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|
1 |
[record_id] |
Record ID |
text |
|
|
2 |
[interviewer_s_name] |
Interviewer's Name |
text, Required |
|
|
3 |
[date_of_interview] |
Date of interview |
text (date_dmy), Required |
|
|
4 |
[mohalla_location] |
Mohalla/Location
मुहल्ला/स्थान
|
text, Required |
|
|
5 |
[a_household_composition_of] |
A. HOUSEHOLD COMPOSITION OF RESPONDENTप्रतिक्रिया देने वाले के घर के सदस्यों की जानकारी |
descriptive |
|
|
6 |
[type_of_family] |
Type of Family
परिवार का प्रकार
|
radio, Required| 1 | Joint / संयुक्त | | 2 | Nuclear / एकल |
|
|
|
7 |
[religion] |
Religion |
radio, Required| 1 | Hindu | | 2 | Muslim | | 3 | Sikh | | 4 | Christian | | 5 | Others |
|
|
|
8 |
[specify_other_religion]
Show the field ONLY if:
[religion] = '5'
|
specify other |
text |
|
|
9 |
[no_of_family_member] |
No of Family Member |
radio, Required |
|
|
10 |
[monthly_income_from_all_so] |
Monthly income from all sourcesमहीने के आय सभी से सूत्रों का कहना है |
text (number), Required |
|
|
11 |
[total_monthly_income_of_ho] |
Total monthly income of household
कुल महीने के की आय परिवार
|
text (number), Required |
|
|
12 |
[monthly_household_expense] |
Monthly household expense on Kitchen
महीने के परिवार व्यय रसोई पर
|
text (number), Required |
|
|
13 |
[house_type] |
House Typeमकान का प्रकार |
descriptive |
|
|
14 |
[house_type_1] |
House Type
(मकान का प्रकार )
|
radio, Required| 1 | Kuccha / कच्चा | | 2 | Jhopri / झोपड़ी | | 3 | Pucca / पक्का |
|
|
|
15 |
[property_owned] |
Property Owned
स्वामित्व वाली संपत्ति
|
yesno, Required |
|
|
16 |
[type_of_property]
Show the field ONLY if:
[property_owned] = '1'
|
Type of property |
radio, Required| 1 | Residential / आवासीय | | 2 | Agricultural / कृषि | | 3 | Commercial / वाणिज्यिक | | 4 | Others / अन्य |
|
|
|
17 |
[specify_other]
Show the field ONLY if:
[type_of_property] = '4'
|
Specify other |
text |
|
|
18 |
[locality] |
Locality
इलाका
|
radio, Required| 1 | Rural / ग्रामीण | | 2 | Semi urban / अर्धशहरी | | 3 | Urban / शहरी | | 4 | Urban slum / शहरी स्लम | | 5 | Urban planned / शहरी नियोजित |
|
|
|
19 |
[household_assets] |
Household Assets
घरेलू संपत्ति
|
checkbox, Required| 1 | household_assets___1 | A.C. / ए.सी | | 2 | household_assets___2 | Refrigerator/ रेफ्रिजरेटर | | 3 | household_assets___3 | TV / टीवी | | 4 | household_assets___4 | VCR / वीसीआर | | 5 | household_assets___5 | Washing machine/ वॉशिंग मशीन | | 6 | household_assets___6 | Scooter / स्कूटर | | 7 | household_assets___7 | Car / कार | | 8 | household_assets___8 | Other |
|
|
|
20 |
[other_household]
Show the field ONLY if:
[household_assets(8)] = '1'
|
Specify Other |
text |
|
|
21 |
[domestic_animals] |
Domestic Animals
घरेलू पशु
|
checkbox, Required| 1 | domestic_animals___1 | Cows / गाय | | 2 | domestic_animals___2 | Buffalos / भैंस | | 3 | domestic_animals___3 | Pigs / सूअर | | 4 | domestic_animals___4 | Horses / घोड़े | | 5 | domestic_animals___5 | Goats / बकरी | | 6 | domestic_animals___6 | Other |
|
|
|
22 |
[specify_other_dom_animal]
Show the field ONLY if:
[domestic_animals(6)] = '1'
|
Specify other |
text |
|
|
23 |
[kitchen_garden] |
Kitchen Garden
किचन गार्डन
|
yesno, Required |
|
|
24 |
[domestic_servants] |
Domestic Servants
घरेलू नौकर
|
yesno, Required |
|
|
25 |
[gender_of_servent]
Show the field ONLY if:
[domestic_servants] = '1'
|
Gender of Servent |
radio, Required |
|
|
26 |
[source_of_water] |
Source of Water
जल का स्रोत
|
radio, Required| 1 | Tap / नल | | 2 | Tank / टैंक | | 3 | Tube-well / ट्यूबवेल | | 4 | Hand or motor pump / हाथ या मोटर पंप | | 5 | Pond / तालाब | | 6 | Well / कुआं | | 7 | River / नदी | | 8 | Other |
|
|
|
27 |
[other_source_of_water]
Show the field ONLY if:
[source_of_water] = '8'
|
Specify other |
text |
|
|
28 |
[do_you_treat_water_before] |
Do you treat water before drinking? |
yesno, Required |
|
|
29 |
[how_do_you_treat_purify_dr]
Show the field ONLY if:
[do_you_treat_water_before]="1"
|
How do you treat/purify drinking water? |
radio, Required| 1 | Boiling (उबालना) | | 2 | Filter (फ़िल्टर) | | 3 | RO (Reverse Osmosis) (आरओ) | | 4 | UV treatment (यूवी उपचार) | | 5 | Chlorine tablets (क्लोरीन की गोलियाँ) | | 6 | No treatment (कोई उपचार नहीं) |
|
|
|
30 |
[have_you_noticed_any_chang] |
Have you noticed any changes in water color/taste/odor?
क्या आपने पानी के रंग/स्वाद/गंध में कोई बदलाव देखा है?
|
yesno, Required |
|
|
31 |
[please_describe]
Show the field ONLY if:
[have_you_noticed_any_chang] ="1"
|
Please describe |
text |
|
|
32 |
[kind_of_milk] |
Kind of Milk
दूध का प्रकार
|
radio, Required| 1 | Domestic source/ घरेलू स्रोत | | 2 | Milkman / दूधवाला | | 3 | Mother dairy/ मदर डेयरी | | 4 | Cow / गाय | | 5 | Buffalo / भैंस | | 6 | Goat / बकरी | | 7 | Other |
|
|
|
33 |
[specify_other_milk]
Show the field ONLY if:
[kind_of_milk] = '7'
|
Specify other |
text |
|
|
34 |
[individual_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
First family Member |
descriptive |
|
|
35 |
[sex_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Sex
लिंग
|
radio, Required |
|
|
36 |
[specify_other_1]
Show the field ONLY if:
[sex_1] = '3'
|
Specify other |
text |
|
|
37 |
[age_year_month_days_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
38 |
[relationship_with_ego_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
39 |
[present_marital_status_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
40 |
[educational_status_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
41 |
[occupational_status_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
42 |
[any_kind_of_illness_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
43 |
[name_of_illness_1]
Show the field ONLY if:
[any_kind_of_illness_1] = '1'
|
Name of illness |
text, Required |
|
|
44 |
[duration_of_illness_1]
Show the field ONLY if:
[any_kind_of_illness_1] = '1'
|
Duration of illness |
text |
|
|
45 |
[any_treatment_given_1]
Show the field ONLY if:
[any_kind_of_illness_1] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
46 |
[if_yes_what_1]
Show the field ONLY if:
[any_treatment_given_1] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
47 |
[nutritional_status]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Nutritional Status |
descriptive |
|
|
48 |
[dietary_habit_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
49 |
[amount_consumed_water_l_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
50 |
[no_of_full_meals_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
51 |
[frequency_non_vegetaria_1]
Show the field ONLY if:
[dietary_habit_1] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
52 |
[frequency_of_vegetarian_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
53 |
[frequency_milk_products_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
54 |
[frequency_of_pulses_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
55 |
[frequency_of_fruits_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
56 |
[any_other_specific_diet_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
57 |
[any_illness]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Any Illnessकोई बीमारी |
descriptive |
|
|
58 |
[nutritional_deficiency]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
59 |
[which_type_of_nutritional]
Show the field ONLY if:
[nutritional_deficiency] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
60 |
[age_at_nurition_def]
Show the field ONLY if:
[nutritional_deficiency] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
61 |
[duration_nutrient_def]
Show the field ONLY if:
[nutritional_deficiency] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
62 |
[physical_disability]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
63 |
[which_type_of_physical_dis]
Show the field ONLY if:
[physical_disability] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
64 |
[duration_how_long_physical]
Show the field ONLY if:
[physical_disability] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
65 |
[emotional_impairment]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
66 |
[which_type_of_emotional_im]
Show the field ONLY if:
[emotional_impairment] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
67 |
[duration_how_long_emontiona]
Show the field ONLY if:
[emotional_impairment] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
68 |
[major_therapeutic_irradiat]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
69 |
[which_type_of_major_therap]
Show the field ONLY if:
[major_therapeutic_irradiat] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
70 |
[duration_how_long_major]
Show the field ONLY if:
[major_therapeutic_irradiat] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
71 |
[long_illness]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
72 |
[which_type_of_long_illness]
Show the field ONLY if:
[long_illness] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
73 |
[duration_how_long_ilness]
Show the field ONLY if:
[long_illness] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
74 |
[g_have_you_ever_been_diagn]
Show the field ONLY if:
[no_of_family_member] >= 1
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
75 |
[heart_failure_disease]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
76 |
[type_heart_disesae]
Show the field ONLY if:
[heart_failure_disease] = '1'
|
Type
प्रकार
|
text |
|
|
77 |
[age_heart_faliour]
Show the field ONLY if:
[heart_failure_disease] = '1'
|
Age
आयु
|
text (number) |
|
|
78 |
[irritable_bowel_disease]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
79 |
[type_irritable_bowel]
Show the field ONLY if:
[irritable_bowel_disease] = '1'
|
Type
प्रकार
|
text |
|
|
80 |
[age_bowel_disease]
Show the field ONLY if:
[irritable_bowel_disease] = '1'
|
Age
आयु
|
text (number) |
|
|
81 |
[chronic_bronchitis]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
82 |
[type_bronchitis]
Show the field ONLY if:
[chronic_bronchitis] = '1'
|
Type
प्रकार
|
text |
|
|
83 |
[age_bronchitis]
Show the field ONLY if:
[chronic_bronchitis] = '1'
|
Age
आयु
|
text (number) |
|
|
84 |
[hernia]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Hernia
हरनिया
|
yesno, Required |
|
|
85 |
[type_hernia]
Show the field ONLY if:
[hernia] = '1'
|
Type
प्रकार
|
text |
|
|
86 |
[age_hernia]
Show the field ONLY if:
[hernia] = '1'
|
Age
आयु
|
text (number) |
|
|
87 |
[emphysema]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
88 |
[type_endometriosis]
Show the field ONLY if:
[emphysema] = '1'
|
Type
प्रकार
|
text |
|
|
89 |
[age_endometriosis]
Show the field ONLY if:
[emphysema] = '1'
|
Age
आयु
|
text (number) |
|
|
90 |
[arthritis]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Arthritis
वात रोग
|
yesno, Required |
|
|
91 |
[type_arthritis]
Show the field ONLY if:
[arthritis] = '1'
|
Type
प्रकार
|
text |
|
|
92 |
[age_arthritis]
Show the field ONLY if:
[arthritis] = '1'
|
Age
आयु
|
text (number) |
|
|
93 |
[inflammatory_bowel_disease]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
94 |
[type_inflammatory_bowel]
Show the field ONLY if:
[inflammatory_bowel_disease] = '1'
|
Type
प्रकार
|
text |
|
|
95 |
[age_inflammatory_bowel_disease]
Show the field ONLY if:
[inflammatory_bowel_disease] = '1'
|
Age
आयु
|
text, Required |
|
|
96 |
[depression]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Depression
अवसाद
|
yesno, Required |
|
|
97 |
[type_depression]
Show the field ONLY if:
[depression] = '1'
|
Type
प्रकार
|
text |
|
|
98 |
[age_depression]
Show the field ONLY if:
[depression] = '1'
|
Age
आयु
|
text (number) |
|
|
99 |
[cancer]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Cancer
कैंसर
|
yesno, Required |
|
|
100 |
[type_cancer]
Show the field ONLY if:
[cancer] = '1'
|
Type
प्रकार
|
text |
|
|
101 |
[age_cancer]
Show the field ONLY if:
[cancer] = '1'
|
Age
आयु
|
text (number) |
|
|
102 |
[have_you_been_diagnose_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
103 |
[age_at_diagnosis_g11]
Show the field ONLY if:
[have_you_been_diagnose_1] = "1"
|
Age at diagnosis: |
text |
|
|
104 |
[g12_have_you_been_diagnose]
Show the field ONLY if:
[no_of_family_member] >= 1
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
105 |
[age_at_diagnosis_g_12]
Show the field ONLY if:
[g12_have_you_been_diagnose] = "1"
|
Age at diagnosis:
|
text |
|
|
106 |
[g13_have_you_been_diagnose]
Show the field ONLY if:
[no_of_family_member] >= 1
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
107 |
[age_at_diagnosis_g13]
Show the field ONLY if:
[g13_have_you_been_diagnose] = "1"
|
Age at diagnosis: |
text |
|
|
108 |
[h_have_you_or_your_family]
Show the field ONLY if:
[no_of_family_member] >= 1
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
109 |
[high_fever]
Show the field ONLY if:
[no_of_family_member] >= 1
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
110 |
[when_highg_fever]
Show the field ONLY if:
[high_fever] = '1'
|
When
कब
|
text |
|
|
111 |
[how_many_times_fever]
Show the field ONLY if:
[high_fever] = '1'
|
How many times
कितनी बार
|
text |
|
|
112 |
[weakness_and_fatigue]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
113 |
[when_weakness]
Show the field ONLY if:
[weakness_and_fatigue] = "1"
|
When
कब
|
text |
|
|
114 |
[how_many_times_weakness]
Show the field ONLY if:
[weakness_and_fatigue] = "1"
|
How many times
कितनी बार
|
text |
|
|
115 |
[muscle_ache]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
116 |
[when_muscle]
Show the field ONLY if:
[muscle_ache] = "1"
|
When
कब
|
text |
|
|
117 |
[how_many_times_muscle]
Show the field ONLY if:
[muscle_ache] = "1"
|
How many times
कितनी बार
|
text |
|
|
118 |
[stomach_pain]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
119 |
[when_stomach]
Show the field ONLY if:
[stomach_pain] = "1"
|
When
कब
|
text |
|
|
120 |
[how_many_times_stomach]
Show the field ONLY if:
[stomach_pain] = "1"
|
How many times
कितनी बार
|
text |
|
|
121 |
[loss_of_appetite_and_weigh]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
122 |
[when_appetite]
Show the field ONLY if:
[loss_of_appetite_and_weigh] ="1"
|
When
कब
|
text |
|
|
123 |
[how_many_times_appetite]
Show the field ONLY if:
[loss_of_appetite_and_weigh] ="1"
|
How many times
कितनी बार
|
text |
|
|
124 |
[dry_cough]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
125 |
[when_dry_cough]
Show the field ONLY if:
[dry_cough] = "1"
|
When
कब
|
text |
|
|
126 |
[how_many_times_dry_cough]
Show the field ONLY if:
[dry_cough] = "1"
|
How many times
कितनी बार
|
text |
|
|
127 |
[diarrhoea]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
128 |
[when_diarrhoea]
Show the field ONLY if:
[diarrhoea] = "1"
|
When
कब
|
text |
|
|
129 |
[how_many_times_diarrheaea]
Show the field ONLY if:
[diarrhoea] = "1"
|
How many times
कितनी बार
|
text |
|
|
130 |
[hair_fall]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
131 |
[when_hair_fall]
Show the field ONLY if:
[hair_fall] = '1'
|
When
कब
|
text |
|
|
132 |
[how_many_times_hair_fall]
Show the field ONLY if:
[hair_fall] = '1'
|
How many times
कितनी बार
|
text |
|
|
133 |
[itching_and_rashes]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
134 |
[when_itching]
Show the field ONLY if:
[itching_and_rashes] = "1"
|
When
कब
|
text |
|
|
135 |
[how_many_times_itching]
Show the field ONLY if:
[itching_and_rashes] = "1"
|
How many times
कितनी बार
|
text |
|
|
136 |
[headaches]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
137 |
[when_headaches]
Show the field ONLY if:
[headaches] = "1"
|
When
कब
|
text |
|
|
138 |
[how_many_times_headaches]
Show the field ONLY if:
[headaches] = "1"
|
How many times
कितनी बार
|
text |
|
|
139 |
[eye_pain]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
140 |
[when_eye_pain]
Show the field ONLY if:
[eye_pain] = "1"
|
When
कब
|
text |
|
|
141 |
[how_many_times_eyepain]
Show the field ONLY if:
[eye_pain] = "1"
|
How many times
कितनी बार
|
text |
|
|
142 |
[h12_shortness_of_breath_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
143 |
[when_h12_1]
Show the field ONLY if:
[h12_shortness_of_breath_1] = "1"
|
When
कब
|
text |
|
|
144 |
[how_many_times_h12_1]
Show the field ONLY if:
[h12_shortness_of_breath_1] = "1"
|
How many times
कितनी बार
|
text |
|
|
145 |
[h13_wheezing_or_whistling_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
146 |
[when_h13_1]
Show the field ONLY if:
[h13_wheezing_or_whistling_1] = "1"
|
When
कब
|
text |
|
|
147 |
[how_many_times_h13_1]
Show the field ONLY if:
[h13_wheezing_or_whistling_1] = "1"
|
How many times
कितनी बार
|
text |
|
|
148 |
[h14_nasal_congestion_runny_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
149 |
[when_h14_1]
Show the field ONLY if:
[h14_nasal_congestion_runny_1] = "1"
|
When
कब
|
text |
|
|
150 |
[how_many_times_h14_1]
Show the field ONLY if:
[h14_nasal_congestion_runny_1] = "1"
|
How many times
कितनी बार
|
text |
|
|
151 |
[h15_vomiting_1]
Show the field ONLY if:
[no_of_family_member] >= 1
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
152 |
[when_h15_1]
Show the field ONLY if:
[h15_vomiting_1] = "1"
|
When
कब
|
text |
|
|
153 |
[how_many_times_h15_1]
Show the field ONLY if:
[h15_vomiting_1] = "1"
|
How many times
कितनी बार
|
text |
|
|
154 |
[alcohol_locally_fermented]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
155 |
[who_consumes_alcohol]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not applicable |
|
|
|
156 |
[do_you_consume_alcohol]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you consume alcohol? |
yesno, Required |
|
|
157 |
[how_do_you_consume]
Show the field ONLY if:
[do_you_consume_alcohol] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
158 |
[at_what_age_did_you_start]
Show the field ONLY if:
[do_you_consume_alcohol] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
159 |
[frequency_of_alcohol_consu]
Show the field ONLY if:
[how_do_you_consume] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
160 |
[quantity_of_alcohol_consum]
Show the field ONLY if:
[how_do_you_consume] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
161 |
[do_you_take_during_pregnan]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
162 |
[frequency_per_day_during_p]
Show the field ONLY if:
[do_you_take_during_pregnan] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
163 |
[tobacco_pan_chewing_smokin]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
164 |
[who_consumes_tobacco_pan]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
165 |
[do_you_consume_tobacco_pan]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
166 |
[how_do_you_consume_tobacco]
Show the field ONLY if:
[do_you_consume_tobacco_pan] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
167 |
[what_form_of_tobacco_pan_d]
Show the field ONLY if:
[do_you_consume_tobacco_pan] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d___1 | Chewing | | 2 | what_form_of_tobacco_pan_d___2 | Smoking | | 3 | what_form_of_tobacco_pan_d___3 | Beedi | | 4 | what_form_of_tobacco_pan_d___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d___5 | Zarda | | 6 | what_form_of_tobacco_pan_d___6 | Other (please specify) |
|
|
|
168 |
[other_specify]
Show the field ONLY if:
[what_form_of_tobacco_pan_d(6)] = '1'
|
Other Specify |
text |
|
|
169 |
[at_what_age_did_you_tobacco]
Show the field ONLY if:
[do_you_consume_tobacco_pan] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
170 |
[frequency_of_tobacco_pan_c]
Show the field ONLY if:
[how_do_you_consume_tobacco] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
171 |
[quantity_consumed_per_day]
Show the field ONLY if:
[how_do_you_consume_tobacco] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
172 |
[do_you_take_tobacco_pan_du]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
173 |
[frequency_per_day_tobaco_pre]
Show the field ONLY if:
[do_you_take_tobacco_pan_du] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
174 |
[other_drugs_charas_ganja_b]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
175 |
[who_consumes_other_drugs]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
176 |
[do_you_consume_other_drugs]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you consume other drugs? |
yesno, Required |
|
|
177 |
[how_do_you_consume_other_d]
Show the field ONLY if:
[do_you_consume_other_drugs] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
178 |
[what_type_of_drug_do_you_u]
Show the field ONLY if:
[do_you_consume_other_drugs] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u___1 | Charas | | 2 | what_type_of_drug_do_you_u___2 | Ganja | | 3 | what_type_of_drug_do_you_u___3 | Bhang | | 4 | what_type_of_drug_do_you_u___4 | Opium | | 5 | what_type_of_drug_do_you_u___5 | LSD | | 6 | what_type_of_drug_do_you_u___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u___7 | Other (please specify) |
|
|
|
179 |
[specify_other_drug]
Show the field ONLY if:
[what_type_of_drug_do_you_u(7)] = '1'
|
Specify Other |
text |
|
|
180 |
[at_what_age_did_you_star_drug]
Show the field ONLY if:
[do_you_consume_other_drugs] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
181 |
[frequency_of_drug_consumpt]
Show the field ONLY if:
[how_do_you_consume_other_d] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
182 |
[quantity_consumed_per_day_drug]
Show the field ONLY if:
[how_do_you_consume_other_d] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
183 |
[do_you_take_drugs_during_p]
Show the field ONLY if:
[no_of_family_member] >= 1
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
184 |
[frequency_per_day_during_drug]
Show the field ONLY if:
[do_you_take_drugs_during_p] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
185 |
[second_family_member]
Show the field ONLY if:
[no_of_family_member] >= 2
|
SECOND FAMILY MEMBER |
descriptive |
|
|
186 |
[sex_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Sex
लिंग
|
radio, Required |
|
|
187 |
[specify_other_2]
Show the field ONLY if:
[sex_2] = '3'
|
Specify other |
text |
|
|
188 |
[age_year_month_days_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
189 |
[relationship_with_ego_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
190 |
[present_marital_status_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
191 |
[educational_status_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
192 |
[occupational_status_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
193 |
[any_kind_of_illness_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
194 |
[name_of_illness_2]
Show the field ONLY if:
[any_kind_of_illness_2] = '1'
|
Name of illness |
text, Required |
|
|
195 |
[duration_of_illness_2]
Show the field ONLY if:
[any_kind_of_illness_2] = '1'
|
Duration of illness |
text |
|
|
196 |
[any_treatment_given_2]
Show the field ONLY if:
[any_kind_of_illness_2] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
197 |
[if_yes_what_2]
Show the field ONLY if:
[any_treatment_given_2] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
198 |
[nutritional_status_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Nutritional Status |
descriptive |
|
|
199 |
[dietary_habit_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
200 |
[amount_consumed_water_l_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
201 |
[no_of_full_meals_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
202 |
[frequency_non_vegetaria_2]
Show the field ONLY if:
[dietary_habit_2] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
203 |
[frequency_of_vegetarian_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
204 |
[frequency_milk_products_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
205 |
[frequency_of_pulses_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
206 |
[frequency_of_fruits_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
207 |
[any_other_specific_diet_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
208 |
[any_illness_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Any Illnessकोई बीमारी |
descriptive |
|
|
209 |
[nutritional_deficiency_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
210 |
[which_type_of_nutritional_2]
Show the field ONLY if:
[nutritional_deficiency_2] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
211 |
[age_at_nurition_def_2]
Show the field ONLY if:
[nutritional_deficiency_2] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
212 |
[duration_nutrient_def_2]
Show the field ONLY if:
[nutritional_deficiency_2] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
213 |
[physical_disability_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
214 |
[which_type_of_physical_dis_2]
Show the field ONLY if:
[physical_disability_2] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
215 |
[duration_how_long_physical_2]
Show the field ONLY if:
[physical_disability_2] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
216 |
[emotional_impairment_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
217 |
[which_type_of_emotional_im_2]
Show the field ONLY if:
[emotional_impairment_2] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
218 |
[duration_how_long_emontiona_2]
Show the field ONLY if:
[emotional_impairment_2] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
219 |
[major_therapeutic_irradiat_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
220 |
[which_type_of_major_therap_2]
Show the field ONLY if:
[major_therapeutic_irradiat_2] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
221 |
[duration_how_long_major_2]
Show the field ONLY if:
[major_therapeutic_irradiat_2] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
222 |
[long_illness_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
223 |
[which_type_of_long_illness_2]
Show the field ONLY if:
[long_illness_2] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
224 |
[duration_how_long_ilness_2]
Show the field ONLY if:
[long_illness_2] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
225 |
[g_have_you_ever_been_diagn_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
226 |
[heart_failure_disease_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
227 |
[type_heart_disesae_2]
Show the field ONLY if:
[heart_failure_disease_2] = '1'
|
Type
प्रकार
|
text |
|
|
228 |
[age_heart_faliour_2]
Show the field ONLY if:
[heart_failure_disease_2] = '1'
|
Age
आयु
|
text (number) |
|
|
229 |
[irritable_bowel_disease_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
230 |
[type_irritable_bowel_2]
Show the field ONLY if:
[irritable_bowel_disease_2] = '1'
|
Type
प्रकार
|
text |
|
|
231 |
[age_bowel_disease_2]
Show the field ONLY if:
[irritable_bowel_disease_2] = '1'
|
Age
आयु
|
text (number) |
|
|
232 |
[chronic_bronchitis_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
233 |
[type_bronchitis_2]
Show the field ONLY if:
[chronic_bronchitis_2] = '1'
|
Type
प्रकार
|
text |
|
|
234 |
[age_bronchitis_2]
Show the field ONLY if:
[chronic_bronchitis_2] = '1'
|
Age
आयु
|
text (number) |
|
|
235 |
[hernia_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Hernia
हरनिया
|
yesno, Required |
|
|
236 |
[type_hernia_2]
Show the field ONLY if:
[hernia_2] = '1'
|
Type
प्रकार
|
text |
|
|
237 |
[age_hernia_2]
Show the field ONLY if:
[hernia_2] = '1'
|
Age
आयु
|
text (number) |
|
|
238 |
[emphysema_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
239 |
[type_endometriosis_2]
Show the field ONLY if:
[emphysema_2] = '1'
|
Type
प्रकार
|
text |
|
|
240 |
[age_endometriosis_2]
Show the field ONLY if:
[emphysema_2] = '1'
|
Age
आयु
|
text (number) |
|
|
241 |
[arthritis_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Arthritis
वात रोग
|
yesno, Required |
|
|
242 |
[type_arthritis_2]
Show the field ONLY if:
[arthritis_2] = '1'
|
Type
प्रकार
|
text |
|
|
243 |
[age_arthritis_2]
Show the field ONLY if:
[arthritis_2] = '1'
|
Age
आयु
|
text (number) |
|
|
244 |
[inflammatory_bowel_disease_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
245 |
[type_inflammatory_bowel_2]
Show the field ONLY if:
[inflammatory_bowel_disease_2] = '1'
|
Type
प्रकार
|
text |
|
|
246 |
[age_inflammatory_bowel_disease_2]
Show the field ONLY if:
[inflammatory_bowel_disease_2] = '1'
|
Age
आयु
|
text, Required |
|
|
247 |
[depression_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Depression
अवसाद
|
yesno, Required |
|
|
248 |
[type_depression_2]
Show the field ONLY if:
[depression_2] = '1'
|
Type
प्रकार
|
text |
|
|
249 |
[age_depression_2]
Show the field ONLY if:
[depression_2] = '1'
|
Age
आयु
|
text (number) |
|
|
250 |
[cancer_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Cancer
कैंसर
|
yesno, Required |
|
|
251 |
[type_cancer_2]
Show the field ONLY if:
[cancer_2] = '1'
|
Type
प्रकार
|
text |
|
|
252 |
[age_cancer_2]
Show the field ONLY if:
[cancer_2] = '1'
|
Age
आयु
|
text (number) |
|
|
253 |
[have_you_been_diagnose_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
254 |
[age_at_diagnosis_g12]
Show the field ONLY if:
[have_you_been_diagnose_2] = "1"
|
Age at diagnosis: |
text |
|
|
255 |
[g12_have_you_been_diagnose_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
256 |
[age_at_diagnosis_g_13]
Show the field ONLY if:
[g12_have_you_been_diagnose_2] = "1"
|
Age at diagnosis:
|
text |
|
|
257 |
[g13_have_you_been_diagnose_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
258 |
[age_at_diagnosis_g14]
Show the field ONLY if:
[g13_have_you_been_diagnose_2] = "1"
|
Age at diagnosis: |
text |
|
|
259 |
[h_have_you_or_your_family_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
260 |
[high_fever_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
261 |
[when_highg_fever_2]
Show the field ONLY if:
[high_fever_2] = '1'
|
When
कब
|
text |
|
|
262 |
[how_many_times_fever_2]
Show the field ONLY if:
[high_fever_2] = '1'
|
How many times
कितनी बार
|
text |
|
|
263 |
[weakness_and_fatigue_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
264 |
[when_weakness_2]
Show the field ONLY if:
[weakness_and_fatigue_2] = "1"
|
When
कब
|
text |
|
|
265 |
[how_many_times_weakness_2]
Show the field ONLY if:
[weakness_and_fatigue_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
266 |
[muscle_ache_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
267 |
[when_muscle_2]
Show the field ONLY if:
[muscle_ache_2] = "1"
|
When
कब
|
text |
|
|
268 |
[how_many_times_muscle_2]
Show the field ONLY if:
[muscle_ache_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
269 |
[stomach_pain_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
270 |
[when_stomach_2]
Show the field ONLY if:
[stomach_pain_2] = "1"
|
When
कब
|
text |
|
|
271 |
[how_many_times_stomach_2]
Show the field ONLY if:
[stomach_pain_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
272 |
[loss_of_appetite_and_weigh_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
273 |
[when_appetite_2]
Show the field ONLY if:
[loss_of_appetite_and_weigh_2] ="1"
|
When
कब
|
text |
|
|
274 |
[how_many_times_appetite_2]
Show the field ONLY if:
[loss_of_appetite_and_weigh_2] ="1"
|
How many times
कितनी बार
|
text |
|
|
275 |
[dry_cough_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
276 |
[when_dry_cough_2]
Show the field ONLY if:
[dry_cough_2] = "1"
|
When
कब
|
text |
|
|
277 |
[how_many_times_dry_cough_2]
Show the field ONLY if:
[dry_cough_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
278 |
[diarrhoea_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
279 |
[when_diarrhoea_2]
Show the field ONLY if:
[diarrhoea_2] = "1"
|
When
कब
|
text |
|
|
280 |
[how_many_times_diarrheaea_2]
Show the field ONLY if:
[diarrhoea_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
281 |
[hair_fall_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
282 |
[when_hair_fall_2]
Show the field ONLY if:
[hair_fall_2] = '1'
|
When
कब
|
text |
|
|
283 |
[how_many_times_hair_fall_2]
Show the field ONLY if:
[hair_fall_2] = '1'
|
How many times
कितनी बार
|
text |
|
|
284 |
[itching_and_rashes_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
285 |
[when_itching_2]
Show the field ONLY if:
[itching_and_rashes_2] = "1"
|
When
कब
|
text |
|
|
286 |
[how_many_times_itching_2]
Show the field ONLY if:
[itching_and_rashes_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
287 |
[headaches_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
288 |
[when_headaches_2]
Show the field ONLY if:
[headaches_2] = "1"
|
When
कब
|
text |
|
|
289 |
[how_many_times_headaches_2]
Show the field ONLY if:
[headaches_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
290 |
[eye_pain_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
291 |
[when_eye_pain_2]
Show the field ONLY if:
[eye_pain_2] = "1"
|
When
कब
|
text |
|
|
292 |
[how_many_times_eyepain_2]
Show the field ONLY if:
[eye_pain_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
293 |
[h12_shortness_of_breath_2]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
294 |
[when_h12_2]
Show the field ONLY if:
[h12_shortness_of_breath_2] = "1"
|
When
कब
|
text |
|
|
295 |
[how_many_times_h12_2]
Show the field ONLY if:
[h12_shortness_of_breath_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
296 |
[h13_wheezing_or_whistling_2]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
297 |
[when_h13_2]
Show the field ONLY if:
[h13_wheezing_or_whistling_2] = "1"
|
When
कब
|
text |
|
|
298 |
[how_many_times_h13_2]
Show the field ONLY if:
[h13_wheezing_or_whistling_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
299 |
[h14_nasal_congestion_runny_2]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
300 |
[when_h14_2]
Show the field ONLY if:
[h14_nasal_congestion_runny_2] = "1"
|
When
कब
|
text |
|
|
301 |
[how_many_times_h14_2]
Show the field ONLY if:
[h14_nasal_congestion_runny_2] = "1"
|
How many times
कितनी बार
|
text |
|
|
302 |
[h15_vomiting_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
303 |
[when_h15_2]
Show the field ONLY if:
[h15_vomiting_2] ="1"
|
When
कब
|
text |
|
|
304 |
[how_many_times_h15_2]
Show the field ONLY if:
[h15_vomiting_2] ="1"
|
How many times
कितनी बार
|
text |
|
|
305 |
[alcohol_locally_fermented_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
306 |
[who_consumes_alcohol_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not Applicable |
|
|
|
307 |
[do_you_consume_alcohol_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you consume alcohol? |
yesno, Required |
|
|
308 |
[how_do_you_consume_2]
Show the field ONLY if:
[do_you_consume_alcohol_2] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
309 |
[at_what_age_did_you_start_2]
Show the field ONLY if:
[do_you_consume_alcohol_2] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
310 |
[frequency_of_alcohol_consu_2]
Show the field ONLY if:
[how_do_you_consume_2] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
311 |
[quantity_of_alcohol_consum_2]
Show the field ONLY if:
[how_do_you_consume_2] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
312 |
[do_you_take_during_pregnan_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
313 |
[frequency_per_day_during_p_2]
Show the field ONLY if:
[do_you_take_during_pregnan_2] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
314 |
[tobacco_pan_chewing_smokin_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
315 |
[who_consumes_tobacco_pan_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not applicable |
|
|
|
316 |
[do_you_consume_tobacco_pan_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
317 |
[how_do_you_consume_tobacco_2]
Show the field ONLY if:
[do_you_consume_tobacco_pan_2] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
318 |
[what_form_of_tobacco_pan_d_2]
Show the field ONLY if:
[do_you_consume_tobacco_pan_2] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d_2___1 | Chewing | | 2 | what_form_of_tobacco_pan_d_2___2 | Smoking | | 3 | what_form_of_tobacco_pan_d_2___3 | Beedi | | 4 | what_form_of_tobacco_pan_d_2___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d_2___5 | Zarda | | 6 | what_form_of_tobacco_pan_d_2___6 | Other (please specify) |
|
|
|
319 |
[other_specify_2]
Show the field ONLY if:
[what_form_of_tobacco_pan_d(6)] = '1'
|
Other Specify |
text |
|
|
320 |
[at_what_age_did_you_tobacco_2]
Show the field ONLY if:
[do_you_consume_tobacco_pan_2] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
321 |
[frequency_of_tobacco_pan_c_2]
Show the field ONLY if:
[how_do_you_consume_tobacco_2] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
322 |
[quantity_consumed_per_day_2]
Show the field ONLY if:
[how_do_you_consume_tobacco_2] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
323 |
[do_you_take_tobacco_pan_du_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
324 |
[frequency_per_day_tobaco_pre_2]
Show the field ONLY if:
[do_you_take_tobacco_pan_du_2] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
325 |
[other_drugs_charas_ganja_b_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
326 |
[who_consumes_other_drugs_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
327 |
[do_you_consume_other_drugs_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you consume other drugs? |
yesno, Required |
|
|
328 |
[how_do_you_consume_other_d_2]
Show the field ONLY if:
[do_you_consume_other_drugs_2] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
329 |
[what_type_of_drug_do_you_u_2]
Show the field ONLY if:
[do_you_consume_other_drugs_2] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u_2___1 | Charas | | 2 | what_type_of_drug_do_you_u_2___2 | Ganja | | 3 | what_type_of_drug_do_you_u_2___3 | Bhang | | 4 | what_type_of_drug_do_you_u_2___4 | Opium | | 5 | what_type_of_drug_do_you_u_2___5 | LSD | | 6 | what_type_of_drug_do_you_u_2___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u_2___7 | Other (please specify) |
|
|
|
330 |
[specify_other_drug_2]
Show the field ONLY if:
[what_type_of_drug_do_you_u(7)] = '1'
|
Specify Other |
text |
|
|
331 |
[at_what_age_did_you_star_drug_2]
Show the field ONLY if:
[do_you_consume_other_drugs_2] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
332 |
[frequency_of_drug_consumpt_2]
Show the field ONLY if:
[how_do_you_consume_other_d_2] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
333 |
[quantity_consumed_per_day_drug_2]
Show the field ONLY if:
[how_do_you_consume_other_d_2] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
334 |
[do_you_take_drugs_during_p_2]
Show the field ONLY if:
[no_of_family_member] >= 2
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
335 |
[frequency_per_day_during_drug_2]
Show the field ONLY if:
[do_you_take_drugs_during_p_2] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
336 |
[third_family_member]
Show the field ONLY if:
[no_of_family_member] >= 3
|
THIRD FAMILY MEMBER |
descriptive |
|
|
337 |
[sex_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Sex
लिंग
|
radio, Required |
|
|
338 |
[specify_other_3]
Show the field ONLY if:
[sex_3] = '3'
|
Specify other |
text |
|
|
339 |
[age_year_month_days_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
340 |
[relationship_with_ego_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
341 |
[present_marital_status_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
342 |
[educational_status_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
343 |
[occupational_status_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
344 |
[any_kind_of_illness_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
345 |
[name_of_illness_3]
Show the field ONLY if:
[any_kind_of_illness_3] = '1'
|
Name of illness |
text, Required |
|
|
346 |
[duration_of_illness_3]
Show the field ONLY if:
[any_kind_of_illness_3] = '1'
|
Duration of illness |
text |
|
|
347 |
[any_treatment_given_3]
Show the field ONLY if:
[any_kind_of_illness_3] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
348 |
[if_yes_what_3]
Show the field ONLY if:
[any_treatment_given_3] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
349 |
[nutritional_status_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Nutritional Status |
descriptive |
|
|
350 |
[dietary_habit_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
351 |
[amount_consumed_water_l_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
352 |
[no_of_full_meals_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
353 |
[frequency_non_vegetaria_3]
Show the field ONLY if:
[dietary_habit_3] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
354 |
[frequency_of_vegetarian_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
355 |
[frequency_milk_products_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
356 |
[frequency_of_pulses_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
357 |
[frequency_of_fruits_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
358 |
[any_other_specific_diet_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
359 |
[any_illness_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Any Illnessकोई बीमारी |
descriptive |
|
|
360 |
[nutritional_deficiency_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
361 |
[which_type_of_nutritional_3]
Show the field ONLY if:
[nutritional_deficiency_3] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
362 |
[age_at_nurition_def_3]
Show the field ONLY if:
[nutritional_deficiency_3] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
363 |
[duration_nutrient_def_3]
Show the field ONLY if:
[nutritional_deficiency_3] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
364 |
[physical_disability_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
365 |
[which_type_of_physical_dis_3]
Show the field ONLY if:
[physical_disability_3] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
366 |
[duration_how_long_physical_3]
Show the field ONLY if:
[physical_disability_3] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
367 |
[emotional_impairment_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
368 |
[which_type_of_emotional_im_3]
Show the field ONLY if:
[emotional_impairment_3] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
369 |
[duration_how_long_emontiona_3]
Show the field ONLY if:
[emotional_impairment_3] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
370 |
[major_therapeutic_irradiat_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
371 |
[which_type_of_major_therap_3]
Show the field ONLY if:
[major_therapeutic_irradiat_3] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
372 |
[duration_how_long_major_3]
Show the field ONLY if:
[major_therapeutic_irradiat_3] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
373 |
[long_illness_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
374 |
[which_type_of_long_illness_3]
Show the field ONLY if:
[long_illness_3] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
375 |
[duration_how_long_ilness_3]
Show the field ONLY if:
[long_illness_3] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
376 |
[g_have_you_ever_been_diagn_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
377 |
[heart_failure_disease_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
378 |
[type_heart_disesae_3]
Show the field ONLY if:
[heart_failure_disease_3] = '1'
|
Type
प्रकार
|
text |
|
|
379 |
[age_heart_faliour_3]
Show the field ONLY if:
[heart_failure_disease_3] = '1'
|
Age
आयु
|
text (number) |
|
|
380 |
[irritable_bowel_disease_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
381 |
[type_irritable_bowel_3]
Show the field ONLY if:
[irritable_bowel_disease_3] = '1'
|
Type
प्रकार
|
text |
|
|
382 |
[age_bowel_disease_3]
Show the field ONLY if:
[irritable_bowel_disease_3] = '1'
|
Age
आयु
|
text (number) |
|
|
383 |
[chronic_bronchitis_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
384 |
[type_bronchitis_3]
Show the field ONLY if:
[chronic_bronchitis_3] = '1'
|
Type
प्रकार
|
text |
|
|
385 |
[age_bronchitis_3]
Show the field ONLY if:
[chronic_bronchitis_3] = '1'
|
Age
आयु
|
text (number) |
|
|
386 |
[hernia_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Hernia
हरनिया
|
yesno, Required |
|
|
387 |
[type_hernia_3]
Show the field ONLY if:
[hernia_3] = '1'
|
Type
प्रकार
|
text |
|
|
388 |
[age_hernia_3]
Show the field ONLY if:
[hernia_3] = '1'
|
Age
आयु
|
text (number) |
|
|
389 |
[emphysema_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
390 |
[type_endometriosis_3]
Show the field ONLY if:
[emphysema_3] = '1'
|
Type
प्रकार
|
text |
|
|
391 |
[age_endometriosis_3]
Show the field ONLY if:
[emphysema_3] = '1'
|
Age
आयु
|
text (number) |
|
|
392 |
[arthritis_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Arthritis
वात रोग
|
yesno, Required |
|
|
393 |
[type_arthritis_3]
Show the field ONLY if:
[arthritis_3] = '1'
|
Type
प्रकार
|
text |
|
|
394 |
[age_arthritis_3]
Show the field ONLY if:
[arthritis_3] = '1'
|
Age
आयु
|
text (number) |
|
|
395 |
[inflammatory_bowel_disease_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
396 |
[type_inflammatory_bowel_3]
Show the field ONLY if:
[inflammatory_bowel_disease_3] = '1'
|
Type
प्रकार
|
text |
|
|
397 |
[age_inflammatory_bowel_disease_3]
Show the field ONLY if:
[inflammatory_bowel_disease_3] = '1'
|
Age
आयु
|
text, Required |
|
|
398 |
[depression_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Depression
अवसाद
|
yesno, Required |
|
|
399 |
[type_depression_3]
Show the field ONLY if:
[depression_3] = '1'
|
Type
प्रकार
|
text |
|
|
400 |
[age_depression_3]
Show the field ONLY if:
[depression_3] = '1'
|
Age
आयु
|
text (number) |
|
|
401 |
[cancer_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Cancer
कैंसर
|
yesno, Required |
|
|
402 |
[type_cancer_3]
Show the field ONLY if:
[cancer_3] = '1'
|
Type
प्रकार
|
text |
|
|
403 |
[age_cancer_3]
Show the field ONLY if:
[cancer_3] = '1'
|
Age
आयु
|
text (number) |
|
|
404 |
[have_you_been_diagnose_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
405 |
[age_at_diagnosis_g15]
Show the field ONLY if:
[have_you_been_diagnose_3] = "1"
|
Age at diagnosis: |
text |
|
|
406 |
[g12_have_you_been_diagnose_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
407 |
[age_at_diagnosis_g_14]
Show the field ONLY if:
[g12_have_you_been_diagnose_3] = "1"
|
Age at diagnosis:
|
text |
|
|
408 |
[g13_have_you_been_diagnose_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
409 |
[age_at_diagnosis_g16]
Show the field ONLY if:
[g13_have_you_been_diagnose_3] = "1"
|
Age at diagnosis: |
text |
|
|
410 |
[h_have_you_or_your_family_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
411 |
[high_fever_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
412 |
[when_highg_fever_3]
Show the field ONLY if:
[high_fever_3] = "1"
|
When
कब
|
text |
|
|
413 |
[how_many_times_fever_3]
Show the field ONLY if:
[high_fever_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
414 |
[weakness_and_fatigue_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
415 |
[when_weakness_3]
Show the field ONLY if:
[weakness_and_fatigue_3] = "1"
|
When
कब
|
text |
|
|
416 |
[how_many_times_weakness_3]
Show the field ONLY if:
[weakness_and_fatigue_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
417 |
[muscle_ache_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
418 |
[when_muscle_3]
Show the field ONLY if:
[muscle_ache_3] = "1"
|
When
कब
|
text |
|
|
419 |
[how_many_times_muscle_3]
Show the field ONLY if:
[muscle_ache_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
420 |
[stomach_pain_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
421 |
[when_stomach_3]
Show the field ONLY if:
[stomach_pain_3] = "1"
|
When
कब
|
text |
|
|
422 |
[how_many_times_stomach_3]
Show the field ONLY if:
[stomach_pain_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
423 |
[loss_of_appetite_and_weigh_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
424 |
[when_appetite_3]
Show the field ONLY if:
[loss_of_appetite_and_weigh_3] ="1"
|
When
कब
|
text |
|
|
425 |
[how_many_times_appetite_3]
Show the field ONLY if:
[loss_of_appetite_and_weigh_3] ="1"
|
How many times
कितनी बार
|
text |
|
|
426 |
[dry_cough_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
427 |
[when_dry_cough_3]
Show the field ONLY if:
[dry_cough_3] = "1"
|
When
कब
|
text |
|
|
428 |
[how_many_times_dry_cough_3]
Show the field ONLY if:
[dry_cough_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
429 |
[diarrhoea_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
430 |
[when_diarrhoea_3]
Show the field ONLY if:
[diarrhoea_3] = "1"
|
When
कब
|
text |
|
|
431 |
[how_many_times_diarrheaea_3]
Show the field ONLY if:
[diarrhoea_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
432 |
[hair_fall_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
433 |
[when_hair_fall_3]
Show the field ONLY if:
[hair_fall_3] = '1'
|
When
कब
|
text |
|
|
434 |
[how_many_times_hair_fall_3]
Show the field ONLY if:
[hair_fall_3] = '1'
|
How many times
कितनी बार
|
text |
|
|
435 |
[itching_and_rashes_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
436 |
[when_itching_3]
Show the field ONLY if:
[itching_and_rashes_3] = "1"
|
When
कब
|
text |
|
|
437 |
[how_many_times_itching_3]
Show the field ONLY if:
[itching_and_rashes_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
438 |
[headaches_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
439 |
[when_headaches_3]
Show the field ONLY if:
[headaches_3] = "1"
|
When
कब
|
text |
|
|
440 |
[how_many_times_headaches_3]
Show the field ONLY if:
[headaches_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
441 |
[eye_pain_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
442 |
[when_eye_pain_3]
Show the field ONLY if:
[eye_pain_3] = "1"
|
When
कब
|
text |
|
|
443 |
[how_many_times_eyepain_3]
Show the field ONLY if:
[eye_pain_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
444 |
[h12_shortness_of_breath_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
445 |
[when_h12_3]
Show the field ONLY if:
[h12_shortness_of_breath_3] ="1"
|
When
कब
|
text |
|
|
446 |
[how_many_times_h12_3]
Show the field ONLY if:
[h12_shortness_of_breath_3] ="1"
|
How many times
कितनी बार
|
text |
|
|
447 |
[h13_wheezing_or_whistling_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
448 |
[when_h13_3]
Show the field ONLY if:
[h13_wheezing_or_whistling_3] = "1"
|
When
कब
|
text |
|
|
449 |
[how_many_times_h13_3]
Show the field ONLY if:
[h13_wheezing_or_whistling_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
450 |
[h14_nasal_congestion_runny_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
451 |
[when_h14_3]
Show the field ONLY if:
[h14_nasal_congestion_runny_3] = "1"
|
When
कब
|
text |
|
|
452 |
[how_many_times_h14_3]
Show the field ONLY if:
[h14_nasal_congestion_runny_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
453 |
[h15_vomiting_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
454 |
[when_h15_3]
Show the field ONLY if:
[h15_vomiting_3] = "1"
|
When
कब
|
text |
|
|
455 |
[how_many_times_h15_3]
Show the field ONLY if:
[h15_vomiting_3] = "1"
|
How many times
कितनी बार
|
text |
|
|
456 |
[alcohol_locally_fermented_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
457 |
[who_consumes_alcohol_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not Applicable |
|
|
|
458 |
[do_you_consume_alcohol_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you consume alcohol? |
yesno, Required |
|
|
459 |
[how_do_you_consume_3]
Show the field ONLY if:
[do_you_consume_alcohol_3] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
460 |
[at_what_age_did_you_start_3]
Show the field ONLY if:
[do_you_consume_alcohol_3] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
461 |
[frequency_of_alcohol_consu_3]
Show the field ONLY if:
[how_do_you_consume_3] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
462 |
[quantity_of_alcohol_consum_3]
Show the field ONLY if:
[how_do_you_consume_3] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
463 |
[do_you_take_during_pregnan_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
464 |
[frequency_per_day_during_p_3]
Show the field ONLY if:
[do_you_take_during_pregnan_3] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
465 |
[tobacco_pan_chewing_smokin_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
466 |
[who_consumes_tobacco_pan_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
467 |
[do_you_consume_tobacco_pan_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
468 |
[how_do_you_consume_tobacco_3]
Show the field ONLY if:
[do_you_consume_tobacco_pan_3] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
469 |
[what_form_of_tobacco_pan_d_3]
Show the field ONLY if:
[do_you_consume_tobacco_pan_3] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d_3___1 | Chewing | | 2 | what_form_of_tobacco_pan_d_3___2 | Smoking | | 3 | what_form_of_tobacco_pan_d_3___3 | Beedi | | 4 | what_form_of_tobacco_pan_d_3___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d_3___5 | Zarda | | 6 | what_form_of_tobacco_pan_d_3___6 | Other (please specify) |
|
|
|
470 |
[other_specify_3]
Show the field ONLY if:
[what_form_of_tobacco_pan_d_3(6)] = '1'
|
Other Specify |
text |
|
|
471 |
[at_what_age_did_you_tobacco_3]
Show the field ONLY if:
[do_you_consume_tobacco_pan_3] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
472 |
[frequency_of_tobacco_pan_c_3]
Show the field ONLY if:
[how_do_you_consume_tobacco_3] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
473 |
[quantity_consumed_per_day_3]
Show the field ONLY if:
[how_do_you_consume_tobacco_3] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
474 |
[do_you_take_tobacco_pan_du_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
475 |
[frequency_per_day_tobaco_pre_3]
Show the field ONLY if:
[do_you_take_tobacco_pan_du_3] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
476 |
[other_drugs_charas_ganja_b_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
477 |
[who_consumes_other_drugs_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
478 |
[do_you_consume_other_drugs_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you consume other drugs? |
yesno, Required |
|
|
479 |
[how_do_you_consume_other_d_3]
Show the field ONLY if:
[do_you_consume_other_drugs_3] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
480 |
[what_type_of_drug_do_you_u_3]
Show the field ONLY if:
[do_you_consume_other_drugs_3] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u_3___1 | Charas | | 2 | what_type_of_drug_do_you_u_3___2 | Ganja | | 3 | what_type_of_drug_do_you_u_3___3 | Bhang | | 4 | what_type_of_drug_do_you_u_3___4 | Opium | | 5 | what_type_of_drug_do_you_u_3___5 | LSD | | 6 | what_type_of_drug_do_you_u_3___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u_3___7 | Other (please specify) |
|
|
|
481 |
[specify_other_drug_3]
Show the field ONLY if:
[what_type_of_drug_do_you_u_3(7)] = '1'
|
Specify Other |
text |
|
|
482 |
[at_what_age_did_you_star_drug_3]
Show the field ONLY if:
[do_you_consume_other_drugs_3] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
483 |
[frequency_of_drug_consumpt_3]
Show the field ONLY if:
[how_do_you_consume_other_d_3] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
484 |
[quantity_consumed_per_day_drug_3]
Show the field ONLY if:
[how_do_you_consume_other_d_3] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
485 |
[do_you_take_drugs_during_p_3]
Show the field ONLY if:
[no_of_family_member] >= 3
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
486 |
[frequency_per_day_during_drug_3]
Show the field ONLY if:
[do_you_take_drugs_during_p_3] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
487 |
[fourth_family_member]
Show the field ONLY if:
[no_of_family_member] >= 4
|
FOURTH FAMILY MEMBER |
descriptive |
|
|
488 |
[sex_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Sex
लिंग
|
radio, Required |
|
|
489 |
[specify_other_4]
Show the field ONLY if:
[sex_4] = '3'
|
Specify other |
text |
|
|
490 |
[age_year_month_days_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
491 |
[relationship_with_ego_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
492 |
[present_marital_status_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
493 |
[educational_status_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
494 |
[occupational_status_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
495 |
[any_kind_of_illness_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
496 |
[name_of_illness_4]
Show the field ONLY if:
[any_kind_of_illness_4] = '1'
|
Name of illness |
text, Required |
|
|
497 |
[duration_of_illness_4]
Show the field ONLY if:
[any_kind_of_illness_4] = '1'
|
Duration of illness |
text |
|
|
498 |
[any_treatment_given_4]
Show the field ONLY if:
[any_kind_of_illness_4] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
499 |
[if_yes_what_4]
Show the field ONLY if:
[any_treatment_given_4] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
500 |
[nutritional_status_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Nutritional Status |
descriptive |
|
|
501 |
[dietary_habit_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
502 |
[amount_consumed_water_l_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
503 |
[no_of_full_meals_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
504 |
[frequency_non_vegetaria_4]
Show the field ONLY if:
[dietary_habit_4] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
505 |
[frequency_of_vegetarian_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
506 |
[frequency_milk_products_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
507 |
[frequency_of_pulses_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
508 |
[frequency_of_fruits_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
509 |
[any_other_specific_diet_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
510 |
[any_illness_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Any Illnessकोई बीमारी |
descriptive |
|
|
511 |
[nutritional_deficiency_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
512 |
[which_type_of_nutritional_4]
Show the field ONLY if:
[nutritional_deficiency_4] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
513 |
[age_at_nurition_def_4]
Show the field ONLY if:
[nutritional_deficiency_4] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
514 |
[duration_nutrient_def_4]
Show the field ONLY if:
[nutritional_deficiency_4] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
515 |
[physical_disability_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
516 |
[which_type_of_physical_dis_4]
Show the field ONLY if:
[physical_disability_4] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
517 |
[duration_how_long_physical_4]
Show the field ONLY if:
[physical_disability_4] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
518 |
[emotional_impairment_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
519 |
[which_type_of_emotional_im_4]
Show the field ONLY if:
[emotional_impairment_4] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
520 |
[duration_how_long_emontiona_4]
Show the field ONLY if:
[emotional_impairment_4] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
521 |
[major_therapeutic_irradiat_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
522 |
[which_type_of_major_therap_4]
Show the field ONLY if:
[major_therapeutic_irradiat_4] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
523 |
[duration_how_long_major_4]
Show the field ONLY if:
[major_therapeutic_irradiat_4] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
524 |
[long_illness_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
525 |
[which_type_of_long_illness_4]
Show the field ONLY if:
[long_illness_4] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
526 |
[duration_how_long_ilness_4]
Show the field ONLY if:
[long_illness_4] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
527 |
[g_have_you_ever_been_diagn_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
528 |
[heart_failure_disease_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
529 |
[type_heart_disesae_4]
Show the field ONLY if:
[heart_failure_disease_4] = '1'
|
Type
प्रकार
|
text |
|
|
530 |
[age_heart_faliour_4]
Show the field ONLY if:
[heart_failure_disease_4] = '1'
|
Age
आयु
|
text (number) |
|
|
531 |
[irritable_bowel_disease_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
532 |
[type_irritable_bowel_4]
Show the field ONLY if:
[irritable_bowel_disease_4] = '1'
|
Type
प्रकार
|
text |
|
|
533 |
[age_bowel_disease_4]
Show the field ONLY if:
[irritable_bowel_disease_4] = '1'
|
Age
आयु
|
text (number) |
|
|
534 |
[chronic_bronchitis_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
535 |
[type_bronchitis_4]
Show the field ONLY if:
[chronic_bronchitis_4] = '1'
|
Type
प्रकार
|
text |
|
|
536 |
[age_bronchitis_4]
Show the field ONLY if:
[chronic_bronchitis_4] = '1'
|
Age
आयु
|
text (number) |
|
|
537 |
[hernia_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Hernia
हरनिया
|
yesno, Required |
|
|
538 |
[type_hernia_4]
Show the field ONLY if:
[hernia_4] = '1'
|
Type
प्रकार
|
text |
|
|
539 |
[age_hernia_4]
Show the field ONLY if:
[hernia_4] = '1'
|
Age
आयु
|
text (number) |
|
|
540 |
[emphysema_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
541 |
[type_endometriosis_4]
Show the field ONLY if:
[emphysema_4] = '1'
|
Type
प्रकार
|
text |
|
|
542 |
[age_endometriosis_4]
Show the field ONLY if:
[emphysema_4] = '1'
|
Age
आयु
|
text (number) |
|
|
543 |
[arthritis_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Arthritis
वात रोग
|
yesno, Required |
|
|
544 |
[type_arthritis_4]
Show the field ONLY if:
[arthritis_4] = '1'
|
Type
प्रकार
|
text |
|
|
545 |
[age_arthritis_4]
Show the field ONLY if:
[arthritis_4] = '1'
|
Age
आयु
|
text (number) |
|
|
546 |
[inflammatory_bowel_disease_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
547 |
[type_inflammatory_bowel_4]
Show the field ONLY if:
[inflammatory_bowel_disease_4] = '1'
|
Type
प्रकार
|
text |
|
|
548 |
[age_inflammatory_bowel_disease_4]
Show the field ONLY if:
[inflammatory_bowel_disease_4] = '1'
|
Age
आयु
|
text, Required |
|
|
549 |
[depression_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Depression
अवसाद
|
yesno, Required |
|
|
550 |
[type_depression_4]
Show the field ONLY if:
[depression_4] = '1'
|
Type
प्रकार
|
text |
|
|
551 |
[age_depression_4]
Show the field ONLY if:
[depression_4] = '1'
|
Age
आयु
|
text (number) |
|
|
552 |
[cancer_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Cancer
कैंसर
|
yesno, Required |
|
|
553 |
[type_cancer_4]
Show the field ONLY if:
[cancer_4] = '1'
|
Type
प्रकार
|
text |
|
|
554 |
[age_cancer_4]
Show the field ONLY if:
[cancer_4] = '1'
|
Age
आयु
|
text (number) |
|
|
555 |
[have_you_been_diagnose_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
556 |
[age_at_diagnosis_g17]
Show the field ONLY if:
[have_you_been_diagnose_4] = "1"
|
Age at diagnosis: |
text |
|
|
557 |
[g12_have_you_been_diagnose_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
558 |
[age_at_diagnosis_g_15]
Show the field ONLY if:
[g12_have_you_been_diagnose_4] = "1"
|
Age at diagnosis:
|
text |
|
|
559 |
[g13_have_you_been_diagnose_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
560 |
[age_at_diagnosis_g18]
Show the field ONLY if:
[g13_have_you_been_diagnose_4] = "1"
|
Age at diagnosis: |
text |
|
|
561 |
[h_have_you_or_your_family_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
562 |
[high_fever_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
563 |
[when_highg_fever_4]
Show the field ONLY if:
[high_fever_4] = '1'
|
When
कब
|
text |
|
|
564 |
[how_many_times_fever_4]
Show the field ONLY if:
[high_fever_4] = '1'
|
How many times
कितनी बार
|
text |
|
|
565 |
[weakness_and_fatigue_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
566 |
[when_weakness_4]
Show the field ONLY if:
[weakness_and_fatigue_4] = "1"
|
When
कब
|
text |
|
|
567 |
[how_many_times_weakness_4]
Show the field ONLY if:
[weakness_and_fatigue_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
568 |
[muscle_ache_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
569 |
[when_muscle_4]
Show the field ONLY if:
[muscle_ache_4] = "1"
|
When
कब
|
text |
|
|
570 |
[how_many_times_muscle_4]
Show the field ONLY if:
[muscle_ache_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
571 |
[stomach_pain_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
572 |
[when_stomach_4]
Show the field ONLY if:
[stomach_pain_4] = "1"
|
When
कब
|
text |
|
|
573 |
[how_many_times_stomach_4]
Show the field ONLY if:
[stomach_pain_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
574 |
[loss_of_appetite_and_weigh_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
575 |
[when_appetite_4]
Show the field ONLY if:
[loss_of_appetite_and_weigh_4] ="1"
|
When
कब
|
text |
|
|
576 |
[how_many_times_appetite_4]
Show the field ONLY if:
[loss_of_appetite_and_weigh_4] ="1"
|
How many times
कितनी बार
|
text |
|
|
577 |
[dry_cough_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
578 |
[when_dry_cough_4]
Show the field ONLY if:
[dry_cough_4] = "1"
|
When
कब
|
text |
|
|
579 |
[how_many_times_dry_cough_4]
Show the field ONLY if:
[dry_cough_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
580 |
[diarrhoea_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
581 |
[when_diarrhoea_4]
Show the field ONLY if:
[diarrhoea_4] = "1"
|
When
कब
|
text |
|
|
582 |
[how_many_times_diarrheaea_4]
Show the field ONLY if:
[diarrhoea_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
583 |
[hair_fall_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
584 |
[when_hair_fall_4]
Show the field ONLY if:
[hair_fall_4] = '1'
|
When
कब
|
text |
|
|
585 |
[how_many_times_hair_fall_4]
Show the field ONLY if:
[hair_fall_4] = '1'
|
How many times
कितनी बार
|
text |
|
|
586 |
[itching_and_rashes_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
587 |
[when_itching_4]
Show the field ONLY if:
[itching_and_rashes_4] = "1"
|
When
कब
|
text |
|
|
588 |
[how_many_times_itching_4]
Show the field ONLY if:
[itching_and_rashes_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
589 |
[headaches_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
590 |
[when_headaches_4]
Show the field ONLY if:
[headaches_4] = "1"
|
When
कब
|
text |
|
|
591 |
[how_many_times_headaches_4]
Show the field ONLY if:
[headaches_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
592 |
[eye_pain_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
593 |
[when_eye_pain_4]
Show the field ONLY if:
[eye_pain_4] = "1"
|
When
कब
|
text |
|
|
594 |
[how_many_times_eyepain_4]
Show the field ONLY if:
[eye_pain_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
595 |
[h12_shortness_of_breath_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
596 |
[when_h12_4]
Show the field ONLY if:
[h12_shortness_of_breath_4] = "1"
|
When
कब
|
text |
|
|
597 |
[how_many_times_h12_4]
Show the field ONLY if:
[h12_shortness_of_breath_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
598 |
[h13_wheezing_or_whistling_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
599 |
[when_h13_4]
Show the field ONLY if:
[h13_wheezing_or_whistling_4] = "1"
|
When
कब
|
text |
|
|
600 |
[how_many_times_h13_4]
Show the field ONLY if:
[h13_wheezing_or_whistling_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
601 |
[h14_nasal_congestion_runny_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
602 |
[when_h14_4]
Show the field ONLY if:
[h14_nasal_congestion_runny_4] = "1"
|
When
कब
|
text |
|
|
603 |
[how_many_times_h14_4]
Show the field ONLY if:
[h14_nasal_congestion_runny_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
604 |
[h15_vomiting_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
605 |
[when_h15_4]
Show the field ONLY if:
[h15_vomiting_4] = "1"
|
When
कब
|
text |
|
|
606 |
[how_many_times_h15_4]
Show the field ONLY if:
[h15_vomiting_4] = "1"
|
How many times
कितनी बार
|
text |
|
|
607 |
[alcohol_locally_fermented_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
608 |
[who_consumes_alcohol_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not Applicable |
|
|
|
609 |
[do_you_consume_alcohol_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you consume alcohol? |
yesno, Required |
|
|
610 |
[how_do_you_consume_4]
Show the field ONLY if:
[do_you_consume_alcohol_4] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
611 |
[at_what_age_did_you_start_4]
Show the field ONLY if:
[do_you_consume_alcohol_4] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
612 |
[frequency_of_alcohol_consu_4]
Show the field ONLY if:
[how_do_you_consume_4] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
613 |
[quantity_of_alcohol_consum_4]
Show the field ONLY if:
[how_do_you_consume_4] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
614 |
[do_you_take_during_pregnan_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
615 |
[frequency_per_day_during_p_4]
Show the field ONLY if:
[do_you_take_during_pregnan_4] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
616 |
[tobacco_pan_chewing_smokin_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
617 |
[who_consumes_tobacco_pan_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not applicable |
|
|
|
618 |
[do_you_consume_tobacco_pan_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
619 |
[how_do_you_consume_tobacco_4]
Show the field ONLY if:
[do_you_consume_tobacco_pan_4] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
620 |
[what_form_of_tobacco_pan_d_4]
Show the field ONLY if:
[do_you_consume_tobacco_pan_4] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d_4___1 | Chewing | | 2 | what_form_of_tobacco_pan_d_4___2 | Smoking | | 3 | what_form_of_tobacco_pan_d_4___3 | Beedi | | 4 | what_form_of_tobacco_pan_d_4___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d_4___5 | Zarda | | 6 | what_form_of_tobacco_pan_d_4___6 | Other (please specify) |
|
|
|
621 |
[other_specify_4]
Show the field ONLY if:
[what_form_of_tobacco_pan_d_4(6)] = '1'
|
Other Specify |
text |
|
|
622 |
[at_what_age_did_you_tobacco_4]
Show the field ONLY if:
[do_you_consume_tobacco_pan_4] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
623 |
[frequency_of_tobacco_pan_c_4]
Show the field ONLY if:
[how_do_you_consume_tobacco_4] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
624 |
[quantity_consumed_per_day_4]
Show the field ONLY if:
[how_do_you_consume_tobacco_4] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
625 |
[do_you_take_tobacco_pan_du_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
626 |
[frequency_per_day_tobaco_pre_4]
Show the field ONLY if:
[do_you_take_tobacco_pan_du_4] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
627 |
[other_drugs_charas_ganja_b_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
628 |
[who_consumes_other_drugs_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
629 |
[do_you_consume_other_drugs_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you consume other drugs? |
yesno, Required |
|
|
630 |
[how_do_you_consume_other_d_4]
Show the field ONLY if:
[do_you_consume_other_drugs_4] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
631 |
[what_type_of_drug_do_you_u_4]
Show the field ONLY if:
[do_you_consume_other_drugs_4] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u_4___1 | Charas | | 2 | what_type_of_drug_do_you_u_4___2 | Ganja | | 3 | what_type_of_drug_do_you_u_4___3 | Bhang | | 4 | what_type_of_drug_do_you_u_4___4 | Opium | | 5 | what_type_of_drug_do_you_u_4___5 | LSD | | 6 | what_type_of_drug_do_you_u_4___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u_4___7 | Other (please specify) |
|
|
|
632 |
[specify_other_drug_4]
Show the field ONLY if:
[what_type_of_drug_do_you_u_4(7)] = '1'
|
Specify Other |
text |
|
|
633 |
[at_what_age_did_you_star_drug_4]
Show the field ONLY if:
[do_you_consume_other_drugs_4] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
634 |
[frequency_of_drug_consumpt_4]
Show the field ONLY if:
[how_do_you_consume_other_d_4] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
635 |
[quantity_consumed_per_day_drug_4]
Show the field ONLY if:
[how_do_you_consume_other_d_4] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
636 |
[do_you_take_drugs_during_p_4]
Show the field ONLY if:
[no_of_family_member] >= 4
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
637 |
[frequency_per_day_during_drug_4]
Show the field ONLY if:
[do_you_take_drugs_during_p_4] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
638 |
[fifth_family_member]
Show the field ONLY if:
[no_of_family_member] >= 5
|
FIFTH FAMILY MEMBER |
descriptive |
|
|
639 |
[sex_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Sex
लिंग
|
radio, Required |
|
|
640 |
[specify_other_5]
Show the field ONLY if:
[sex_5] = '3'
|
Specify other |
text |
|
|
641 |
[age_year_month_days_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
642 |
[relationship_with_ego_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
643 |
[present_marital_status_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
644 |
[educational_status_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
645 |
[occupational_status_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
646 |
[any_kind_of_illness_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
647 |
[name_of_illness_5]
Show the field ONLY if:
[any_kind_of_illness_5] = '1'
|
Name of illness |
text, Required |
|
|
648 |
[duration_of_illness_5]
Show the field ONLY if:
[any_kind_of_illness_5] = '1'
|
Duration of illness |
text |
|
|
649 |
[any_treatment_given_5]
Show the field ONLY if:
[any_kind_of_illness_5] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
650 |
[if_yes_what_5]
Show the field ONLY if:
[any_treatment_given_5] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
651 |
[nutritional_status_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Nutritional Status |
descriptive |
|
|
652 |
[dietary_habit_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
653 |
[amount_consumed_water_l_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
654 |
[no_of_full_meals_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
655 |
[frequency_non_vegetaria_5]
Show the field ONLY if:
[dietary_habit_5] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
656 |
[frequency_of_vegetarian_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
657 |
[frequency_milk_products_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
658 |
[frequency_of_pulses_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
659 |
[frequency_of_fruits_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
660 |
[any_other_specific_diet_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
661 |
[any_illness_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Any Illnessकोई बीमारी |
descriptive |
|
|
662 |
[nutritional_deficiency_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
663 |
[which_type_of_nutritional_5]
Show the field ONLY if:
[nutritional_deficiency_5] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
664 |
[age_at_nurition_def_5]
Show the field ONLY if:
[nutritional_deficiency_5] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
665 |
[duration_nutrient_def_5]
Show the field ONLY if:
[nutritional_deficiency_5] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
666 |
[physical_disability_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
667 |
[which_type_of_physical_dis_5]
Show the field ONLY if:
[physical_disability_5] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
668 |
[duration_how_long_physical_5]
Show the field ONLY if:
[physical_disability_5] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
669 |
[emotional_impairment_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
670 |
[which_type_of_emotional_im_5]
Show the field ONLY if:
[emotional_impairment_5] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
671 |
[duration_how_long_emontiona_5]
Show the field ONLY if:
[emotional_impairment_5] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
672 |
[major_therapeutic_irradiat_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
673 |
[which_type_of_major_therap_5]
Show the field ONLY if:
[major_therapeutic_irradiat_5] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
674 |
[duration_how_long_major_5]
Show the field ONLY if:
[major_therapeutic_irradiat_5] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
675 |
[long_illness_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
676 |
[which_type_of_long_illness_5]
Show the field ONLY if:
[long_illness_5] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
677 |
[duration_how_long_ilness_5]
Show the field ONLY if:
[long_illness_5] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
678 |
[g_have_you_ever_been_diagn_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
679 |
[heart_failure_disease_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
680 |
[type_heart_disesae_5]
Show the field ONLY if:
[heart_failure_disease_5] = '1'
|
Type
प्रकार
|
text |
|
|
681 |
[age_heart_faliour_5]
Show the field ONLY if:
[heart_failure_disease_5] = '1'
|
Age
आयु
|
text (number) |
|
|
682 |
[irritable_bowel_disease_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
683 |
[type_irritable_bowel_5]
Show the field ONLY if:
[irritable_bowel_disease_5] = '1'
|
Type
प्रकार
|
text |
|
|
684 |
[age_bowel_disease_5]
Show the field ONLY if:
[irritable_bowel_disease_5] = '1'
|
Age
आयु
|
text (number) |
|
|
685 |
[chronic_bronchitis_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
686 |
[type_bronchitis_5]
Show the field ONLY if:
[chronic_bronchitis_5] = '1'
|
Type
प्रकार
|
text |
|
|
687 |
[age_bronchitis_5]
Show the field ONLY if:
[chronic_bronchitis_5] = '1'
|
Age
आयु
|
text (number) |
|
|
688 |
[hernia_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Hernia
हरनिया
|
yesno, Required |
|
|
689 |
[type_hernia_5]
Show the field ONLY if:
[hernia_5] = '1'
|
Type
प्रकार
|
text |
|
|
690 |
[age_hernia_5]
Show the field ONLY if:
[hernia_5] = '1'
|
Age
आयु
|
text (number) |
|
|
691 |
[emphysema_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
692 |
[type_endometriosis_5]
Show the field ONLY if:
[emphysema_5] = '1'
|
Type
प्रकार
|
text |
|
|
693 |
[age_endometriosis_5]
Show the field ONLY if:
[emphysema_5] = '1'
|
Age
आयु
|
text (number) |
|
|
694 |
[arthritis_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Arthritis
वात रोग
|
yesno, Required |
|
|
695 |
[type_arthritis_5]
Show the field ONLY if:
[arthritis_5] = '1'
|
Type
प्रकार
|
text |
|
|
696 |
[age_arthritis_5]
Show the field ONLY if:
[arthritis_5] = '1'
|
Age
आयु
|
text (number) |
|
|
697 |
[inflammatory_bowel_disease_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
698 |
[type_inflammatory_bowel_5]
Show the field ONLY if:
[inflammatory_bowel_disease_5] = '1'
|
Type
प्रकार
|
text |
|
|
699 |
[depression_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Depression
अवसाद
|
yesno, Required |
|
|
700 |
[type_depression_5]
Show the field ONLY if:
[depression_5] = '1'
|
Type
प्रकार
|
text |
|
|
701 |
[age_depression_5]
Show the field ONLY if:
[depression_5] = '1'
|
Age
आयु
|
text (number) |
|
|
702 |
[cancer_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Cancer
कैंसर
|
yesno, Required |
|
|
703 |
[type_cancer_5]
Show the field ONLY if:
[cancer_5] = '1'
|
Type
प्रकार
|
text |
|
|
704 |
[age_cancer_5]
Show the field ONLY if:
[cancer_5] = '1'
|
Age
आयु
|
text (number) |
|
|
705 |
[have_you_been_diagnose_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
706 |
[age_at_diagnosis_g19]
Show the field ONLY if:
[have_you_been_diagnose_5] = "1"
|
Age at diagnosis: |
text |
|
|
707 |
[g12_have_you_been_diagnose_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
708 |
[age_at_diagnosis_g_16]
Show the field ONLY if:
[g12_have_you_been_diagnose_5] = "1"
|
Age at diagnosis:
|
text |
|
|
709 |
[g13_have_you_been_diagnose_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
710 |
[age_at_diagnosis_g20]
Show the field ONLY if:
[g13_have_you_been_diagnose_5] = "1"
|
Age at diagnosis: |
text |
|
|
711 |
[h_have_you_or_your_family_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
712 |
[high_fever_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
713 |
[when_highg_fever_5]
Show the field ONLY if:
[high_fever_5] = '1'
|
When
कब
|
text |
|
|
714 |
[how_many_times_fever_5]
Show the field ONLY if:
[high_fever_5] = '1'
|
How many times
कितनी बार
|
text |
|
|
715 |
[weakness_and_fatigue_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
716 |
[when_weakness_5]
Show the field ONLY if:
[weakness_and_fatigue_5] = "1"
|
When
कब
|
text |
|
|
717 |
[how_many_times_weakness_5]
Show the field ONLY if:
[weakness_and_fatigue_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
718 |
[muscle_ache_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
719 |
[when_muscle_5]
Show the field ONLY if:
[muscle_ache_5] = "1"
|
When
कब
|
text |
|
|
720 |
[how_many_times_muscle_5]
Show the field ONLY if:
[muscle_ache_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
721 |
[stomach_pain_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
722 |
[when_stomach_5]
Show the field ONLY if:
[stomach_pain_5] = "1"
|
When
कब
|
text |
|
|
723 |
[how_many_times_stomach_5]
Show the field ONLY if:
[stomach_pain_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
724 |
[loss_of_appetite_and_weigh_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
725 |
[when_appetite_5]
Show the field ONLY if:
[loss_of_appetite_and_weigh_5] ="1"
|
When
कब
|
text |
|
|
726 |
[how_many_times_appetite_5]
Show the field ONLY if:
[loss_of_appetite_and_weigh_5] ="1"
|
How many times
कितनी बार
|
text |
|
|
727 |
[dry_cough_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
728 |
[when_dry_cough_5]
Show the field ONLY if:
[dry_cough_5] = "1"
|
When
कब
|
text |
|
|
729 |
[how_many_times_dry_cough_5]
Show the field ONLY if:
[dry_cough_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
730 |
[diarrhoea_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
731 |
[when_diarrhoea_5]
Show the field ONLY if:
[diarrhoea_5] = "1"
|
When
कब
|
text |
|
|
732 |
[how_many_times_diarrheaea_5]
Show the field ONLY if:
[diarrhoea_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
733 |
[hair_fall_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
734 |
[when_hair_fall_5]
Show the field ONLY if:
[hair_fall_5] = '1'
|
When
कब
|
text |
|
|
735 |
[how_many_times_hair_fall_5]
Show the field ONLY if:
[hair_fall_5] = '1'
|
How many times
कितनी बार
|
text |
|
|
736 |
[itching_and_rashes_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
737 |
[how_many_times_itching_5]
Show the field ONLY if:
[itching_and_rashes_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
738 |
[when_itching_5]
Show the field ONLY if:
[itching_and_rashes_5] = "1"
|
When
कब
|
text |
|
|
739 |
[headaches_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
740 |
[when_headaches_5]
Show the field ONLY if:
[headaches_5] = "1"
|
When
कब
|
text |
|
|
741 |
[how_many_times_headaches_5]
Show the field ONLY if:
[headaches_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
742 |
[eye_pain_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
743 |
[when_eye_pain_5]
Show the field ONLY if:
[eye_pain_5] = "1"
|
When
कब
|
text |
|
|
744 |
[how_many_times_eyepain_5]
Show the field ONLY if:
[eye_pain_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
745 |
[h12_shortness_of_breath_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
746 |
[when_h12_5]
Show the field ONLY if:
[h12_shortness_of_breath_5] = "1"
|
When
कब
|
text |
|
|
747 |
[how_many_times_h12_5]
Show the field ONLY if:
[h12_shortness_of_breath_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
748 |
[h13_wheezing_or_whistling_5] |
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
749 |
[when_h13_5]
Show the field ONLY if:
[h13_wheezing_or_whistling_5] = "1"
|
When
कब
|
text |
|
|
750 |
[how_many_times_h13_5]
Show the field ONLY if:
[h13_wheezing_or_whistling_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
751 |
[h14_nasal_congestion_runny_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
752 |
[when_h14_5]
Show the field ONLY if:
[h14_nasal_congestion_runny_5] = "1"
|
When
कब
|
text |
|
|
753 |
[how_many_times_h14_5]
Show the field ONLY if:
[h14_nasal_congestion_runny_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
754 |
[h15_vomiting_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
755 |
[when_h15_5]
Show the field ONLY if:
[h15_vomiting_5] = "1"
|
When
कब
|
text |
|
|
756 |
[how_many_times_h15_5]
Show the field ONLY if:
[h15_vomiting_5] = "1"
|
How many times
कितनी बार
|
text |
|
|
757 |
[alcohol_locally_fermented_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
758 |
[who_consumes_alcohol_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not Applicable |
|
|
|
759 |
[do_you_consume_alcohol_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you consume alcohol? |
yesno, Required |
|
|
760 |
[how_do_you_consume_5]
Show the field ONLY if:
[do_you_consume_alcohol_5] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
761 |
[at_what_age_did_you_start_5]
Show the field ONLY if:
[do_you_consume_alcohol_5] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
762 |
[frequency_of_alcohol_consu_5]
Show the field ONLY if:
[how_do_you_consume_5] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
763 |
[quantity_of_alcohol_consum_5]
Show the field ONLY if:
[how_do_you_consume_5] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
764 |
[do_you_take_during_pregnan_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
765 |
[frequency_per_day_during_p_5]
Show the field ONLY if:
[do_you_take_during_pregnan_5] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
766 |
[tobacco_pan_chewing_smokin_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
767 |
[who_consumes_tobacco_pan_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
768 |
[do_you_consume_tobacco_pan_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
769 |
[how_do_you_consume_tobacco_5]
Show the field ONLY if:
[do_you_consume_tobacco_pan_5] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
770 |
[what_form_of_tobacco_pan_d_5]
Show the field ONLY if:
[do_you_consume_tobacco_pan_5] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d_5___1 | Chewing | | 2 | what_form_of_tobacco_pan_d_5___2 | Smoking | | 3 | what_form_of_tobacco_pan_d_5___3 | Beedi | | 4 | what_form_of_tobacco_pan_d_5___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d_5___5 | Zarda | | 6 | what_form_of_tobacco_pan_d_5___6 | Other (please specify) |
|
|
|
771 |
[other_specify_5]
Show the field ONLY if:
[what_form_of_tobacco_pan_d_5(6)] = '1'
|
Other Specify |
text |
|
|
772 |
[at_what_age_did_you_tobacco_5]
Show the field ONLY if:
[do_you_consume_tobacco_pan_5] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
773 |
[frequency_of_tobacco_pan_c_5]
Show the field ONLY if:
[how_do_you_consume_tobacco_5] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
774 |
[quantity_consumed_per_day_5]
Show the field ONLY if:
[how_do_you_consume_tobacco_5] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
775 |
[do_you_take_tobacco_pan_du_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
776 |
[frequency_per_day_tobaco_pre_5]
Show the field ONLY if:
[do_you_take_tobacco_pan_du_5] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
777 |
[other_drugs_charas_ganja_b_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
778 |
[who_consumes_other_drugs_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
779 |
[do_you_consume_other_drugs_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you consume other drugs? |
yesno, Required |
|
|
780 |
[how_do_you_consume_other_d_5]
Show the field ONLY if:
[do_you_consume_other_drugs_5] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
781 |
[what_type_of_drug_do_you_u_5]
Show the field ONLY if:
[do_you_consume_other_drugs_5] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u_5___1 | Charas | | 2 | what_type_of_drug_do_you_u_5___2 | Ganja | | 3 | what_type_of_drug_do_you_u_5___3 | Bhang | | 4 | what_type_of_drug_do_you_u_5___4 | Opium | | 5 | what_type_of_drug_do_you_u_5___5 | LSD | | 6 | what_type_of_drug_do_you_u_5___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u_5___7 | Other (please specify) |
|
|
|
782 |
[specify_other_drug_5]
Show the field ONLY if:
[what_type_of_drug_do_you_u_5(7)] = '1'
|
Specify Other |
text |
|
|
783 |
[at_what_age_did_you_star_drug_5]
Show the field ONLY if:
[do_you_consume_other_drugs_5] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
784 |
[frequency_of_drug_consumpt_5]
Show the field ONLY if:
[how_do_you_consume_other_d_5] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
785 |
[quantity_consumed_per_day_drug_5]
Show the field ONLY if:
[how_do_you_consume_other_d_5] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
786 |
[do_you_take_drugs_during_p_5]
Show the field ONLY if:
[no_of_family_member] >= 5
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
787 |
[frequency_per_day_during_drug_5]
Show the field ONLY if:
[do_you_take_drugs_during_p_5] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
788 |
[sixth_family_member]
Show the field ONLY if:
[no_of_family_member] >= 6
|
SIXTH FAMILY MEMBER |
descriptive |
|
|
789 |
[sex_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Sex
लिंग
|
radio, Required |
|
|
790 |
[specify_other_6]
Show the field ONLY if:
[sex_6] = '3'
|
Specify other |
text |
|
|
791 |
[age_year_month_days_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Age
(Year/Month/Days)
आयु
(वर्ष/महीना/दिन)
Age in years
|
text (number, Min: 1, Max: 99), Required Field Annotation: @FORCE-MINMAX |
|
|
792 |
[relationship_with_ego_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Relationship with ego
संबंध अहंकार के साथ
|
text, Required |
|
|
793 |
[present_marital_status_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Present Marital Status
उपस्थित वैवाहिक स्थिति
|
radio, Required| 1 | Single (never married) | | 2 | Married | | 3 | Widowed | | 4 | Divorced | | 5 | Separated. |
|
|
|
794 |
[educational_status_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Educational Status
शैक्षणिक स्थिति
|
radio, Required| 1 | 1. Primary / प्राथमिक | | 2 | 2. Secondary / गौण | | 3 | 3. And above /और ऊपर |
|
|
|
795 |
[occupational_status_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Occupational Status
व्यावसायिक स्थिति
|
text, Required |
|
|
796 |
[any_kind_of_illness_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Any kind of Illness?
किसी तरह का बीमारी?
|
yesno, Required |
|
|
797 |
[name_of_illness_6]
Show the field ONLY if:
[any_kind_of_illness_6] = '1'
|
Name of illness |
text, Required |
|
|
798 |
[duration_of_illness_6]
Show the field ONLY if:
[any_kind_of_illness_6] = '1'
|
Duration of illness |
text |
|
|
799 |
[any_treatment_given_6]
Show the field ONLY if:
[any_kind_of_illness_6] = '1'
|
Any treatment Given?
कोई इलाज दिया गया?
|
yesno, Required |
|
|
800 |
[if_yes_what_6]
Show the field ONLY if:
[any_treatment_given_6] = '1'
|
If yes, what?
अगर हाँ क्या?
|
text |
|
|
801 |
[nutritional_status_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Nutritional Status |
descriptive |
|
|
802 |
[dietary_habit_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Dietary Habit
आहार संबंधी आदत
|
radio, Required| 1 | Veg / शाकाहारी | | 2 | Non-Veg / गैर-शाकाहारी |
|
|
|
803 |
[amount_consumed_water_l_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Amount Consumed water (L/day):
उपभोग की गई राशि पानी (एल/दिन):
|
radio, Required| 1 | Less than 0.5 L | | 2 | 0.5 - 1 L | | 3 | 1 - 2 L | | 4 | 2 - 3 L | | 5 | More than 3 L |
|
|
|
804 |
[no_of_full_meals_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
No of Full Meals:
पूर्ण भोजन की संख्या:
|
radio, Required| 1 | 1 meal/day | | 2 | 2 meals/day | | 3 | 3 meals/day | | 4 | More than 3 meals/day |
Field Annotation: @FORCE-MINMAX |
|
|
805 |
[frequency_non_vegetaria_6]
Show the field ONLY if:
[dietary_habit_6] = '2'
|
Frequency of Non-Vegetarian Food:
मांसाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/month) | | 3 | Weekly (1-2 times/week) | | 4 | Frequently (3-5 times/week) | | 5 | Daily |
|
|
|
806 |
[frequency_of_vegetarian_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Frequency of Vegetarian Food:
शाकाहारी भोजन की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
807 |
[frequency_milk_products_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Frequency of Milk Products:
दुग्ध उत्पादों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
808 |
[frequency_of_pulses_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Frequency of Pulses:
दालों की आवृत्ति:
|
radio, Required| 1 | Never | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
809 |
[frequency_of_fruits_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Frequency of Fruits:
फलों की आवृत्ति:
|
radio, Required| 1 | Rarely (less than 1 time/week) | | 2 | Occasionally (1-2 times/week) | | 3 | Frequently (3-5 times/week) | | 4 | Daily |
|
|
|
810 |
[any_other_specific_diet_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Any other specific diet
कोई अन्य विशिष्ट आहार
|
text |
|
|
811 |
[any_illness_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Any Illnessकोई बीमारी |
descriptive |
|
|
812 |
[nutritional_deficiency_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Nutritional Deficiency
पोषण की कमी
|
yesno, Required |
|
|
813 |
[which_type_of_nutritional_6]
Show the field ONLY if:
[nutritional_deficiency_6] = '1'
|
Which type of Nutritional Deficiency |
text, Required |
|
|
814 |
[age_at_nurition_def_6]
Show the field ONLY if:
[nutritional_deficiency_6] = '1'
|
Age (आयु) - At what age illness started? |
text (number) |
|
|
815 |
[duration_nutrient_def_6]
Show the field ONLY if:
[nutritional_deficiency_6] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
816 |
[physical_disability_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Physical Disability
शारीरिक अपंगता
|
yesno, Required |
|
|
817 |
[which_type_of_physical_dis_6]
Show the field ONLY if:
[physical_disability_6] = '1'
|
Which type of Physical Disability
|
text, Required |
|
|
818 |
[duration_how_long_physical_6]
Show the field ONLY if:
[physical_disability_6] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
819 |
[emotional_impairment_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Emotional Impairment
भावनात्मक क्षति
|
yesno, Required |
|
|
820 |
[which_type_of_emotional_im_6]
Show the field ONLY if:
[emotional_impairment_6] = '1'
|
Which type of Emotional Impairment
|
text, Required |
|
|
821 |
[duration_how_long_emontiona_6]
Show the field ONLY if:
[emotional_impairment_6] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
822 |
[major_therapeutic_irradiat_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Major Therapeutic Irradiation Exposure
प्रमुख चिकित्सीय विकिरण एक्सपोजर
|
yesno, Required |
|
|
823 |
[which_type_of_major_therap_6]
Show the field ONLY if:
[major_therapeutic_irradiat_6] = '1'
|
Which type of Major Therapeutic Irradiation Exposure
|
text, Required |
|
|
824 |
[duration_how_long_major_6]
Show the field ONLY if:
[major_therapeutic_irradiat_6] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
825 |
[long_illness_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Long Illness
लंबी बीमारी
|
yesno, Required |
|
|
826 |
[which_type_of_long_illness_6]
Show the field ONLY if:
[long_illness_6] = '1'
|
Which type of Long Illness
|
text, Required |
|
|
827 |
[duration_how_long_ilness_6]
Show the field ONLY if:
[long_illness_6] = '1'
|
Duration (अवधि) - How long did it last? |
text |
|
|
828 |
[g_have_you_ever_been_diagn_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
G. Have you ever been diagnosed by a doctor for any of the following conditions?जी. क्या आपको कभी किसी डॉक्टर द्वारा निम्नलिखित में से किसी भी स्थिति का निदान किया गया है? |
descriptive |
|
|
829 |
[heart_failure_disease_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Heart failure/disease
हृदय विफलता/बीमारी
|
yesno, Required |
|
|
830 |
[type_heart_disesae_6]
Show the field ONLY if:
[heart_failure_disease_6] = '1'
|
Type
प्रकार
|
text |
|
|
831 |
[age_heart_faliour_6]
Show the field ONLY if:
[heart_failure_disease_6] = '1'
|
Age
आयु
|
text (number) |
|
|
832 |
[irritable_bowel_disease_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Irritable Bowel Disease
चिड़चिड़ा आंत्र रोग
|
yesno, Required |
|
|
833 |
[type_irritable_bowel_6]
Show the field ONLY if:
[irritable_bowel_disease_6] = '1'
|
Type
प्रकार
|
text |
|
|
834 |
[age_bowel_disease_6]
Show the field ONLY if:
[irritable_bowel_disease_6] = '1'
|
Age
आयु
|
text (number) |
|
|
835 |
[chronic_bronchitis_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Chronic Bronchitis
क्रोनिक ब्रोंकाइटिस
|
yesno, Required |
|
|
836 |
[type_bronchitis_6]
Show the field ONLY if:
[chronic_bronchitis_6] = '1'
|
Type
प्रकार
|
text |
|
|
837 |
[age_bronchitis_6]
Show the field ONLY if:
[chronic_bronchitis_6] = '1'
|
Age
आयु
|
text (number) |
|
|
838 |
[hernia_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Hernia
हरनिया
|
yesno, Required |
|
|
839 |
[type_hernia_6]
Show the field ONLY if:
[hernia_6] = '1'
|
Type
प्रकार
|
text |
|
|
840 |
[age_hernia_6]
Show the field ONLY if:
[hernia_6] = '1'
|
Age
आयु
|
text (number) |
|
|
841 |
[emphysema_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Emphysema
वातस्फीति
|
yesno, Required |
|
|
842 |
[type_endometriosis_6]
Show the field ONLY if:
[emphysema_6] = '1'
|
Type
प्रकार
|
text |
|
|
843 |
[age_endometriosis_6]
Show the field ONLY if:
[emphysema_6] = '1'
|
Age
आयु
|
text (number) |
|
|
844 |
[arthritis_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Arthritis
वात रोग
|
yesno, Required |
|
|
845 |
[type_arthritis_6]
Show the field ONLY if:
[arthritis_6] = '1'
|
Type
प्रकार
|
text |
|
|
846 |
[age_arthritis_6]
Show the field ONLY if:
[arthritis_6] = '1'
|
Age
आयु
|
text (number) |
|
|
847 |
[inflammatory_bowel_disease_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Inflammatory bowel disease
सूजा आंत्र रोग
|
yesno, Required |
|
|
848 |
[type_inflammatory_bowel_6]
Show the field ONLY if:
[inflammatory_bowel_disease_6] = '1'
|
Type
प्रकार
|
text |
|
|
849 |
[age_imflamatry_bowel_6]
Show the field ONLY if:
[inflammatory_bowel_disease_6] = '1'
|
Age
आयु
|
text (number) |
|
|
850 |
[depression_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Depression
अवसाद
|
yesno, Required |
|
|
851 |
[type_depression_6]
Show the field ONLY if:
[depression_6] = '1'
|
Type
प्रकार
|
text |
|
|
852 |
[age_depression_6]
Show the field ONLY if:
[depression_6] = '1'
|
Age
आयु
|
text (number) |
|
|
853 |
[cancer_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Cancer
कैंसर
|
yesno, Required |
|
|
854 |
[type_cancer_6]
Show the field ONLY if:
[cancer_6] = '1'
|
Type
प्रकार
|
text |
|
|
855 |
[age_cancer_6]
Show the field ONLY if:
[cancer_6] = '1'
|
Age
आयु
|
text (number) |
|
|
856 |
[have_you_been_diagnose_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
G11. Have you been diagnosed with Asthma?
क्या आपको अस्थमा का निदान हुआ है?
|
yesno, Required |
|
|
857 |
[age_at_diagnosis_g21]
Show the field ONLY if:
[have_you_been_diagnose_6] = "1"
|
Age at diagnosis: |
text |
|
|
858 |
[g12_have_you_been_diagnose_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
G12. Have you been diagnosed with Typhoid/Enteric Fever? |
yesno, Required |
|
|
859 |
[age_at_diagnosis_g_17]
Show the field ONLY if:
[g12_have_you_been_diagnose_6] = "1"
|
Age at diagnosis:
|
text |
|
|
860 |
[g13_have_you_been_diagnose_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
G13. Have you been diagnosed with Jaundice/Hepatitis? |
yesno, Required |
|
|
861 |
[age_at_diagnosis_g22]
Show the field ONLY if:
[g13_have_you_been_diagnose_6] = "1"
|
Age at diagnosis: |
text |
|
|
862 |
[h_have_you_or_your_family_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
H. Have you or your family member suffered from any of the listed symptoms in last 1 year?क्या आप या आपके परिवार के सदस्य पिछले एक वर्ष में सूचीबद्ध लक्षणों में से किसी से पीड़ित हुए हैं? |
descriptive |
|
|
863 |
[high_fever_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
High fever / तेज़ बुखार |
yesno, Required |
|
|
864 |
[when_highg_fever_6]
Show the field ONLY if:
[high_fever_6] = '1'
|
When
कब
|
text |
|
|
865 |
[how_many_times_fever_6]
Show the field ONLY if:
[high_fever_6] = '1'
|
How many times
कितनी बार
|
text |
|
|
866 |
[weakness_and_fatigue_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Weakness and Fatigue
कमज़ोरी और थकान
|
yesno, Required |
|
|
867 |
[when_weakness_6]
Show the field ONLY if:
[weakness_and_fatigue_6] = "1"
|
When
कब
|
text |
|
|
868 |
[how_many_times_weakness_6]
Show the field ONLY if:
[weakness_and_fatigue_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
869 |
[muscle_ache_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Muscle ache
मांसपेशियों में दर्द
|
yesno, Required |
|
|
870 |
[when_muscle_6]
Show the field ONLY if:
[muscle_ache_6] = "1"
|
When
कब
|
text |
|
|
871 |
[how_many_times_muscle_6]
Show the field ONLY if:
[muscle_ache_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
872 |
[stomach_pain_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Stomach pain
पेट दर्द
|
yesno, Required |
|
|
873 |
[when_stomach_6]
Show the field ONLY if:
[stomach_pain_6] = "1"
|
When
कब
|
text |
|
|
874 |
[how_many_times_stomach_6]
Show the field ONLY if:
[stomach_pain_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
875 |
[loss_of_appetite_and_weigh_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Loss of appetite and weight
भूख और वजन में कमी
|
yesno, Required |
|
|
876 |
[when_appetite_6]
Show the field ONLY if:
[loss_of_appetite_and_weigh_6] ="1"
|
When
कब
|
text |
|
|
877 |
[how_many_times_appetite_6]
Show the field ONLY if:
[loss_of_appetite_and_weigh_6] ="1"
|
How many times
कितनी बार
|
text |
|
|
878 |
[dry_cough_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Dry cough
सूखी खाँसी
|
yesno, Required |
|
|
879 |
[when_dry_cough_6]
Show the field ONLY if:
[dry_cough_6] = "1"
|
When
कब
|
text |
|
|
880 |
[how_many_times_dry_cough_6]
Show the field ONLY if:
[dry_cough_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
881 |
[diarrhoea_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Diarrhoea
दस्त
|
yesno, Required |
|
|
882 |
[when_diarrhoea_6]
Show the field ONLY if:
[diarrhoea_6] = "1"
|
When
कब
|
text |
|
|
883 |
[how_many_times_diarrheaea_6]
Show the field ONLY if:
[diarrhoea_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
884 |
[hair_fall_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Hair fall
बाल झड़ना
|
yesno, Required |
|
|
885 |
[when_hair_fall_6]
Show the field ONLY if:
[hair_fall_6] = '1'
|
When
कब
|
text |
|
|
886 |
[how_many_times_hair_fall_6]
Show the field ONLY if:
[hair_fall_6] = '1'
|
How many times
कितनी बार
|
text |
|
|
887 |
[itching_and_rashes_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Itching and rashes
खुजली और चकत्ते
|
yesno, Required |
|
|
888 |
[when_itching_6]
Show the field ONLY if:
[itching_and_rashes_6] = "1"
|
When
कब
|
text |
|
|
889 |
[how_many_times_itching_6]
Show the field ONLY if:
[itching_and_rashes_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
890 |
[headaches_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Headaches
सिर दर्द
|
yesno, Required |
|
|
891 |
[when_headaches_6]
Show the field ONLY if:
[headaches_6] = "1"
|
When
कब
|
text |
|
|
892 |
[how_many_times_headaches_6]
Show the field ONLY if:
[headaches_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
893 |
[eye_pain_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Eye pain
आँख का दर्द
|
yesno, Required |
|
|
894 |
[when_eye_pain_6]
Show the field ONLY if:
[eye_pain_6] = "1"
|
When
कब
|
text |
|
|
895 |
[how_many_times_eyepain_6]
Show the field ONLY if:
[eye_pain_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
896 |
[h12_shortness_of_breath_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
H12. Shortness of breath/Difficulty breathing
सांस की तकलीफ/सांस लेने में कठिनाई
|
yesno, Required |
|
|
897 |
[when_h12_6]
Show the field ONLY if:
[h12_shortness_of_breath_6] = "1"
|
When
कब
|
text |
|
|
898 |
[how_many_times_h12_6]
Show the field ONLY if:
[h12_shortness_of_breath_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
899 |
[h13_wheezing_or_whistling_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
H13. Wheezing or whistling sound while breathing
सांस लेते समय घरघराहट या सीटी की आवाज
|
yesno, Required |
|
|
900 |
[when_h13_6]
Show the field ONLY if:
[h13_wheezing_or_whistling_6] = "1"
|
When
कब
|
text |
|
|
901 |
[how_many_times_h13_6]
Show the field ONLY if:
[h13_wheezing_or_whistling_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
902 |
[h14_nasal_congestion_runny_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
H14. Nasal congestion/Runny nose
नाक बंद/नाक बहना
|
yesno, Required |
|
|
903 |
[when_h14_6]
Show the field ONLY if:
[h14_nasal_congestion_runny_6] = "1"
|
When
कब
|
text |
|
|
904 |
[how_many_times_h14_6]
Show the field ONLY if:
[h14_nasal_congestion_runny_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
905 |
[h15_vomiting_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
H15. Vomiting
उल्टी
|
yesno, Required |
|
|
906 |
[when_h15_6]
Show the field ONLY if:
[h15_vomiting_6] = "1"
|
When
कब
|
text |
|
|
907 |
[how_many_times_h15_6]
Show the field ONLY if:
[h15_vomiting_6] = "1"
|
How many times
कितनी बार
|
text |
|
|
908 |
[alcohol_locally_fermented_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Alcohol / Locally Fermented Beer (Mahua, Whisky, Rum, Beer, Other (Mahua; Whisky; Rum; any other / महुआ; व्हिस्की; रम; कोई और) |
descriptive |
|
|
909 |
[who_consumes_alcohol_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Who consumes alcohol? |
radio, Required| 1 | You/ आप | | 2 | Family member/ परिवार के सदस्य | | 3 | Both / दोनों | | 4 | Not Applicable |
|
|
|
910 |
[do_you_consume_alcohol_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you consume alcohol? |
yesno, Required |
|
|
911 |
[how_do_you_consume_6]
Show the field ONLY if:
[do_you_consume_alcohol_6] = '1'
|
How do you consume? |
radio, Required| 1 | Regular/ नियमित | | 2 | Occasional/प्रासंगिक |
|
|
|
912 |
[at_what_age_did_you_start_6]
Show the field ONLY if:
[do_you_consume_alcohol_6] = '1'
|
At what age did you start consuming alcohol? |
text (number), Required |
|
|
913 |
[frequency_of_alcohol_consu_6]
Show the field ONLY if:
[how_do_you_consume_6] = '1'
|
Frequency of alcohol consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day | | 5 | Occasional |
|
|
|
914 |
[quantity_of_alcohol_consum_6]
Show the field ONLY if:
[how_do_you_consume_6] = '1'
|
Quantity of alcohol consumed per day (average in ml): |
text (number), Required |
|
|
915 |
[do_you_take_during_pregnan_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you take during pregnancy?
क्या आप गर्भावस्था के दौरान लेते हैं?
|
radio, Required |
|
|
916 |
[frequency_per_day_during_p_6]
Show the field ONLY if:
[do_you_take_during_pregnan_6] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
917 |
[tobacco_pan_chewing_smokin_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Tobacco / Pan (Chewing, Smoking, Beedi, Cigarette, Zarda, Other ( चबाना; धूम्रपान; प्रत्यक्ष तम्बाकू; बीड़ी; सिगरेट; ज़र्दा; कोई और ) |
descriptive |
|
|
918 |
[who_consumes_tobacco_pan_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Who consumes tobacco/pan? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
919 |
[do_you_consume_tobacco_pan_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you consume tobacco/pan? |
yesno, Required |
|
|
920 |
[how_do_you_consume_tobacco_6]
Show the field ONLY if:
[do_you_consume_tobacco_pan_6] = '1'
|
How do you consume tobacco/pan? |
radio, Required |
|
|
921 |
[what_form_of_tobacco_pan_d_6]
Show the field ONLY if:
[do_you_consume_tobacco_pan_6] = '1'
|
What form of tobacco/pan do you use? |
checkbox, Required| 1 | what_form_of_tobacco_pan_d_6___1 | Chewing | | 2 | what_form_of_tobacco_pan_d_6___2 | Smoking | | 3 | what_form_of_tobacco_pan_d_6___3 | Beedi | | 4 | what_form_of_tobacco_pan_d_6___4 | Cigarette | | 5 | what_form_of_tobacco_pan_d_6___5 | Zarda | | 6 | what_form_of_tobacco_pan_d_6___6 | Other (please specify) |
|
|
|
922 |
[other_specify_6]
Show the field ONLY if:
[what_form_of_tobacco_pan_d_6(6)] = '1'
|
Other Specify |
text |
|
|
923 |
[at_what_age_did_you_tobacco_6]
Show the field ONLY if:
[do_you_consume_tobacco_pan_6] = '1'
|
At what age did you start consuming tobacco/pan? |
text (number), Required |
|
|
924 |
[frequency_of_tobacco_pan_c_6]
Show the field ONLY if:
[how_do_you_consume_tobacco_6] = '1'
|
Frequency of tobacco/pan consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
925 |
[quantity_consumed_per_day_6]
Show the field ONLY if:
[how_do_you_consume_tobacco_6] = '1'
|
Quantity consumed per day (average): |
text, Required |
|
|
926 |
[do_you_take_tobacco_pan_du_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you take tobacco/pan during pregnancy? |
radio, Required |
|
|
927 |
[frequency_per_day_tobaco_pre_6]
Show the field ONLY if:
[do_you_take_tobacco_pan_du_6] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
928 |
[other_drugs_charas_ganja_b_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Other Drugs (Charas, Ganja, Bhang, Opium, LSD, Brown Sugar, Other)(चरस; गांजा; भांग; अफ़ीम; एल.एस.डी.; ब्राउन शुगर; कोई और) |
descriptive |
|
|
929 |
[who_consumes_other_drugs_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Who consumes other drugs? |
radio, Required| 1 | You | | 2 | Family member | | 3 | Both | | 4 | Not Applicable |
|
|
|
930 |
[do_you_consume_other_drugs_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you consume other drugs? |
yesno, Required |
|
|
931 |
[how_do_you_consume_other_d_6]
Show the field ONLY if:
[do_you_consume_other_drugs_6] = '1'
|
How do you consume other drugs? |
radio, Required |
|
|
932 |
[what_type_of_drug_do_you_u_6]
Show the field ONLY if:
[do_you_consume_other_drugs_6] = '1'
|
What type of drug do you use? |
checkbox, Required| 1 | what_type_of_drug_do_you_u_6___1 | Charas | | 2 | what_type_of_drug_do_you_u_6___2 | Ganja | | 3 | what_type_of_drug_do_you_u_6___3 | Bhang | | 4 | what_type_of_drug_do_you_u_6___4 | Opium | | 5 | what_type_of_drug_do_you_u_6___5 | LSD | | 6 | what_type_of_drug_do_you_u_6___6 | Brown Sugar | | 7 | what_type_of_drug_do_you_u_6___7 | Other (please specify) |
|
|
|
933 |
[specify_other_drug_6]
Show the field ONLY if:
[what_type_of_drug_do_you_u_6(7)] = '1'
|
Specify Other |
text |
|
|
934 |
[at_what_age_did_you_star_drug_6]
Show the field ONLY if:
[do_you_consume_other_drugs_6] = '1'
|
At what age did you start consuming drugs? |
text (number), Required |
|
|
935 |
[frequency_of_drug_consumpt_6]
Show the field ONLY if:
[how_do_you_consume_other_d_6] = '1'
|
Frequency of drug consumption per day: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
936 |
[quantity_consumed_per_day_drug_6]
Show the field ONLY if:
[how_do_you_consume_other_d_6] = '1'
|
Quantity consumed per day (average): |
text (number), Required |
|
|
937 |
[do_you_take_drugs_during_p_6]
Show the field ONLY if:
[no_of_family_member] >= 6
|
Do you take drugs during pregnancy? |
radio, Required |
|
|
938 |
[frequency_per_day_during_drug_6]
Show the field ONLY if:
[do_you_take_drugs_during_p_6] = '1'
|
Frequency per day during pregnancy: |
radio, Required| 1 | 1 time/day | | 2 | 2-3 times/day | | 3 | 4-5 times/day | | 4 | More than 5 times/day |
|
|
|
939 |
[section_i_environmental_ex] |
SECTION I: ENVIRONMENTAL EXPOSURE & PLANT PROXIMITY |
descriptive |
|
|
940 |
[i1_how_far_is_your_house_f] |
I1. How far is your house from the Tehkhand Waste-to-Energy plant?
घर से तेहखंद कचरा से ऊर्जा संयंत्र की दूरी कितनी है?
|
radio, Required| 1 | Less than 500 meters | | 2 | 500 meters to 1 km | | 3 | 1 to 2 km | | 4 | 2 to 3 km | | 5 | 3 to 4 km | | 6 | 4 to 5 km | | 7 | More than 5 km | | 8 | Don't know |
|
|
|
941 |
[i2_how_long_have_you_been] |
I2. How long have you been living at this address?
आप इस पते पर कितने समय से रह रहे हैं?Years: _____ Months: _____
|
text (number), Required |
|
|
942 |
[a15_previous_place_of_resi]
Show the field ONLY if:
[i2_how_long_have_you_been] <= 5
|
A15. Previous place of residence (if moved to this address in last 5 years):
पिछला निवास स्थान (यदि पिछले 5 वर्षों में यहां आए हैं):
_____________ District: _____________ State: _____________ Village/Town:
|
text |
|
|
943 |
[i3_have_you_noticed_any_ch] |
I3. Have you noticed any changes in air quality in your area?
क्या आपने अपने क्षेत्र में वायु गुणवत्ता में कोई परिवर्तन देखा है?
|
radio, Required |
|
|
944 |
[when_did_you_first_notice]
Show the field ONLY if:
[i3_have_you_noticed_any_ch] = '1'
|
when did you first notice? _______________
यदि हां, तो आपने पहली बार कब देखा?
|
text |
|
|
945 |
[i4_type_of_changes_noticed] |
I4. Type of changes noticed in air quality (select all that apply): |
checkbox, Required| 1 | i4_type_of_changes_noticed___1 | Smoke/Haze (धुआं/कोहरा) | | 2 | i4_type_of_changes_noticed___2 | Unusual odor (असामान्य गंध) | | 3 | i4_type_of_changes_noticed___3 | Dust (धूल) | | 4 | i4_type_of_changes_noticed___4 | Ash/Particulates (राख/कण) | | 5 | i4_type_of_changes_noticed___5 | None (कोई नहीं) |
|
|
|
946 |
[i5_have_you_or_your_family] |
I5. Have you or your family members noticed any changes in health since the Waste-to-Energy plant started or expanded operations?/ or since you have started living here?
क्या प्लांट शुरू होने या विस्तार के बाद आपने या आपके परिवार ने स्वास्थ्य में कोई बदलाव देखा है?
|
radio, Required| 1 | Yes | | 2 | No | | 3 | Don't know | | 4 | Not aware of plant operations |
|
|
|
947 |
[what_changes]
Show the field ONLY if:
[i5_have_you_or_your_family] = '1'
|
what changes? |
text |
|
|
948 |
[i6_direction_of_your_house] |
I6. Direction of your house from the Waste-to-Energy plant: |
radio, Required| 1 | North (उत्तर) | | 2 | South (दक्षिण) | | 3 | East (पूर्व) | | 4 | West (पश्चिम) | | 5 | Northeast (उत्तर-पूर्व) | | 6 | Northwest (उत्तर-पश्चिम) | | 7 | Southeast (दक्षिण-पूर्व) | | 8 | Southwest (दक्षिण-पश्चिम) | | 9 | Don't know (पता नहीं) |
|
|
|
949 |
[section_j_sanitation_hygie] |
SECTION J: SANITATION & HYGIENE |
descriptive |
|
|
950 |
[j1_type_of_toilet_facility] |
J1. Type of toilet facility used by household: |
radio, Required| 1 | Flush toilet (own) | | 2 | Flush toilet (shared) | | 3 | Pit latrine | | 4 | Community toilet | | 5 | Open defecation |
|
|
|
951 |
[j2_how_is_household_garbag] |
J2. How is household garbage disposed? |
radio, Required| 1 | Municipal collection | | 2 | Open dumping | | 3 | Burning | | 4 | Burying | | 5 | Other |
|
|
|
952 |
[specify_other_garbej]
Show the field ONLY if:
[j2_how_is_household_garbag] = '5'
|
Specify other |
text |
|
|
953 |
[j3_frequency_of_garbage_co] |
J3. Frequency of garbage collection: |
radio, Required| 1 | Daily | | 2 | Alternate days | | 3 | Weekly | | 4 | Fortnightly | | 5 | No collection |
|
|
|
954 |
[section_k_healthcare_acces] |
SECTION K: HEALTHCARE ACCESS |
descriptive |
|
|
955 |
[k1_distance_to_nearest_hea] |
K1. Distance to nearest health facility:
निकटतम स्वास्थ्य सुविधा की दूरी: KM
|
text (number), Required |
|
|
956 |
[k2_type_of_health_facility] |
K2. Type of health facility usually visited:
|
radio, Required| 1 | Government hospital | | 2 | PHC/CHC | | 3 | Private clinic | | 4 | Pharmacy | | 5 | Traditional healer | | 6 | No regular facility |
|
|
|
957 |
[form_1_complete] |
Section Header: Form Status
Complete?
|
dropdown| 0 | Incomplete | | 1 | Unverified | | 2 | Complete |
|