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    WOMEN’S HEALTH QUESTIONNAIRE

    WOMEN’S HEALTH QUESTIONNAIRE 2017-04-27T15:34:26+00:00












    Full TimePart TimeRetiredUnemployed

            MarriedSingleDivorcedOther

            SpouseAlonePartnerParentsChildrenOther


    Another Patient
    Books/Articles
    Course/Seminar
    Ads
    Physician/Healthcare
    Pharmacy Solutions
    Other


    ExcellentGoodFairPoor






    NoYes,
    NoYes,
    NoYes,


    Childhood Disease       
    Cardiovascular Disease
    Cancer                          
    Fractures, where?         
    Other                            

    Arthritis
    Asthma/COPD
    Chronic Fatigue
    Clotting Defects
    Cron's/Colitis
    Depression
    Diabetes
    Eating Disorder
    Epilepsy
    Fibromyalgia
    Gallbladder Trouble
    High Blood Pressure
    High Cholesterol
    Insomnia
    Kidney Trouble
    Malnutrition
    Osteoporosis
    Stroke/Heart Attack
    Varicose Veins










    noyes,
    NoYes,Previously,
    NoYes,Previously,
    NoYes,Previously,



    NoYes, treatment
    NoYes
    NoYes










    NoYes, explain
    NoYes, when?
    NoYes, describe
    NoYes, describe




    NoYes
    NoYes, when?
    NoYes
    NoYes, when?
    NoYes


    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere


    AbsentMildModerateSevere

    AbsentMildModerateSevere

    AbsentMildModerateSevere