE_A_117, Waiting for results"
cdc_covid_19_n_a,cam_care_pd_questionnaire,,checkbox,How were you tested? Select all that apply.,"COPE_A_166, Nasal swab | COPE_A_124, Throat Swab | COPE_A_55, Blood Sample"
cdc_covid_19_9b,cam_care_pd_questionnaire,,radio,Were you tested for influenza (flu) in the past month?,"COPE_A_44, Yes | COPE_A_13, No | COPE_A_14, Unknown"
ies_r_6_1,cam_care_pd_questionnaire,"COVID-19 Related Impact

Please indicate how much you felt each of the following within the last week. Please choose the answer that best applies to your situation within the past 7 days.",radio,"In the past 7 days, I thought about COVID-19 when I didn't mean to.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
ies_r_6_2,cam_care_pd_questionnaire,,radio,"In the past 7 days, I felt watchful or on-guard.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
ies_r_6_3,cam_care_pd_questionnaire,,radio,"In the past 7 days, other things kept making me think about COVID-19.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
ies_r_6_4,cam_care_pd_questionnaire,,radio,"In the past 7 days, I was aware that I still had a lot of feelings about COVID-19, but I didn't deal with them.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
ies_r_6_5,cam_care_pd_questionnaire,,radio,"In the past 7 days, I tried not to think about COVID-19.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
ies_r_6_6,cam_care_pd_questionnaire,,radio,"In the past 7 days, I had trouble concentrating.","COPE_A_168, Not at all | COPE_A_21, A little bit | COPE_A_139, Moderately | COPE_A_72, Quite a bit | COPE_A_93, Extremely"
cdc_covid_19_18,cam_care_pd_questionnaire,,checkbox,"In the past month, how has the COVID-19 outbreak affected you? Please select all that apply.","COPE_A_135, Worked remotely or from home more than you usually do | COPE_A_101, Worked more hours than usual | COPE_A_12, Worked reduced hours | COPE_A_90, Was not able to work due to COVID-19 related illness | COPE_A_71, I became unemployed | COPE_A_92, Had difficulty arranging for childcare | COPE_A_147, Incurred increased costs for childcare expenses | COPE_A_5, Worked with children at home with me | COPE_A_179, Income or pay has been reduced | COPE_A_17, Not paid at all | COPE_A_87, Had serious financial problems"
cdc_covid_19_23,cam_care_pd_questionnaire,,checkbox,"In the past month, have you experienced the following as a result of COVID-19? Select all that apply.","COPE_A_149, Not enough money to pay rent | COPE_A_164, Not enough money to pay for gas | COPE_A_165, Not enough money to pay for food | COPE_A_112, Not enough money to pay for medications | COPE_A_162, Did not have a regular place to sleep or stay"
cdc_covid_19_26,cam_care_pd_questionnaire,,checkbox,"In the past month, have the following behaviors increased in your household? Select all that apply.","COPE_A_27, Interpersonal conflict with family members or loved ones | COPE_A_81, Snapping at or yelling at family members | COPE_A_195, Interpersonal conflict with friends or coworkers"
cdc_covid_19_25,cam_care_pd_questionnaire,,checkbox,"In the past month, to cope with social distancing and isolation, are you doing any of the following? Select all that apply.","COPE_A_82, Taking breaks from watching, reading, or listening to news stories, including social media | COPE_A_115, Increasing watching, reading, or listening to news stories, including social media | COPE_A_157, Taking care of your body, such as taking deep breaths, stretching, or meditating | COPE_A_97, Engaging in healthy behaviors like trying to eat healthy, well-balanced meals, exercising regularly, getting plenty of sleep, or avoiding alcohol and drugs | COPE_A_173, Making time to relax | COPE_A_48, Connecting with others, including talking with people you trust about your concerns and how you are feeling | COPE_A_182, Contacting a healthcare provider | COPE_A_110, Smoking more cigarettes or vaping more | COPE_A_79, Drinking alcohol more than usual | COPE_A_74, Using prescription drugs (like valium, etc.) more than usual | COPE_A_28, Using non-prescription drugs more than usual | COPE_A_1, Using cannabis or marijuana more than usual | COPE_A_118, Eating high fat or sugary foods more than usual | COPE_A_123, Cutting or self-injury more than usual | COPE_A_156, Over exercise | COPE_A_121, Eating more food than usual | COPE_A_178, Eating less food than usual"
lot_r_1,cam_care_pd_questionnaire,"COVID-19:  General Well-Being

We would like to know how you feel about things in general.",radio,"Choose the answer that best describes how you felt in the past month.
In uncertain times, I usually expect the best.","COPE_A_76, I agree a lot | COPE_A_47, I agree a little | COPE_A_80, I neither agree nor disagree | COPE_A_59, I Disagree a little | COPE_A_143, I Disagree a lot"
ukmh_j1,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how you felt in the past month.
In general, how happy are you?","COPE_A_19, Extremely happy | COPE_A_38, Very happy | COPE_A_7, Moderately happy | COPE_A_31, Moderately unhappy | COPE_A_140, Very unhappy | COPE_A_144, Extremely unhappy | COPE_A_202, Don't know | COPE_A_30, Prefer not to answer"
ukmh_j3,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how you felt in the past month.
To what extent do you feel your life to be meaningful?","COPE_A_168, Not at all | COPE_A_67, A little | COPE_A_200, A moderate amount | COPE_A_10, Very much | COPE_A_132, An extreme amount | COPE_A_202, Don't know | COPE_A_30, Prefer not to answer"
basics_xx,cam_care_pd_questionnaire,"COVID-19:  Basic Information

The next questions ask about circumstances that affect your general health.",text,"Not including yourself, how many other people live at home with you? ",
basics_xx20,cam_care_pd_questionnaire,,text,Think of other people who live with you. How many are under the age of 18 years?,
cu_covid,cam_care_pd_questionnaire,,radio,What type of household do you live in?,"COPE_A_205, Studio | COPE_A_206, One-bedroom apartment | COPE_A_207, Two-bedroom apartment | COPE_A_208, Three-bedroom (or more) apartment | COPE_A_209, Townhouse | COPE_A_210, Free-standing house | COPE_A_211, Nursing home, or rehab facility | COPE_A_212, Homeless | CU_COVID_COPE_A_204, Other | COPE_A_30, Prefer not to answer"
cu_covid_cope_a_204,cam_care_pd_questionnaire,,text,Please specify.,
basics_12,cam_care_pd_questionnaire,,checkbox,What is your current employment status? Select all that apply.,"COPE_A_106, Employed for wages (part- time or full-time) | COPE_A_186, Self-employed | COPE_A_153, Out of work for 1 year or more | COPE_A_61, Out of work for less than 1 year | COPE_A_142, A homemaker | COPE_A_50, A student | COPE_A_196, Retired | COPE_A_128, Unable to work (disabled) | COPE_A_30, Prefer not to answer"
basics_11,cam_care_pd_questionnaire,,radio,Are you covered by health insurance or some other kind of health care plan?,"COPE_A_44, Yes | COPE_A_13, No | COPE_A_202, Don't know | COPE_A_30, Prefer not to answer"
basics_11a,cam_care_pd_questionnaire,,checkbox,Are you currently covered by any of the following types of health insurance or health care plans? Select all that apply.,"COPE_A_170, Insurance purchased directly from an insurance company (by you or another family member) | COPE_A_63, Insurance through a current or former employer or union (by you or another family member) | COPE_A_193, Medicare, for people 65 and older or people with certain disabilities | COPE_A_134, Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or disability | COPE_A_109, TRICARE or other military health care | COPE_A_181, Veterans Affairs (VA) (including those who have ever used or enrolled for VA health care) | COPE_A_68, Indian Health Service | COPE_A_33, Any other type of health insurance or health coverage plan | COPE_A_60, I don't have health insurance, self-pay"
basics_11a_cope_a_33,cam_care_pd_questionnaire,,text,Other health insurance or health coverage plan. Please specify.,
copect_54,cam_care_pd_questionnaire,,radio,Are you currently on chemotherapy or immunotherapy?,"COPE_A_44, Yes | COPE_A_13, No"
copect_58,cam_care_pd_questionnaire,,radio,"Do you regularly take immunosuppressant medications (including steroids, methotrexate, biologic agents)?","COPE_A_44, Yes | COPE_A_13, No"
basics_8,cam_care_pd_questionnaire,,radio,What is your current marital status?,"COPE_A_116, Married | COPE_A_133, Divorced | COPE_A_58, Widowed | COPE_A_177, Separated | COPE_A_163, Never married | COPE_A_104, Living with partner | COPE_A_30, Prefer not to answer"
overallhealth_14b,cam_care_pd_questionnaire,,radio,Are you currently pregnant?,"COPE_A_13, No | COPE_A_44, Yes | COPE_A_52, Not sure | COPE_A_30, Prefer not to answer"
mos_ss_1,cam_care_pd_questionnaire,"COVID-19:  Social Support

People sometimes look to others for friendship and help. We want to know how social support affects your health. Each of the following statements describes a type of social support. ",radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to help you if you were confined to bed","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_2,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to take you to the doctor if you needed it","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_3,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to prepare your meals if you were unable to do it yourself","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_4,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to help with daily chores if you were sick","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_5,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to have a good time with","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_6,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to turn to for suggestions about how to deal with a personal problem","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_7,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone who understands your problems","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_8,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to love and make you feel wanted","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_13,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to confide in or talk to about yourself or your problems","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
mos_ss_17,cam_care_pd_questionnaire,,radio,"Choose the answer that best describes how often you can find this kind of support in the past month.
Someone to do things with to help you get your mind off things","COPE_A_99, None of the time | COPE_A_95, A little of the time | COPE_A_158, Some of the time | COPE_A_102, Most of the time | COPE_A_129, All of the time"
cpss_1,cam_care_pd_questionnaire,"COVID-19: Stress

The next 10 questions ask how often you felt stress in the last month. This includes stress about events that you did not expect or could not predict or control, and how much you worry about your life. Your answers will help us understand how often stress impacts daily life.",radio,"In the last month, how often have you been upset because of something that happened unexpectedly?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_2,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt that you were unable to control the important things in your life?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_3,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt nervous and ""stressed""?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_4,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt confident about your ability to handle your personal problems?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_5,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt that things were going your way?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_6,cam_care_pd_questionnaire,,radio,"In the last month, how often have you found that you could not cope with all the things that you had to do?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_7,cam_care_pd_questionnaire,,radio,"In the last month, how often have you been able to control irritations in your life?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_8,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt that you were on top of things?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_9,cam_care_pd_questionnaire,,radio,"In the last month, how often have you been angered because of things that were outside of your control?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
cpss_10,cam_care_pd_questionnaire,,radio,"In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?","COPE_A_120, Never | COPE_A_154, Almost never | COPE_A_151, Sometimes | COPE_A_42, Fairly often | COPE_A_86, Very often"
ucla_ls8_2,cam_care_pd_questionnaire,"COVID-19: Loneliness

The next questions ask about your relationships with others.",radio,"Choose the answer that is true for you in the past month.
I lack companionship","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_3,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
There is no one I can turn to","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_9,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
I am an outgoing person","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_11,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
I feel left out","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_14,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
I feel isolated from others","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_15,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
I can find companionship when I want it","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_17,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
I am unhappy being so withdrawn","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
ucla_ls8_18,cam_care_pd_questionnaire,,radio,"Choose the answer that is true for you in the past month.
People are around me but not with me","COPE_A_120, Never | COPE_A_41, Rarely | COPE_A_151, Sometimes | COPE_A_148, Often"
brcs_1,cam_care_pd_questionnaire,"COVID-19: Resilience

The next four questions ask about your behavior and actions in the past month.",radio,"Please select the response that best reflects your behavior in the past month.
I look for creative ways to alter difficult situations.","COPE_A_15, Does not describe me at all | COPE_A_35, Does not describe me | COPE_A_176, Neutral | COPE_A_70, Describes me | COPE_A_88, Describes me very well"
brcs_2,cam_care_pd_questionnaire,,radio,"Please select the response that best reflects your behavior in the past month.
Regardless of what happens to me, I believe I can control my reaction to it.","COPE_A_15, Does not describe me at all | COPE_A_35, Does not describe me | COPE_A_176, Neutral | COPE_A_70, Describes me | COPE_A_88, Describes me very well"
brcs_3,cam_care_pd_questionnaire,,radio,"Please select the response that best reflects your behavior in the past month.
I believe I can grow in positive ways by dealing with difficult situations.","COPE_A_15, Does not describe me at all | COPE_A_35, Does not describe me | COPE_A_176, Neutral | COPE_A_70, Describes me | COPE_A_88, Describes me very well"
brcs_4,cam_care_pd_questionnaire,,radio,"Please select the response that best reflects your behavior in the past month.
I actively look for ways to replace the losses I encounter in life.","COPE_A_15, Does not describe me at all | COPE_A_35, Does not describe me | COPE_A_176, Neutral | COPE_A_70, Describes me | COPE_A_88, Describes me very well"
eds_1,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
You are treated with less courtesy than other people are.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_2,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
You are treated with less respect than other people are.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_3,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
You receive poorer service than other people at restaurants or stores.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_4,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
People act as if they think you are not smart.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_5,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
People act as if they are afraid of you.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_6,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
People act as if they think you are dishonest.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_7,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
People act as if they're better than you are.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_8,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
You are called names or insulted.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_9,cam_care_pd_questionnaire,,radio,"In your day-to-day life, how often did this happen to you during the past month?
You are threatened or harassed.","COPE_A_113, Almost everyday | COPE_A_62, At least once a week | COPE_A_84, A few times a month | COPE_A_120, Never"
eds_follow_up_1,cam_care_pd_questionnaire,,checkbox,What do you think is the main reason for these experiences? Select all that apply.,"COPE_A_11, Your ancestry or national origins | COPE_A_100, Your gender | COPE_A_98, Your race | COPE_A_8, Your age | COPE_A_190, Your religion | COPE_A_66, Your height | COPE_A_46, Your weight | COPE_A_108, Some other aspect of your physical appearance | COPE_A_45, Your sexual orientation | COPE_A_145, Your education or income level | COPE_A_226, Other"
eds_follow_up_1_xx,cam_care_pd_questionnaire,,text,Other reason - please specify.,
outro_text,cam_care_pd_questionnaire,,descriptive,"This is the end of the COVID-19 section of the survey. Please continue with the final survey sections below. Thank you!

To learn more about COVID-19: <a href=""https://www.cdc.gov"">https://www.cdc.gov</a> and <a href=""https://www.coronavirus.gov/"">https://www.coronavirus.gov/</a>",
gsf_1,cam_care_pd_questionnaire,"
The General Self-Efficacy Scale (GSF) 

",radio,I can always manage to solve difficult problems if I try hard enough.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_2,cam_care_pd_questionnaire,,radio,"If someone opposes me, I can find the means and ways to get what I want.","1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_3,cam_care_pd_questionnaire,,radio,It is easy for me to stick to my aims and accomplish my goals.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_4,cam_care_pd_questionnaire,,radio,I am confident that I could deal efficiently with unexpected events.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_5,cam_care_pd_questionnaire,,radio,"Thanks to my resourcesfulness, I know how to handle unforseen situations.","1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_6,cam_care_pd_questionnaire,,radio,I can solve most problems if I invest the necessary effort.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_7,cam_care_pd_questionnaire,,radio,I can remain calm when facing difficulties becaseu I can rely on my coping abilities.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_8,cam_care_pd_questionnaire,,radio,"When I am confronted with a problem, I can usually find several solutions.","1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_9,cam_care_pd_questionnaire,,radio,"If I am in trouble, I can usually think of a solution.","1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
gsf_10,cam_care_pd_questionnaire,,radio,I can usually handle whatever comes my way.,"1, Not at all true | 2, Hardly true | 3, Moderately true | 4, Exactly true"
aces_1,cam_care_pd_questionnaire,"<div align = ""center"">
Adverse Childhood Experience Questionnaire (this section is optional) 

While you were growing up, during your first 18 years of life:

</div>",yesno,"Did a parent or other adult in the household often or very often... 

Swear at you, insult you, put you down, or humiliate you? 

or Act in a way that made you afraid that you might be physically hurt?",
aces_2,cam_care_pd_questionnaire,,yesno,"Did a parent or other adult in the household often or very often... 

Push, grab, slap, or throw something at you? 

or Ever hit you so hard that you had marks or were injured?",
aces_3,cam_care_pd_questionnaire,,yesno,"Did an adult or person at least 5 years older than you ever... 

Touch or fondle you or have you touch their body in a sexual way?

or Attempt or actually have oral, anal, or vaginal intercourse with you?",
aces_4,cam_care_pd_questionnaire,,yesno,"Did you often or very often feel that ... 

No one in your family loved you or thought you were important or special? 

or Your family didn't look out for each other, feel close to each other, or support each other?",
aces_5,cam_care_pd_questionnaire,,yesno,"Did you often or very often feel that ... 

You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you? 

or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?",
aces_6,cam_care_pd_questionnaire,,yesno,Were your parents ever separated or divorced?,
aces_7,cam_care_pd_questionnaire,,yesno,"Was your mother or stepmother: 

Often or very often pushed, grabbed, slapped, or had something thrown at her? 

or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? 

or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?",
aces_8,cam_care_pd_questionnaire,,yesno,"Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?",
aces_9,cam_care_pd_questionnaire,,yesno,"Was a household member depressed or mentally ill, or did a household member attempt suicide?       ",
aces_10,cam_care_pd_questionnaire,,yesno,Did a household member go to prison?,
aces_score,cam_care_pd_questionnaire,,calc,ACES score,1=1
grit_1,cam_care_pd_questionnaire,"
12-Item Grit Test by Angela Duckworth, PhD

",radio,I have overcome setbacks to conquer an important challeng.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_2,cam_care_pd_questionnaire,,radio,New ideas and projects sometimes distract me from previous ones.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_3,cam_care_pd_questionnaire,,radio,My interests change from year to year,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_4,cam_care_pd_questionnaire,,radio,Setbacks don't discourage me.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_5,cam_care_pd_questionnaire,,radio,I have been obsessed with a certain idea or project for a short time but later lost interest.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_6,cam_care_pd_questionnaire,,radio,I am a hard worker.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_7,cam_care_pd_questionnaire,,radio,I often set a goal but later choose to pursue a different one.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_8,cam_care_pd_questionnaire,,radio,I have difficulty maintaining my focus on project that take more than a few months to complete.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_9,cam_care_pd_questionnaire,,radio,I finish whatever I begin.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_10,cam_care_pd_questionnaire,,radio,I have achielved a goal that took years of work.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_11,cam_care_pd_questionnaire,,radio,I become interested in new pursuits every few months.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_12,cam_care_pd_questionnaire,,radio,I am very diligent.,"1, Very much like me | 2, Mostly like me | 3, Somewhat like me | 4, Not much like me | 5, Not like me at all"
grit_score,cam_care_pd_questionnaire,,calc,Grit score,1=1
pharma,cam_care_pd_questionnaire,MEDICATIONS,checkbox,"Which of the following medications, if any, are you taking?","1, Amantadine (Symmetrel) | 2, Apomorphine (Apokyn) | 3, Benztropine (Cogentin) | 4, Bromocriptine (Parlodel) | 5, Carbidopa, levodopa, and entacapone (Stalevo) | 6, Carbidopa-levodopa (Sinemet)-- Immediate release | 7, Carbidopa-levodopa -- Controlled release | 8, Carbidopa-levodopa -- Extended release | 9, Duodopa | 10, Entacapone (Comtan) | 11, Levodopa-benserazide (Madopar) | 12, Melevodopa (Sirio) | 13, Pramipexole (Mirapex, Mirapex ER, Mirapexin, Sifrol) | 14, Rasagiline (Azilect) | 15, Ropinirole (Adartel, Requip, Requip XL, Ropark) | 16, Rotigotine (Neupro) | 17, Rytary (carbidopa and levodopa) | 18, Selegiline (I-deprenyl, Eldepryl, Zelapar) | 19, Tolcapone (Tasmar) | 20, Trihexyphenidyl (Apo-Trihex, Artane) | 21, Other PD medication"
amantadine_dose,cam_care_pd_questionnaire,Medication Doses and Frequencies,text,Amantadine (Symmetrel) - Dose,
amantadine_freq,cam_care_pd_questionnaire,,text,Amantadine (Symmetrel) - Frequency,
apormorphine_dose,cam_care_pd_questionnaire,,text,Apomorphine (Apokyn) - Dose,
apormorphine_freq,cam_care_pd_questionnaire,,text,Apomorphine (Apokyn) - Frequency,
benztropine_dose,cam_care_pd_questionnaire,,text,Benztropine (Cogentin) - Dose,
benztropine_freq,cam_care_pd_questionnaire,,text,Benztropine (Cogentin) - Frequency,
bromocriptine_dose,cam_care_pd_questionnaire,,text,Bromocriptine (Parlodel) - Dose,
bromocriptine_freq,cam_care_pd_questionnaire,,text,Bromocriptine (Parlodel) - Frequency,
stavelo_dose,cam_care_pd_questionnaire,,text,"Carbidopa, levodopa, and entacapone (Stalevo) - Dose",
stavelo_freq,cam_care_pd_questionnaire,,text,"Carbidopa, levodopa, and entacapone (Stalevo) - Frequency",
sinemet_dose,cam_care_pd_questionnaire,,text,Carbidopa-levodopa (Sinemet)-- Immediate release - Dose,
sinemet_freq,cam_care_pd_questionnaire,,text,Carbidopa-levodopa (Sinemet)-- Immediate release - Frequency,
carbidopa_control_dose,cam_care_pd_questionnaire,,text,Carbidopa-levodopa -- Controlled release - Dose,
carbidopa_control_freq,cam_care_pd_questionnaire,,text,Carbidopa-levodopa -- Controlled release - Frequency,
carbidopa_ext_dose,cam_care_pd_questionnaire,,text,Carbidopa-levodopa -- Extended release - Dose,
carbidopa_ext_freq,cam_care_pd_questionnaire,,text,Carbidopa-levodopa -- Extended release - Frequency,
duodopa_dose,cam_care_pd_questionnaire,,text,Duodopa - Dose,
duodopa_freq,cam_care_pd_questionnaire,,text,Duodopa - Frequency,
entacapone_dose,cam_care_pd_questionnaire,,text,Entacapone (Comtan) - Dose,
entacapone_freq,cam_care_pd_questionnaire,,text,Entacapone (Comtan) - Frequency,
madopar_dose,cam_care_pd_questionnaire,,text,Levodopa-benserazide (Madopar) - Dose,
madopar_freq,cam_care_pd_questionnaire,,text,Levodopa-benserazide (Madopar) - Frequency,
melevodopa_dose,cam_care_pd_questionnaire,,text,Melevodopa (Sirio) - Dose,
melevodopa_freq,cam_care_pd_questionnaire,,text,Melevodopa (Sirio) - Frequency,
pramipexole_dose,cam_care_pd_questionnaire,,text,"Pramipexole (Mirapex, Mirapex ER, Mirapexin, Sifrol) - Dose",
pramipexole_freq,cam_care_pd_questionnaire,,text,"Pramipexole (Mirapex, Mirapex ER, Mirapexin, Sifrol) - Frequency",
rasagiline_dose,cam_care_pd_questionnaire,,text,Rasagiline (Azilect) - Dose,
rasagiline_freq,cam_care_pd_questionnaire,,text,Rasagiline (Azilect) - Frequency,
ropinirole_dose,cam_care_pd_questionnaire,,text,"Ropinirole (Adartel, Requip, Requip XL, Ropark) - Dose",
ropinirole_freq,cam_care_pd_questionnaire,,text,"Ropinirole (Adartel, Requip, Requip XL, Ropark) - Frequency",
rotigotine_dose,cam_care_pd_questionnaire,,text,Rotigotine (Neupro) - Dose,
rotigotine_freq,cam_care_pd_questionnaire,,text,Rotigotine (Neupro) - Frequency,
rytary_dose,cam_care_pd_questionnaire,,text,Rytary (carbidopa and levodopa) - Dose,
rytary_freq,cam_care_pd_questionnaire,,text,Rytary (carbidopa and levodopa) - Frequency,
selegiline_dose,cam_care_pd_questionnaire,,text,"Selegiline (I-deprenyl, Eldepryl, Zelapar) - Dose",
selegiline_freq,cam_care_pd_questionnaire,,text,"Selegiline (I-deprenyl, Eldepryl, Zelapar) - Frequency",
tolcapone_dose,cam_care_pd_questionnaire,,text,Tolcapone (Tasmar) - Dose,
tolcapone_freq,cam_care_pd_questionnaire,,text,Tolcapone (Tasmar) - Frequency,
artane_dose,cam_care_pd_questionnaire,,text,"Trihexyphenidyl (Apo-Trihex, Artane) - Dose",
artane_freq,cam_care_pd_questionnaire,,text,"Trihexyphenidyl (Apo-Trihex, Artane) - Frequency",
otherpdmeds,cam_care_pd_questionnaire,,notes,"Other PD Medications - List medications, doses, and frequencies",
pharmaceuticals,cam_care_pd_questionnaire,"LIST OF MEDICATIONS & SUPPLEMENTS, whether or not they are for PD    For those of you on many therapies, we realize this is can be a difficult section to fill out. For this study to have meaning, we need to know everything you are taking. Please be as detailed as possible, including doses, brands, and frequency of conventional and alternative medicines.    We appreciate your effort!",notes,"Supplements, herbs, etc. 

(dose, frequency, brand, duration)



examples:



Pharmax finest pure fish oil, 1 Tbsp daily x 4 months

Jarrow Citicoline, 500 mg/ d x 1 year

Centrum multi-vitamin, 2 tabs daily, 10 years",
supplement_herbs,cam_care_pd_questionnaire,,notes,"Non-PD Pharmaceutical Prescriptions (not listed above.)

(dose, frequency, duration)







",
caminfo,cam_care_pd_questionnaire,INFORMATION SOURCES,dropdown,"What is your primary source of information for Complementary and Alternative Medical Care?

","1, Books | 2, Web / Online | 3, Health food / Supplement store | 4, Licensed Healthcare Provider | 5, Unlicensed Healthcare Provider | 6, Other"
camprovider,cam_care_pd_questionnaire,,checkbox,"In the past 6 months, have you consulted any of the following provider types about CAM strategies for PD?","1, ND (naturopathic physician) | 2, MD (medical doctor, conventional physician) | 3, DO (osteopathic physician) | 4, DC (chiropractor) | 5, ARNP (nurse practioner) | 6, LAc (acupuncturist, Traditional Chinese Medicine) | 7, Other"
othercam,cam_care_pd_questionnaire,,text,Other CAM,
other_dx,cam_care_pd_questionnaire,,notes,"Co- morbidities 



List any other diagnosis or illnesses with which you have dealt with over the past 6 months.



(examples: obesity, high blood pressure, hypothyroid, prostate cancer, arthritis, addiction, etc.)",
sarc_strength,cam_care_pd_questionnaire,"
Sarcopenia Assessment: Sarcopenia is a syndrome characterized by progressive loss of muscle mass and strength.

",radio,STRENGTH -- How much difficulty do you have in lifting and carrying 10 pounds (4.5 kg)? ,"1, None |2, Some | 3, A lot or unable"
sarc_walking,cam_care_pd_questionnaire,,radio,ASSISTANCE IN WALKING-- How much difficulty to you have walking across a room?,"1, None |2, Some | 3, A lot, use aids, or unable"
sarc_rising,cam_care_pd_questionnaire,,radio,RISE FROM A CHAIR -- How much difficulty do you have transferring from a chair or bed?,"1, None |2, Some | 3, A lot or unable without help"
sarc_stairs,cam_care_pd_questionnaire,,radio,CLIMB STAIRS -- How much difficulty do you have climbing a flight of 10 stairs? ,"1, None |2, Some | 3, A lot or unable"
sarc_falls,cam_care_pd_questionnaire,,radio,FALLS -- How many times have you fallen in the past year?,"1, None |2, 1-3 falls | 3, 4 or more falls"
sarc_redflags,cam_care_pd_questionnaire,,checkbox,Do you have any of the following? Check all that apply: ,"1, Loss of weight |2, Loss of muscle strength, in arms |3, General weakness |4, Fatigue |5, Falls |6, Mobility impairment |7, Loss of energy |8, Difficulties in physical activities of daily living"
covid_vaccine,cam_care_pd_questionnaire,,yesno,Have you been given at least one dose of the COVID vaccine?,
covid_vaccine_offer,cam_care_pd_questionnaire,,yesno,"If offered the COVID vaccine, would you take it?",
covid_vaccine_not,cam_care_pd_questionnaire,,text,"If not, why?",
menses_onset,cam_care_pd_questionnaire,"
Reproductive Health

",text,How old were you when your menses/periods started?,
menses_still,cam_care_pd_questionnaire,,yesno,Are you still menstruating?,
menses_stopped_age,cam_care_pd_questionnaire,,text,How old were you when your periods/menses stopped?,
pms,cam_care_pd_questionnaire,,yesno,Have you ever been diagnosed with premenstrual syndrome?,
pd_onset_menses,cam_care_pd_questionnaire,,radio,My Parkinsons onset started when...,"1, While I was still having regular periods | 2, While I was going through perimenopause (irregular cycles, hot flashes, etc.) | 3, One year or more after my last menstrual period"
pd_menses_better,cam_care_pd_questionnaire,,yesno,Did/Do you notice that PD symptoms improved at any part of the menstrual cycle?,
pd_change_menses,cam_care_pd_questionnaire,,radio,Did/Do you notice that PD symptoms worsen at any part of the menstrual cycle?,"0, No | 1, In the 1-7 days before my period started | 2, During period, while I was bleeding | 3, In the 1-7 days after I stopped bleeding | 4,  In the middle of my cycle, with ovulation | 5, 7 days after ovulation"
pd_menses_sx,cam_care_pd_questionnaire,,checkbox,What did you notice with symptom worsening around menses? (check all that apply),"1, Medication felt less effective | 2, Higher doses of meds were required to maintain function | 3, More off periods | 4, Non-motor issues"
pd_menses_sx_nm,cam_care_pd_questionnaire,,text,Please specify which non-motor symptoms worsened.,
pd_menses_sx_dopa,cam_care_pd_questionnaire,,yesno,"During this period of worsening, does additional dopamine relieve the symptoms? Meaning, are your dopamine requirements higher during these periods of exacerbation?",
pd_menses_sx_other,cam_care_pd_questionnaire,,text,Has/Had anything else helped these periods of exacerbation?,
pd_menses_other,cam_care_pd_questionnaire,,text,Is there anything else you've noticed about your period/cycles and your PD symptoms?,
pregnant_before,cam_care_pd_questionnaire,,yesno,Did you experience pregnancy before being diagnosed with PD?,
pd_pregnant_beforedx,cam_care_pd_questionnaire,,yesno,Do you think you already had PD symptoms while being pregnant in retrospect before being diagnosed with PD?,
pd_pregnant,cam_care_pd_questionnaire,,yesno,Did you experience a pregnancy after being diagnosed with PD?,
pd_pregnant_details,cam_care_pd_questionnaire,,text,"If yes, please tell us about your experience.",
pd_perimenopause,cam_care_pd_questionnaire,,yesno,Did perimenopause effect your PD symptoms?,
pd_menopause,cam_care_pd_questionnaire,,yesno,Did PD symptoms improve when you entered menopause?,
hrt,cam_care_pd_questionnaire,,checkbox,Have you ever used hormone replacement therapy?,"0, Never | 1, Yes, oral hormone replacement therapy | 2, Yes, cream-based, topical hormone replacement therapy | 3, Yes, injectible hormone replacement therapy | 4, Other"
hrt_other,cam_care_pd_questionnaire,,text,"If other, please explain:",
hrt_pdsx_chg,cam_care_pd_questionnaire,,yesno,Do you feel that your PD symptoms changed by taking hormone replacement therapy?,
hrt_change,cam_care_pd_questionnaire,,text,"If yes, please explain:",
hrt_start,cam_care_pd_questionnaire,,text,When did you start hormone replacement therapy?,
hrt_still,cam_care_pd_questionnaire,,yesno,Are you still taking hormone replacement therapy?,
hrt_stop,cam_care_pd_questionnaire,,text,When did you stop hormone replacement therapy?,
hyst_oo,cam_care_pd_questionnaire,,yesno,Have you had a hysterectomy and/or oophorectomy?,
hyst_oo_age,cam_care_pd_questionnaire,,text,At what age did you have a hysteroctomy and/or oophorectomy?,
hyst_oo_sxchg,cam_care_pd_questionnaire,,yesno,Have you PD symptoms changed since this surgery?,
hyst_oo_sxchg_describe,cam_care_pd_questionnaire,,text,Please describe any changes in symptoms:,
brca,cam_care_pd_questionnaire,,yesno,Have you ever been diagnosed with breast cancer?,
brca_year,cam_care_pd_questionnaire,,text,What year were you diagnosed with breast cancer?,
brca_hormones,cam_care_pd_questionnaire,,yesno,Did you take hormonal therapy for breast cancer?,
physician_often,cam_care_pd_questionnaire,Other Health Related Questions,text,How often do you see a physician?,
tbi,cam_care_pd_questionnaire,,yesno,Have you been diagnosed with a traumatic brain injury?,
osteoporosis,cam_care_pd_questionnaire,,yesno,Have you been diagnosed with osteoporosis?,
autoimmune,cam_care_pd_questionnaire,,yesno,"Have you been diiagnosed with an autoimmune disease (e.g., Celiac disease, Rheumatoid Arthritis, Lupus, Hashimoto's, etc.?)",
genetictest,cam_care_pd_questionnaire,,yesno,Have you had any genetic testing for Parkinsons performed?,
geneticyes,cam_care_pd_questionnaire,,radio,Do you have a Parkinson's causal gene?,"0, No | 1, Yes | 2, I don't know"
genetictype,cam_care_pd_questionnaire,,checkbox,"If so, which genetic change(s) do you have?","1, LRRK2 | 2, PARK2 | 3, GBA | 4, Other"
geneticother,cam_care_pd_questionnaire,,text,"If other, what genetic change do you have?",
geneticoffer,cam_care_pd_questionnaire,,yesno,Would you want genetic testing for Parkinsons if offered?,
clinic,cam_care_pd_questionnaire,,checkbox,"Do you recieve care or attend classes at any of
the following in the past 6 months?
(check all that apply)

","1, Bastyr Center for Natural Health | 2, Bastyr Clinical Research Center | 3, National College of Naturopathic Medicine | 4, Seattle Integrative Medicine | 5, Powering Forward Boot Camp (BGF/YMCA)"
excellencecenter,cam_care_pd_questionnaire,,checkbox,"In the last year, have you received care at any of the following Centers of Excellence? 
(check all that apply)","2, AZ (USA) - Barrow Neurological Institute | 3, CA (USA) - Keck School of Medicine of University of Southern California | 4, CA (USA) - University of California, San Francisco | 5, CA (USA) - Altman Clinical Translational Research Institute University of California, San Diego Movement Disorder Center | 6, CO (USA) - University of Colorado Movement Disorders Center | 7, DC (USA) - Georgetown University Hospital* | 8, FL (USA) - University of Florida Center for Movement Disorders and Neurorestoration* | 9, FL (USA) - Miller School of Medicine, University of Miami | 10, FL (USA) - University of South Florida Parkinson's Disease and Movement Disorders Center | 11, GA (USA) - Medical College of Georgia, Augusta University* | 12, GA (USA) - Emory University | 13, IA (USA) - University of Iowa | 14, IL (USA) - Northwestern University Movement Disorders Center | 15, IL (USA) - Rush University Medical Center | 16, IN (USA) - Indiana University School of Medicine | 17, KS (USA) - University of Kansas Medical Center | 18, MD (USA) - Johns Hopkins Parkinson's Disease & Movement Disorders Center | 19, MA (USA) - Massachusetts General Hospital | 20, MA (USA) - Beth Israel Deaconess Medical Center | 21, MN (USA) - Struthers Parkinson's Center | 22, NY (USA) - Mount Sinai Beth Israel | 23, NY (USA) - Columbia University Department of Neurology | 24, NY (USA) - Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders at NYU Langone Medical Center | 25, NY (USA) - University of Rochester Medical Center | 26, NC (USA) - Duke Health Movement Disorders Center | 27, NC (USA) - University of North Carolina at Chapel Hill School of Medicine | 28, OH (USA) - Cleveland Clinic Ohio | 29, OR (USA) - Oregon Health & Science University Parkinson Center | 30, PA (USA) - University of Pennsylvania Movement Disorder Center | 31, PA (USA) - Jefferson Health's Comprehensive Parkinson's Disease & Movement Disorder Center | 32, SC (USA) - Medical University of South Carolina | 33, TN (USA) - Vanderbilt University Medical Center* | 34, TX (USA) - Baylor College of Medicine | 35, Australia- Victorian Comprehensive Parkinson's Program | 38, Canada - McGill Parkinson Program | 39, Canada - University of Western Ontario, London Health Sciences Centre | 40, Canada - University of Calgary | 41, Canada - University of Alberta | 42, Canada - Pacific Parkinson's Research Centre, University of British Columbia | 43, Canada - Toronto Western Hospital Movement Disorders Center | 44, Germany- Philipps University | 45, Israel- Tel Aviv Sourasky Medical Center | 46, Netherlands- Nijmegen Parkinson Center | 47, Singapore - Singapore National Neuroscience Institute | 48, Taiwan - National Taiwan University Hospital, Center for Parkinson & Movement Disorders | 49, United Kingdom- Kings College Hospital | 50, United Kingdom - Derby Hospitals NHS Foundation Trust and The University of Nottingham"
onlineed,cam_care_pd_questionnaire,,checkbox,"In the past 6 months, have you participated in any of the following online education series related to PD?
(check all that apply)","1, Online ""PD School"" - Instructor: L. Mischley | 2, ""ParkinsonTV"" - Instructor B. Bloem | 3, ""wHolistic"" - Instructor I. Subramanian | 4, ""Expert Briefings"" - Parkinson Foundation | 5, Other | 0, I have not participated in any PD related online education"
onlineedother,cam_care_pd_questionnaire,,text,"If other, please type the name of the PD-related online education series:",
mischleypdschoolcount,cam_care_pd_questionnaire,,dropdown,"Online ""PD School"" with Dr. Mischley - Approximately how many courses have you watched?","1, 1 | 2, 2 | 3, 3 | 4, 4 | 5, 5 | 6, 6 | 7, 7 | 8, 8 | 9, 9 | 10, 10 | 11, 11 | 12, 12 or more"
mischleypdschoolchanges,cam_care_pd_questionnaire,,yesno,"Online ""PD School"" with Dr. Mischley - Have you made any changes as a result of this course?",
pdretreat,cam_care_pd_questionnaire,,checkbox,"Have you ever attended a Parkinsons-specific retreat? If so, please check all that apply.","1, PD Summer School @ Bastyr University | 2, PWR! in Arizona (USA) | 3, European Parkinson Therapy Center / FPTC in Bolerio (Italy) | 4, Other | 0, I have never attended a PD retreat"
pdretreatother,cam_care_pd_questionnaire,,notes,"If other, please type the name of the retreat and tell us a little bit about it:",
doctornames,cam_care_pd_questionnaire,,text,"Please list the name of the health care provider(s) you turn to for Parkinson's-related medical advice. This may be your primary care provider, neurologist, movement disorder specialist, etc.

*We will NOT contact this provider on your behalf or share any of your data! 

Why are we asking? 
If some providers are getting consistently better outcomes than others, we want to know who they are so we can learn from them. 

Provider name, provider type, city, and state:
e.g. Jane Smith, ND, Seattle, WA
e.g. Bob Smith, MD, Austin, TX",
qrquestion,cam_care_pd_questionnaire,Qualitative Research,notes,Please tell us anything else you think we should know.,