知己健康管理健康信息调查表（Intimate health management health information questionnaire）.docVIP

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知己健康管理健康信息调查表（Intimate health management health information questionnaire）.doc

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知己健康管理健康信息调查表（Intimate health management health information questionnaire）

知己健康管理健康信息调查表（Intimate health management health information questionnaire） Intimate health management health information questionnaire I. Basic Conditions 1. name, ID number 2. sex, mouth, male, female 3. date of birth The 4. national export of Hankou Zhuang mouth mouthful of other 5. marital status unmarried married Yikou mouth mouth mouth mouth from the other spouse 6. literacy, oral illiteracy, primary school, junior high school, high school and technical secondary school, bachelors degree or above 7. professional cadres, medical and health professionals, teachers, scientific and technical personnel, financial staff, financial personnel Mouth worker population, farmer mouth, unemployed mouth, retirement mouth, household affairs, etc. 8. address 9. telephone number Two. Current health status 1. generally speaking, your health condition is: the mouth is very good, the mouth is good, the mouth is general, the mouth is bad 2., you feel tired for some time: mouth fatigue, mouth a little tired, mouth tired, mouth very tired 3. compared with the same year ago, your weight is: mouth increase, mouth basic unchanged, mouth drops, mouth is not clear 4. have you tried to lose weight in nearly a year? Mouth is mouth 5. have you had any blood pressure in the past half a year? The mouth has not been measured and the mouth has been measured 6. have you tested blood lipid in the past half year? The mouth has not been measured and the mouth has been measured 7. how often have neck, waist, hip joint pain: - is not. 8. have chronic diarrhea, constipation, stool is not normal: - - is not 9. chronic lifestyle diseases Mouth hypertension, coronary heart disease, oral diabetes mellitus, dyslipidemia, and stroke Oral fatty liver, mouth fat, mouth pain, tuyere, lower limb artery occlusion, polycystic ovary syndrome 10. family history; diabetes mellitus; hypertension; hyperlipidemia; coronary heart disease; stroke; obesity; lower extremity arterial occlusion; metabolic syndrome (MS) Father