RIC         1  1                                        C SURVEY HEALTH STATUS & FUNC RECORD

FILEYR      2  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      4  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                              13,039             LOW-HIGH BASEID Count

GENHELTH   13  2  GENHFMT            HS1                N GENERAL HEALTH OF SP

                                   5                   -9 NOT ASCERTAINED
                                  27                   -8 DONT KNOW
                                   2                   -7 REFUSED
                               1,921                    1 EXCELLENT
                               2,980                    2 VERY GOOD
                               3,731                    3 GOOD
                               2,820                    4 FAIR
                               1,553                    5 POOR

HELMTACT   15  2  HELLFMT            HS2                N HEALTH LIMIT SOCIAL LIFE IN PAST MONTH?

                                 155                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                  15                   -8 DONT KNOW
                               7,479                    1 NONE OF THE TIME
                               2,834                    2 SOME OF THE TIME
                               1,479                    3 MOST OF THE TIME
                               1,072                    4 ALL OF THE TIME
                                   0                    5 POOR

ECHELP     17  2  BLNDFMT            HS3                N SP WEAR EYEGLASSES/CONTACT LENSES?

                                   3                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                              10,916                    1 YES
                               1,993                    2 NO
                                 123                    3 BLIND

ECTROUB    19  2  LOOKFMT            HS4                N DESCRIPTION OF SP VISION

                                 126                    . INAPPLICABLE
                                   6                   -9 NOT ASCERTAINED
                                  71                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               7,117                    1 NO TROUBLE
                               4,191                    2 LITTLE TROUBLE
                               1,527                    3 LOT OF TROUBLE

                  Note: Applies only if ECHELP = 1 or 2

ECCATOP    21  2  CNDITFMT           HS5                N SP EVER HAD OPERATION FOR CATARACTS?

                                 110                    . INAPPLICABLE
                                  36                   -8 DONT KNOW
                               2,190                    1 YES
                              10,703                    2 NO

                  Note: Inapplicable if ECHELP = 3 in SP's first MCBS interview.

HCHELP     23  2  DEAFFMT            HS6                N SP USE HEARING AID?

                                   3                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,263                    1 YES
                              11,723                    2 NO
                                  44                    3 DEAF

HCTROUB    25  2  LOOKFMT            HS7                N DESCRIPTION OF SP HEARING

                                  50                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                  32                   -8 DONT KNOW
                               7,350                    1 NO TROUBLE
                               4,495                    2 LITTLE TROUBLE
                               1,107                    3 LOT OF TROUBLE

                  Note: Applies only if HCHELP = 1 or 2

DCTROUB    27  2  CNDITFMT           HS8                N SP HAVE DIFFICULTY EATING SOLID FOODS?

                                  23                   -9 NOT ASCERTAINED
                                   9                   -8 DONT KNOW
                                   2                   -7 REFUSED
                               2,051                    1 YES
                              10,954                    2 NO

HEIGHTFT   29  2  HEITFMT            HS9                N HEIGHT OF SP--FEET

                                   5                   -9 NOT ASCERTAINED
                                  92                   -8 DONT KNOW
                                   1                   -7 REFUSED
                              12,941                  3-7 HEIGHT IN FEET

HEIGHTIN   31  2  INCHFMT            HS9                N HEIGHT OF SP--INCHES

                                   6                   -9 NOT ASCERTAINED
                                 121                   -8 DONT KNOW
                                   2                   -7 REFUSED
                              12,910                 0-11 INCH PORTION-HGHT

WEIGHT     33  3  WEITFMT            HS10               N WEIGHT OF SP--POUNDS

                                   4                   -9 NOT ASCERTAINED
                                 145                   -8 DONT KNOW
                                  34                   -7 REFUSED
                                   2                 0-50   0-50 POUNDS
                                 502               51-100  51-100 POUNDS
                               5,617              101-150 101-150 POUNDS
                               5,438              151-200 151-200 POUNDS
                               1,115              201-250 201-250 POUNDS
                                 149              251-300 251-300 POUNDS
                                  25              301-350 301-350 POUNDS
                                   5              351-400 351-400 POUNDS
                                   3              401-450 401-450 POUNDS
                                   0              451-500 451-500 POUNDS
                                   0              501-999 OVER 500 POUNDS

MAMMOGRM   36  2  CNDITFMT           HS11               N SP HAD MAMMOGRAM IN LAST YEAR?

                               5,728                    . INAPPLICABLE
                                   4                   -9 NOT ASCERTAINED
                                 107                   -8 DONT KNOW
                               2,133                    1 YES
                               5,067                    2 NO

                  Note: Inapplicable if SP is male

PAPSMEAR   38  2  CNDITFMT           HS12               N SP HAD PAPSMEAR IN LAST YEAR?

                               5,728                    . INAPPLICABLE
                                   4                   -9 NOT ASCERTAINED
                                 125                   -8 DONT KNOW
                               1,905                    1 YES
                               5,277                    2 NO

                  Note: Inapplicable if SP is male

HYSTEREC   40  2  CNDITFMT           HS13               N SP EVER HAD HYSTERECTOMY?

                               8,060                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                  76                   -8 DONT KNOW
                               1,758                    1 YES
                               3,143                    2 NO

                  Note: Applies to females in supplemental sample or where PAPNHYST = 2

FLUSHOT    42  2  CNDITFMT           HS14               N SP HAVE FLU SHOT FOR LAST WINTER?

                                   5                   -9 NOT ASCERTAINED
                                 243                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               5,793                    1 YES
                               6,997                    2 NO

PNEUSHOT   44  2  CNDITFMT           HS15               N SP EVER HAVE SHOT FOR PNEUMONIA?

                                   4                   -9 NOT ASCERTAINED
                                 325                   -8 DONT KNOW
                               2,572                    1 YES
                              10,138                    2 NO

EVERSMOK   46  2  CNDITFMT           HS16               N SP EVER SMOKED CIGARETTES/CIGARS?

                                   1                   -9 NOT ASCERTAINED
                                  94                   -8 DONT KNOW
                               7,458                    1 YES
                               5,486                    2 NO

SMOKNOW    48  2  CNDITFMT           HS17               N SP SMOKE NOW?

                               5,629                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                   9                   -8 DONT KNOW
                                   2                   -7 REFUSED
                               2,343                    1 YES
                               5,051                    2 NO

                  Note: Applies only if EVERSMOK = 1

DIFSTOOP   50  2  DIFYFMT            HS18               N SP HAVE DIFFICULTY STOOPING/KNEELING?

                                   2                   -9 NOT ASCERTAINED
                                  10                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               3,776                    1 NO DIFFICULTY
                               2,712                    2 LITTLE DIFFCULTY
                               2,167                    3 SOME DIFFICULTY
                               2,345                    4 LOT OF DIFFCULTY
                               2,026                    5 UNABLE TO DO IT

DIFLIFT    52  2  DIFYFMT            HS19               N SP HAVE DIFFICULTY LIFTING 10 LBS?

                                   2                   -9 NOT ASCERTAINED
                                  20                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               6,720                    1 NO DIFFICULTY
                               1,651                    2 LITTLE DIFFCULTY
                               1,237                    3 SOME DIFFICULTY
                               1,245                    4 LOT OF DIFFCULTY
                               2,163                    5 UNABLE TO DO IT

DIFREACH   54  2  DIFYFMT            HS20               N SP HAVE DIFFICULTY REACHING OVER HEAD?

                                   3                   -9 NOT ASCERTAINED
                                  15                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               8,355                    1 NO DIFFICULTY
                               1,667                    2 LITTLE DIFFCULTY
                               1,301                    3 SOME DIFFICULTY
                                 984                    4 LOT OF DIFFCULTY
                                 713                    5 UNABLE TO DO IT

DIFWRITE   56  2  DIFYFMT            HS21               N SP HAVE DIFFICULTY WRITING?

                                   3                   -9 NOT ASCERTAINED
                                   9                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               8,610                    1 NO DIFFICULTY
                               1,886                    2 LITTLE DIFFCULTY
                               1,226                    3 SOME DIFFICULTY
                                 907                    4 LOT OF DIFFCULTY
                                 397                    5 UNABLE TO DO IT

DIFWALK    58  2  DIFYFMT            HS22               N SP HAVE DIFFICULTY WALKING 2-3 BLOCKS?

                                   3                   -9 NOT ASCERTAINED
                                  14                   -8 DONT KNOW
                                   2                   -7 REFUSED
                               6,253                    1 NO DIFFICULTY
                               1,425                    2 LITTLE DIFFCULTY
                               1,184                    3 SOME DIFFICULTY
                               1,256                    4 LOT OF DIFFCULTY
                               2,902                    5 UNABLE TO DO IT

OCARTERY   60  2  CNDITFMT           HS23a              N SP EVER TOLD HAD HARDENING OF ARTERIES?

                                   4                   -9 NOT ASCERTAINED
                                  19                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,910                    1 YES
                              11,105                    2 NO

OCHBP      62  2  CNDITFMT           HS23b              N SP EVER TOLD HAD HYPERTENSION?

                                   3                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                               6,396                    1 YES
                               6,635                    2 NO

OCMYOCAR   64  2  CNDITFMT           HS23c              N SP EVER TOLD HAD MYOCARDIAL INFARCTION?

                                   2                   -9 NOT ASCERTAINED
                                  12                   -8 DONT KNOW
                               1,886                    1 YES
                              11,139                    2 NO

OCCHD      66  2  CNDITFMT           HS23d              N SP EVER TOLD HAD ANGINA PECTORIS/CHD?

                                   2                   -9 NOT ASCERTAINED
                                  13                   -8 DONT KNOW
                               1,982                    1 YES
                              11,042                    2 NO

OCOTHART   68  2  CNDITFMT           HS23e              N SP EVER TOLD HAD OTHER HEART CONDITIONS?

                                   2                   -9 NOT ASCERTAINED
                                  15                   -8 DONT KNOW
                               3,714                    1 YES
                               9,308                    2 NO

OCSTROKE   70  2  CNDITFMT           HS23f              N SP EVER TOLD HAD STROKE/BRAIN HEMORRHAGE

                                   2                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                               1,557                    1 YES
                              11,475                    2 NO

OCCSKIN    72  2  CNDITFMT           HS23g              N SP EVER TOLD HAD SKIN CANCER?

                                   2                   -9 NOT ASCERTAINED
                                   8                   -8 DONT KNOW
                               1,765                    1 YES
                              11,264                    2 NO

OCCANCER   74  2  CNDITFMT           HS23h              N SP EVER TOLD HAD OTHER CANCER/TUMOR?

                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               2,250                    1 YES
                              10,785                    2 NO

OCCLUNG    76  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--LUNG

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 106                    1 YES
                               2,140                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCCOLON   78  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--COLON/BOWEL

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 361                    1 YES
                               1,885                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCBREST   80  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--BREAST

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 523                    1 YES
                               1,723                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCUTER    82  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--UTERUS

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 245                    1 YES
                               2,001                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCPROST   84  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--PROSTATE

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 232                    1 YES
                               2,014                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCBLAD    86  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--BLADDER

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                  90                    1 YES
                               2,156                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCOVARY   88  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--OVARY

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                  95                    1 YES
                               2,151                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCSTOM    90  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--STOMACH

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                  79                    1 YES
                               2,167                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCCERVX   92  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--CERVIX

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                  64                    1 YES
                               2,182                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCOTHER   94  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--OTHER

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 556                    1 YES
                               1,690                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCKIDNY   96  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--KIDNEY

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  52                    1 YES
                               2,195                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCBRAIN   98  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--BRAIN

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  40                    1 YES
                               2,207                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCTHROA  100  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--THROAT

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  50                    1 YES
                               2,197                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCBACK   102  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--BACK

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  58                    1 YES
                               2,189                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCHEAD   104  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER--HEAD

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  52                    1 YES
                               2,195                    2 NO

                  Note: Applies only if OCCANCER = 1

OCCFONEC  106  2  CNDITFMT           HS23i              N PART OF BODY HAD CANCER-FEMALE ORGANS

                              10,789                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                  65                    1 YES
                               2,182                    2 NO

                  Note: Applies only if OCCANCER = 1

OCDIABTS  108  2  CNDITFMT           HS23j              N SP EVER TOLD HAD DIABETES?

                                   3                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               2,048                    1 YES
                              10,986                    2 NO

OCARTHRH  110  2  CNDITFMT           HS23k              N SP EVER TOLD HAD RHEUMATOID ARTHRITIS?

                                   3                   -9 NOT ASCERTAINED
                                  23                   -8 DONT KNOW
                               1,694                    1 YES
                              11,319                    2 NO

OCARTH    112  2  CNDITFMT           HS23l              N SP EVER TOLD HAD ARTHRITIS?

                                   2                   -9 NOT ASCERTAINED
                                  18                   -8 DONT KNOW
                               6,396                    1 YES
                               6,623                    2 NO

OCAARM    114  2  CNDITFMT           HS23m              N PART OF BODY HAD ARTHRITIS-ARMS/HANDS?

                               6,643                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                   8                   -8 DONT KNOW
                               4,069                    1 YES
                               2,314                    2 NO

                  Note: Applies only if OCARTH = 1

OCAFEET   116  2  CNDITFMT           HS23m              N PART OF BODY HAD ARTHRITIS-KNEES/FEET?

                               6,643                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                   8                   -8 DONT KNOW
                               4,147                    1 YES
                               2,236                    2 NO

                  Note: Applies only if OCARTH = 1

OCABACK   118  2  CNDITFMT           HS23m              N PART OF BODY HAD ARTHRITIS-BACK?

                               6,643                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                   8                   -8 DONT KNOW
                               2,463                    1 YES
                               3,920                    2 NO

                  Note: Applies only if OCARTH = 1

OCANECK   120  2  CNDITFMT           HS23m              N PART OF BODY HAD ARTHRITIS-NECK?

                               6,643                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                                 534                    1 YES
                               5,854                    2 NO

                  Note: Applies only if OCARTH = 1

OCAALOVR  122  2  CNDITFMT           HS23m              N PART BODY HAD ARTHRITIS-ALL OVER/JOINT?

                               6,643                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                                 415                    1 YES
                               5,973                    2 NO

                  Note: Applies only if OCARTH = 1

OCAOTHER  124  2  CNDITFMT           HS23m              N PART OF BODY HAD ARTHRITIS-OTHER?

                               6,643                    . INAPPLICABLE
                                   4                   -9 NOT ASCERTAINED
                                   9                   -8 DONT KNOW
                                  93                    1 YES
                               6,290                    2 NO

                  Note: Applies only if OCARTH = 1

OCMENTAL  126  2  CNDITFMT           HS23n              N SP EVER TOLD HAD MENTAL RETARDATION?

                                   2                   -9 NOT ASCERTAINED
                                  13                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 539                    1 YES
                              12,483                    2 NO

OCALZHMR  128  2  CNDITFMT           HS23o              N SP EVER TOLD HAD ALZHEIMERS DISEASE?

                                   1                   -9 NOT ASCERTAINED
                                   3                   -8 DONT KNOW
                                 658                    1 YES
                              12,377                    2 NO

OCPSYCH   130  2  CNDITFMT           HS23p              N SP EVER TOLD HAD MENTAL DISORDER?

                                   1                   -9 NOT ASCERTAINED
                                   7                   -8 DONT KNOW
                               1,328                    1 YES
                              11,703                    2 NO

OCOSTEOP  132  2  CNDITFMT           HS23q              N SP EVER TOLD HAD OSTEOPOROSIS?

                                   1                   -9 NOT ASCERTAINED
                                  10                   -8 DONT KNOW
                               1,192                    1 YES
                              11,836                    2 NO

OCBRKHIP  134  2  CNDITFMT           HS23r              N SP EVER TOLD HAD BROKEN HIP?

                                   1                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                 762                    1 YES
                              12,272                    2 NO

OCPARKIN  136  2  CNDITFMT           HS23s              N SP EVER TOLD HAD PARKINSONS DISEASE?

                                   1                   -9 NOT ASCERTAINED
                                   3                   -8 DONT KNOW
                                 252                    1 YES
                              12,783                    2 NO

OCEMPHYS  138  2  CNDITFMT           HS23t              N SP EVER TOLD HAD EMPHYSEMA,ASTHMA,COPD?

                                   1                   -9 NOT ASCERTAINED
                                   3                   -8 DONT KNOW
                               1,808                    1 YES
                              11,227                    2 NO

OCPPARAL  140  2  CNDITFMT           HS23u              N SP EVER TOLD HAD PARTIAL PARALYSIS?

                                   1                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               1,221                    1 YES
                              11,815                    2 NO

OCAMPUTE  142  2  CNDITFMT           HS23v              N SP EVER TOLD HAD LOSS ARM OR LEG?

                                   1                   -9 NOT ASCERTAINED
                                   1                   -7 REFUSED
                                 174                    1 YES
                              12,863                    2 NO

EMCAUSC1  144  2  CAUSFMT            HS25               N 1ST CAUSE OF MEDICARE ELIGIBILITY

                              12,238                    . INAPPLICABLE
                                  13                   -9 NOT ASCERTAINED
                                  11                   -8 DONT KNOW
                                   2                   -7 REFUSED
                                 190                    1 BACK/SPINE/DISC
                                  68                    2 SEVERE EYESIGHT
                                  14                    3 SEVERE HEARING
                                  54                    4 KIDNEY/RENAL
                                  44                    5 SEIZURE DISORDER
                                  50                    6 CAR/BIKE/TRAIN ACC
                                  25                    7 MS
                                   9                    8 MD
                                  13                    9 CEREBRAL PALSY
                                  16                   10 BROKEN BONES
                                 292                   91 OTHER

EMCAUSC2  146  2  CAUSFMT            HS25               N 2ND CAUSE OF MEDICARE ELIGIBILITY

                              12,985                    . INAPPLICABLE
                                  17                    1 BACK/SPINE/DISC
                                   1                    2 SEVERE EYESIGHT
                                   4                    3 SEVERE HEARING
                                   3                    4 KIDNEY/RENAL
                                   0                    5 SEIZURE DISORDER
                                   3                    6 CAR/BIKE/TRAIN ACC
                                   0                    7 MS
                                   0                    8 MD
                                   1                    9 CEREBRAL PALSY
                                   8                   10 BROKEN BONES
                                  17                   91 OTHER

                  Note: Applies only if SP has more than one cause for Medicare eligibility

PRBTELE   148  2  MUSTFMT            HS27a              N ANY DIFFICULTY USING PHONE?

                                   4                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                               1,364                    1 YES
                              10,929                    2 NO
                                 736                    3 DOESNT DO

PRBLHWK   150  2  MUSTFMT            HS27b              N ANY DIFFICULTY DOING LIGHT HOUSEWORK?

                               1,071                    . INAPPLICABLE
                                   3                   -9 NOT ASCERTAINED
                                   6                   -8 DONT KNOW
                               1,333                    1 YES
                               9,284                    2 NO
                               1,342                    3 DOESNT DO

PRBHHWK   152  2  MUSTFMT            HS27c              N ANY DIFFICULTY DOING HEAVY HOUSEWORK?

                               1,071                    . INAPPLICABLE
                                   4                   -9 NOT ASCERTAINED
                                   7                   -8 DONT KNOW
                               2,984                    1 YES
                               6,086                    2 NO
                               2,887                    3 DOESNT DO

PRBMEAL   154  2  MUSTFMT            HS27d              N ANY DIFFICULTY MAKING MEALS?

                               1,071                    . INAPPLICABLE
                                   3                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                               1,059                    1 YES
                               9,351                    2 NO
                               1,550                    3 DOESNT DO

PRBSHOP   156  2  MUSTFMT            HS27e              N ANY DIFFICULTY SHOPPING?

                                   4                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               2,174                    1 YES
                               9,150                    2 NO
                               1,705                    3 DOESNT DO

PRBBILS   158  2  MUSTFMT            HS27f              N ANY DIFFICULTY MANAGING MONEY?

                                   4                   -9 NOT ASCERTAINED
                                   9                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,358                    1 YES
                              10,171                    2 NO
                               1,496                    3 DOESNT DO

DONTTELE  160  2  CNDITFMT           HS28a              N HEALTH REASON DONT USE PHONE?

                              12,303                    . INAPPLICABLE
                                   3                   -9 NOT ASCERTAINED
                                 601                    1 YES
                                 132                    2 NO

                  Note: Applies only if PRBTELE = 3

DONTLHWK  162  2  CNDITFMT           HS28b              N HEALTH REASON DONT DO LIGHT HOUSEWORK?

                              11,697                    . INAPPLICABLE
                                   2                   -8 DONT KNOW
                                 761                    1 YES
                                 579                    2 NO

                  Note: Applies only if PRBLHWK = 3

DONTHHWK  164  2  CNDITFMT           HS28c              N HEALTH REASON DONT DO HEAVY HOUSEWORK?

                              10,152                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                               1,845                    1 YES
                               1,037                    2 NO

                  Note: Applies only if PRBHHWK = 3

DONTMEAL  166  2  CNDITFMT           HS28d              N HEALTH REASON DONT MAKE MEALS?

                              11,489                    . INAPPLICABLE
                                   1                   -8 DONT KNOW
                                 705                    1 YES
                                 844                    2 NO

                  Note: Applies only if PRBMEAL = 3

DONTSHOP  168  2  CNDITFMT           HS28e              N HEALTH REASON DONT DO SHOPPING?

                              11,334                    . INAPPLICABLE
                                   7                   -9 NOT ASCERTAINED
                               1,418                    1 YES
                                 280                    2 NO

                  Note: Applies only if PRBSHOP = 3

DONTBILS  170  2  CNDITFMT           HS28f              N HEALTH REASON DONT MANAGE MONEY?

                              11,543                    . INAPPLICABLE
                                   9                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               1,130                    1 YES
                                 355                    2 NO

                  Note: Applies only if PRBBILS = 3

HELPTELE  172  2  CNDITFMT           HS29a              N RECEIVE HELP WITH PHONE?

                              11,074                    . INAPPLICABLE
                                  21                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               1,120                    1 YES
                                 822                    2 NO

                  Note: Applies only if PRBTELE = 1 or DONTTELE = 1

HELPLHWK  174  2  CNDITFMT           HS29b              N RECEIVE HELP WITH LIGHT HOUSEWORK?

                              10,945                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                               1,734                    1 YES
                                 358                    2 NO

                  Note: Applies only if PRBLHWK = 1 or DONTLHWK = 1

HELPHHWK  176  2  CNDITFMT           HS29c              N RECEIVE HELP WITH HEAVY HOUSEWORK?

                               8,210                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               3,726                    1 YES
                               1,100                    2 NO

                  Note: Applies only if PRBHHWK = 1 or DONTHHWK = 1

HELPMEAL  178  2  CNDITFMT           HS29d              N RECEIVE HELP MAKING MEALS?

                              11,275                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                               1,487                    1 YES
                                 275                    2 NO

                  Note: Applies only if PRBMEAL = 1 or DONTMEAL = 1

HELPSHOP  180  2  CNDITFMT           HS29e              N RECEIVE HELP WITH SHOPPING?

                               9,447                    . INAPPLICABLE
                                  24                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                               3,254                    1 YES
                                 313                    2 NO

                  Note: Applies only if PRBSHOP = 1 or DONTSHOP = 1

HELPBILS  182  2  CNDITFMT           HS29f              N RECEIVE HELP MANAGING MONEY?

                              10,551                    . INAPPLICABLE
                                  27                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               2,297                    1 YES
                                 162                    2 NO

                  Note: Applies only if PRBBILS = 1 or DONTBILS = 1

HPPDBATH  184  2  BEDAFMT            HS31a              N ANY DIFFICULTY BATHING/SHOWERING?

                                   3                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                                   2                   -7 REFUSED
                               2,618                    1 YES
                              10,222                    2 NO
                                 189                    3 BEDRIDDEN,ETC

HPPDDRES  186  2  BEDAFMT            HS31b              N ANY DIFFICULTY DRESSING?

                                   3                   -9 NOT ASCERTAINED
                                   3                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,969                    1 YES
                              10,905                    2 NO
                                 158                    3 BEDRIDDEN,ETC

HPPDEAT   188  2  BEDAFMT            HS31c              N ANY DIFFICULTY EATING?

                                   3                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   1                   -7 REFUSED
                                 896                    1 YES
                              12,063                    2 NO
                                  72                    3 BEDRIDDEN,ETC

HPPDCHAR  190  2  BEDAFMT            HS31d              N ANY DIFFICULTY GETTING IN/OUT OF CHAIRS?

                                   3                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               2,645                    1 YES
                              10,248                    2 NO
                                 138                    3 BEDRIDDEN,ETC

HPPDWALK  192  2  BEDAFMT            HS31e              N ANY DIFFICULTY WALKING?

                                   3                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               4,045                    1 YES
                               8,560                    2 NO
                                 426                    3 BEDRIDDEN,ETC

HPPDTOIL  194  2  BEDAFMT            HS31f              N ANY DIFFICULTY USING THE TOILET?

                                   4                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                   1                   -7 REFUSED
                               1,432                    1 YES
                              11,446                    2 NO
                                 152                    3 BEDRIDDEN,ETC

DONTBATH  196  2  CNDITFMT           HS31aa             N B/C HEALTH PROBLEM - SP DOESNT BATHE

                              12,876                    . INAPPLICABLE
                                   2                   -9 NOT ASCERTAINED
                                 158                    1 YES
                                   3                    2 NO

                  Note: Applies only if HPPDBATH = 3

DONTDRES  198  2  CNDITFMT           HS31ba             N B/C HEALTH PROBLEM - SP DOESNT DRESS

                              12,903                    . INAPPLICABLE
                                   3                   -9 NOT ASCERTAINED
                                 132                    1 YES
                                   1                    2 NO

                  Note: Applies only if HPPDDRES = 3

DONTEAT   200  2  CNDITFMT           HS31ca             N B/C HEALTH PROBLEM - SP DOESNT EAT

                              12,977                    . INAPPLICABLE
                                   1                   -9 NOT ASCERTAINED
                                  60                    1 YES
                                   1                    2 NO

                  Note: Applies only if HPPDEAT = 3

DONTCHAR  202  2  CNDITFMT           HS31da             N B/C HLTH PROB - SP DOESNT GET OUT OF BED

                              12,919                    . INAPPLICABLE
                                   5                   -9 NOT ASCERTAINED
                                 114                    1 YES
                                   1                    2 NO

                  Note: Applies only if HPPDCHAR = 3

DONTWALK  204  2  CNDITFMT           HS31ea             N B/C HEALTH PROBLEM - SP DOESNT WALK

                              12,656                    . INAPPLICABLE
                                  10                   -9 NOT ASCERTAINED
                                 370                    1 YES
                                   3                    2 NO

                  Note: Applies only if HPPDWALK = 3

DONTTOIL  206  2  CNDITFMT           HS31fa             N B/C HLTH PROBLEM - SP DOESNT USE TOILET?

                              12,906                    . INAPPLICABLE
                                   6                   -9 NOT ASCERTAINED
                                 126                    1 YES
                                   1                    2 NO

                  Note: Applies only if HPPDTOIL = 3

HELPBATH  208  2  CNDITFMT           HS32a              N RECEIVE HELP BATHING/SHOWERING?

                              10,237                    . INAPPLICABLE
                                   8                   -9 NOT ASCERTAINED
                               1,997                    1 YES
                                 797                    2 NO

                  Note: Applies only if HPPDBATH = 1 or DONTBATH = 1

HELPDRES  210  2  CNDITFMT           HS32b              N RECEIVE HELP DRESSING?

                              10,916                    . INAPPLICABLE
                                   8                   -9 NOT ASCERTAINED
                               1,677                    1 YES
                                 438                    2 NO

                  Note: Applies only if HPPDDRES = 1 or DONTDRES = 1

HELPEAT   212  2  CNDITFMT           HS32c              N RECEIVE HELP EATING?

                              12,073                    . INAPPLICABLE
                                   6                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 618                    1 YES
                                 341                    2 NO

                  Note: Applies only if HPPDEAT = 1 or DONTEAT = 1

HELPCHAR  214  2  CNDITFMT           HS32d              N RECEIVE HELP GETTING IN/OUT OF CHAIRS?

                              10,262                    . INAPPLICABLE
                                   8                   -9 NOT ASCERTAINED
                               1,280                    1 YES
                               1,489                    2 NO

                  Note: Applies only if HPPDCHAR = 1 or DONTCHAR = 1

HELPWALK  216  2  CNDITFMT           HS32e              N RECEIVE HELP WALKING?

                               8,581                    . INAPPLICABLE
                                  29                   -9 NOT ASCERTAINED
                                   3                   -8 DONT KNOW
                               1,322                    1 YES
                               3,104                    2 NO

                  Note: Applies only if HPPDWALK = 1 or DONTWALK = 1

HELPTOIL  218  2  CNDITFMT           HS32f              N RECEIVE HELP USING THE TOILET?

                              11,462                    . INAPPLICABLE
                                   7                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 960                    1 YES
                                 609                    2 NO

                  Note: Applies only if HPPDTOIL = 1 or DONTTOIL = 1

PCHKBATH  220  2  CNDITFMT           HS33a              N PERSON NEARBY WHILE BATHING/SHOWERING?

                              12,234                    . INAPPLICABLE
                                   7                   -9 NOT ASCERTAINED
                                 161                    1 YES
                                 637                    2 NO

                  Note: Applies only if HELPBATH = 2

PCHKDRES  222  2  CNDITFMT           HS33b              N PERSON NEARBY WHILE DRESSING?

                              12,593                    . INAPPLICABLE
                                   7                   -9 NOT ASCERTAINED
                                  61                    1 YES
                                 378                    2 NO

                  Note: Applies only if HELPDRES = 2

PCHKEAT   224  2  CNDITFMT           HS33c              N PERSON NEARBY WHILE EATING?

                              12,691                    . INAPPLICABLE
                                   8                   -9 NOT ASCERTAINED
                                  73                    1 YES
                                 267                    2 NO

                  Note: Applies only if HELPEAT = 2

PCHKCHAR  226  2  CNDITFMT           HS33d              N PERSON NEARBY WHILE GETS IN/OUT CHAIRS?

                              11,542                    . INAPPLICABLE
                                  16                   -9 NOT ASCERTAINED
                                 211                    1 YES
                               1,270                    2 NO

                  Note: Applies only if HELPCHAR = 2

PCHKWALK  228  2  CNDITFMT           HS33e              N PERSON NEARBY WHILE WALKING?

                               9,903                    . INAPPLICABLE
                                  75                   -9 NOT ASCERTAINED
                                   1                   -8 DONT KNOW
                                 394                    1 YES
                               2,666                    2 NO

                  Note: Applies only if HELPWALK = 2

PCHKTOIL  230  2  CNDITFMT           HS33f              N PERSON NEARBY WHILE USING TOILET?

                              12,422                    . INAPPLICABLE
                                  21                   -9 NOT ASCERTAINED
                                   1                   -7 REFUSED
                                  99                    1 YES
                                 496                    2 NO

                  Note: Applies only if HELPTOIL = 2

EQIPBATH  232  2  CNDITFMT           HS34a              N USE EQUIPMENT TO HELP BATH/SHOWER?

                              10,236                    . INAPPLICABLE
                                  10                   -9 NOT ASCERTAINED
                                   5                   -8 DONT KNOW
                               1,404                    1 YES
                               1,384                    2 NO

                  Note: Applies only if HPPDBATH = 1 or DONTBATH = 1

EQIPDRES  234  2  CNDITFMT           HS34b              N USE EQUIPMENT TO HELP DRESS?

                              10,916                    . INAPPLICABLE
                                  13                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 173                    1 YES
                               1,935                    2 NO

                  Note: Applies only if HPPDDRES = 1 or DONTDRES = 1

EQIPEAT   236  2  CNDITFMT           HS34c              N USE EQUIPMENT TO HELP EAT?

                              12,073                    . INAPPLICABLE
                                  12                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                                 176                    1 YES
                                 776                    2 NO

                  Note: Applies only if HPPDEAT = 1 or DONTEAT = 1

EQIPCHAR  238  2  CNDITFMT           HS34d              N USE EQUIPMENT TO HELP GET IN/OUT CHAIRS?

                              10,262                    . INAPPLICABLE
                                  18                   -9 NOT ASCERTAINED
                                   2                   -8 DONT KNOW
                               1,113                    1 YES
                               1,644                    2 NO

                  Note: Applies only if HPPDCHAR = 1 or DONTCHAR = 1

EQIPWALK  240  2  CNDITFMT           HS34e              N USE EQUIPMENT TO HELP USE TOILET?

                               8,581                    . INAPPLICABLE
                                  44                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                               2,357                    1 YES
                               2,053                    2 NO

                  Note: Applies only if HPPDWALK = 1 or DONTWALK = 1

EQIPTOIL  242  2  CNDITFMT           HS34f              N

                              11,462                    . INAPPLICABLE
                                  17                   -9 NOT ASCERTAINED
                                   4                   -8 DONT KNOW
                                 912                    1 YES
                                 644                    2 NO

                  Note: Applies only if HPPDTOIL = 1 or DONTTOIL = 1

D_ADLHNM  244  2  HELPRFMT           HS30, 35           N NUMBER OF HELPERS

                               6,342                    . INAPPLICABLE
                               4,947                    1  1 HELPER
                               1,219                    2  2 HELPERS
                                 380                    3  3 HELPERS
                                 100                    4  4 HELPERS
                                  33                    5  5 HELPERS
                                   9                    6  6 HELPERS
                                   5                    7  7 HELPERS
                                   3                    8  8 HELPERS
                                   0                    9  9 HELPERS
                                   1                   10 10 HELPERS

                  Note: Applies only if SP has at least one ADL or IADL

D_ADLHRL  246  2  RELFMT                                N PRIMARY HELPERS RELATIONSHIP

                              12,523                    . INAPPLICABLE
                                   0                   -5 NEVER ASK AGN
                                   0                    1 SAMPLE PERSON
                                 145                    2 SPOUSE
                                  33                    3 SON
                                 142                    4 DAUGHTER
                                   1                    5 BROTHER
                                  16                    6 SISTER
                                   3                    7 FATHER
                                  14                    8 MOTHER
                                   1                    9 SON-IN-LAW
                                  18                   10 DAUGHTER-IN-LAW
                                   3                   11 GRANDSON
                                  14                   12 GRANDDAUGHTER
                                   1                   13 NEPHEW
                                   5                   14 NIECE
                                   2                   50 PARTNER/ROOMATE
                                  19                   51 FRIEND/NEIGHBOR
                                   0                   52 BOARDER
                                  32                   53 NURSE/NURSES AIDE
                                   0                   54 LEGAL/FINAN OFFICER
                                   0                   55 GUARDIAN
                                  10                   91 OTHER RELATIVE
                                  57                   92 OTHER NON-RELATIVE

                  Note: See Notes for derivation

D_ADLHDB  248  6                                        C DOB HELPER HELPS MOST

                  Note: See Notes for derivation

LOSTURIN  254  2  URIFMT             HS37               N HOW OFTEN SP LOST URINE LAST 12 MONTHS

                                   6                   -9 NOT ASCERTAINED
                                  70                   -8 DONT KNOW
                                  10                   -7 REFUSED
                               1,417                    1 > ONCE A WEEK
                                 331                    2 ABT ONCE/WEEK
                                 266                    3 2-3 TIMES/MONTH
                                 235                    4 ONCE A MONTH
                                 243                    5 EVERY 2-3 MONTH
                                 412                    6 1-2 TIMES/YEAR
                               9,917                    7 NOT AT ALL
                                 132                    8 DIALYSIS,CATHER

PLACEPAR  256  2  MOSTFMT            US1                N PARTICULAR PLACE USUALLY GO FOR MED CARE

                                 898                    . INAPPLICABLE
                                   7                   -9 NOT ASCERTAINED
                                  13                   -8 DONT KNOW
                                   2                   -7 REFUSED
                              10,946                    1 YES
                               1,173                    2 NO

PLACEKND  258  2  PLACEFMT           US2                N KIND OF PLACE USUALLY GO FOR MED CARE

                               2,093                    . INAPPLICABLE
                               8,187                    1 DR OFF/GRP PRAC
                               1,123                    2 DOCTORS CLINIC
                                 476                    3 HMO
                                 172                    4 NEIGH/FAM HTH CTR
                                   0                    5 FREEST SURGI CTR
                                  14                    6 RURAL HLTH CLINIC
                                  12                    7 COMPANY CLINIC
                                 105                    8 OTHER CLINIC
                                  26                    9 WALK-IN URGT CTR
                                  48                   10 AT HOME
                                  61                   11 HOSPITAL ER
                                 480                   12 HOSP OUTPAT DEPT
                                 201                   13 VA FACILITY
                                   2                   14 MENTAL HLTH CTR
                                  39                   91 OTHER SPECIFY

                  Note: Applies only if PLACEPAR = 1

