| YHEA-100 [S66611.00] | Section: Health |
Now I would like to ask you some questions about your health.
In general, how is your health?
| | 1 Excellent |
| | 2 Very good |
| | 3 Good |
| | 4 Fair |
| | 5 Poor |
| YHEA-1880 [S66612.00] | Section: Health |
During the past 12 months, how many times were you injured or ill and had to be treated by a doctor or nurse?
| | 1 None |
| | 2 1 time |
| | 3 2 times |
| | 4 3 times |
| | 5 4 or more times |
| YHEA-1890 [S66613.00] | Section: Health |
Some injuries are not treated by a doctor or nurse. During the past 12 months, how many times were you injured or ill so that you missed at least one full day of usual activities such as work or school, but were not treated by a doctor or nurse?
| | 1 None |
| | 2 1 time |
| | 3 2 times |
| | 4 3 times |
| | 5 4 or more times |
| YHEA-1910 [S66614.00] | Section: Health |
Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid?
| YHEA-1912 [S66615.00] | Section: Health |
What is the source of your primary health or hospitalization plan? Is it from a policy from your current or previous employer, [yheamarriagtextsub] a policy bought directly from a medical insurance company, is it Medicaid or an alternative Medicaid provider, or is it from some other source?
| | 1 1. Policy from your CURRENT Employer |
| | 2 2. Policy from a PREVIOUS Employer |
| | 3 3. Policy from spouse's or partner's CURRENT employer |
| | 4 4. Policy from spouse's or partner's PREVIOUS employer |
| | 8 Policy from your parents or another family member ...(Go To YHEA-1914) |
| | 5 5. Policy you or your spouse or partner bought directly from medical insurance company |
| | 6 6. Medicaid or Medicaid provider/Medi-Cal/Medical Assist/Welfare/Medical Service |
| | 7 7. Other (SPECIFY) ...(Go To YHEA-1914) |
| YHEA-1913 [S66616.00] | Section: Health |
Who else in your family is covered by this plan?
(SELECT ALL THAT APPLY.)
| | 1 Spouse |
| | 2 Partner |
| | 3 Residential children |
| | 4 Your non-residential biological/adopted children |
| | 5 Your spouse/partner's non-residential biological/adopted children |
| | 6 Other dependents |
| | 99 No other person |
| YHEA-1914 [S66617.00] | Section: Health |
([YHEA-1910] == 0 || [YHEAINSSOURCE] != 3) && ([KEY_MARSTAT] ==1 || [YOUTH_PARTNER]==1)
COMMENT: R has no health insurance Or R is not covered by spouse/partner's current employer AND R has a spouse or partner
If Answer = 1 Then Go To YHEA-1915
| YHEA-1915 [S66618.00] | Section: Health |
Can you obtain coverage from a health plan from your [spouse/partner]?
| YHEA-1917 [S66619.00] | Section: Health |
[YHEA-1910] == 1
COMMENT: R currently has health insurance
If Answer = 1 Then Go To YHEA-1920
| YHEA-1920 [S66620.00] | Section: Health |
Since [LINTDATE~X], was there any time that you did not have any health insurance or coverage?
| YHEA-1930 [S66621.00] | Section: Health |
Since [LINTDATE~X], was there any time that you had health coverage?
| YHEA-1940A [S66622.00] | Section: Health |
In the past twelve months, have you visited a doctor for a routine checkup?