1. Have you ever had...(disease)...?
|
|
Peptic ulcer |
|
|
Diabetes |
|
|
Gall stones |
|
|
Hepatitis |
2. Have you ever had a diagnosis of...(disease)...?
3. Have you had any ...... before ?
|
|
Operations |
|
|
Serious illnesses |
4. Has anyone in your family had....?
|
|
Polyps of the colon |
|
|
Breast mass |
|
|
Breast lump |
|
|
Coronary artery disease |
5. Did anyone ever find that you had...(symptom
or disease or problem)?
|
|
Peptic ulcer |
|
|
Jaundice |
|
|
Urinary infection |
6. Do you take any...(medicine)...?
|
|
Tranquilizers |
|
|
Laxatives |
|
|
Analgesics |
|
