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Protocol - Medication Inventory

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Protocol Name from Source:

2000 Multi-Ethnic Study of Arthrosclerosis (MESA), Medications

Availability:

Publicly available

Description:

Participants are asked to bring all their current medications with them at the time of their appointment. For prescription medications, the interviewer records the name of the medications, the strength, the number prescribed, and the actual amount taken during the last 2 weeks. For over-the-counter medications (including vitamins and supplements), the interviewer records the name, strength, and actual amount consumed in the previous 2 weeks.

Protocol:

Medication Reception

As you know, the XXX Study will be describing all medications its participants are using, both prescription and over-the-counter. These include pills, liquid medications, skin patches, eye drops, creams, salves, inhalers, and injections, as well as cold or allergy medications, vitamins, herbal remedies, and other supplements. The letter you received about this appointment included a plastic medications bag for all your current medications and asked you to bring them to the clinic. Have you brought this bag with you? Are these all the medications that you have taken in the past 2 weeks?

[ ] Yes May I see them? Continue with Section B

[ ] No Make arrangements to obtain

[ ] Refused Record reason for refusal in Comments Section

[ ] Took No MEDICINES Go to end of form

Prescription Medications

1. Copy the name of the medicine, the strength (include units), and the total number of doses prescribed per day/week/month. Include all pills, skin patches, eye drops, creams, salves, and injections.

Medication Name Print the first 20 letters only-Please print clearly

Strength (mg, IU, etc.) Write the decimal as one of the digits

Number Prescribed Circle: Day, Week, Month

PRN Medicine?

On the average during the last 2 weeks, how many of these pills did you take a day/week/month?

1.

___D W M

Y N

___D W M

2.

___D W M

Y N

___D W M

3.

___D W M

Y N

___D W M

4.

___D W M

Y N

___D W M

5.

___D W M

Y N

___D W M

6.

___D W M

Y N

___D W M

7.

___D W M

Y N

___D W M

8.

___D W M

Y N

___D W M

9.

___D W M

Y N

___D W M

10.

___D W M

Y N

___D W M

11.

___D W M

Y N

___D W M

12.

___D W M

Y N

___D W M

13.

___D W M

Y N

___D W M

14.

___D W M

Y N

___D W M

15.

___D W M

Y N

___D W M

Number unable to transcribe: [ ][ ]

Over-the-Counter Medications

3. Copy the name of the medicine, the strength (include units), and the total number of doses prescribed per day/week/month. Include all pills, skin patches, eye drops, creams, salves, and injections.

Medication Name Print the first 20 letters only-Please print clearly

Strength (mg, IU, etc.) Write the decimal as one of the digits

Number Prescribed Circle: Day, Week, Month

PRN Medicine?

On the average during the last 2 weeks, how many of these pills did you take a day/week/month?

1.

___D W M

Y N

___D W M

2.

___D W M

Y N

___D W M

3.

___D W M

Y N

___D W M

4.

___D W M

Y N

___D W M

5.

___D W M

Y N

___D W M

6.

___D W M

Y N

___D W M

7.

___D W M

Y N

___D W M

8.

___D W M

Y N

___D W M

9.

___D W M

Y N

___D W M

10.

___D W M

Y N

___D W M

11.

___D W M

Y N

___D W M

12.

___D W M

Y N

___D W M

13.

___D W M

Y N

___D W M

14.

___D W M

Y N

___D W M

15.

___D W M

Y N

___D W M

Number unable to transcribe: [ ][ ]

Comments:

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Interpretation

The U.S. Food and Drug Administration (FDA) maintains a searchable database of brand-name drugs, generic drugs, and therapeutic biological products that can assist with classification and action of medications.

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

These questions can be administered in a computerized or non-computerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Child, Adolescent, Adult, Senior

Specific Instructions:

Researchers should review the Multi-Ethnic Study of Atherosclerosis Medication (MESA) Methods section in the Diabetes Supplemental Information for specific directions on coding medications (see Diabetes Supplemental Information, [link[www.phenxtoolkit.org/toolkit_content/supplemental_info/diabetes/additional_info/MESA_Manual_of_Operations.doc|MESA Manual of Operations]]). The U.S. Food and Drug Administration (FDA) maintains a searchable database of brand-name drugs, generic drugs, and therapeutic biological products, which is useful in classifying the medications.

Expert Review Panel note: The Expert Review Panel wants to alert investigators to the fact that the form requests information about medications taken over the previous 2 weeks, which may result in the form omitting a medication taken on a monthly basis. However, this medication will be captured in the prescribed medication section.

Research Domain Information

Release Date:

October 1, 2015

Definition

A questionnaire that captures the type and dosage of all prescription and over-the-counter medications as well as dietary supplements.

Purpose

This measure captures whether an individual is currently taking insulin or other oral drugs to treat diabetes. Additionally, some medications may be taken to address other conditions that could be associated with the presence of type 1 or 2 diabetes.

Selection Rationale

The Diabetes Working Group preferred a comprehensive, interviewer-administered review of medication containers to simple questions about insulin and oral diabetes medications because respondents may be taking many medications for multiple conditions.

Language

English, Mandarin Chinese, Spanish

Standards

StandardNameIDSource
Common Data Elements (CDE)Person Medication Inventory Assessment Description Text3070662CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Medication inventory proto62793-5LOINC

Process and Review

The [link[phenx.org/node/62|Expert Review Panel #1]] reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• Revised descriptions of measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive ([link[www.phenxtoolkit.org/index.php?pageLink=browse.archive.protocols&id=140000|link]])

Source

U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung and Blood Institute. (2000). Multi-Ethnic Study of Arthrosclerosis (MESA). Medications.

General References

American Diabetes Association (ADA). (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Suppl. 1), S81-S90.

Protocol ID:

140301

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX140301_PRN_Medicine_Prescription_Medication7PX140301080400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication7PX140301080500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication7PX140301080501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication8PX140301090100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication8PX140301090200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication8PX140301090201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication8PX140301090300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication8PX140301090301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication8PX140301090400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication8PX140301090500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication8PX140301090501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication9PX140301100100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication9PX140301100200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication9PX140301100201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication9PX140301100300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication9PX140301100301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication9PX140301100400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication9PX140301100500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication9PX140301100501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication10PX140301110100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication10PX140301110200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication7PX140301080301Circle: Day, Week, Month4N/A
PX140301_Units_Prescription_Medication10PX140301110201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication10PX140301110300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication10PX140301110301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication10PX140301110400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication10PX140301110500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication10PX140301110501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication11PX140301120100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication11PX140301120200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication11PX140301120201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication11PX140301120300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication11PX140301120301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication11PX140301120400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication11PX140301120500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication11PX140301120501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication12PX140301130100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication12PX140301130200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication12PX140301130201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication12PX140301130300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication12PX140301130301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication12PX140301130400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication12PX140301130500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication12PX140301130501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication13PX140301140100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication13PX140301140200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication13PX140301140201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication13PX140301140300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication13PX140301140301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication13PX140301140400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication13PX140301140500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication13PX140301140501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication14PX140301150100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication14PX140301150200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication14PX140301150201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication14PX140301150300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication14PX140301150301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication14PX140301150400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication14PX140301150500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication14PX140301150501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication15PX140301160100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication15PX140301160200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication15PX140301160201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication15PX140301160300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication15PX140301160301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication15PX140301160400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication15PX140301160500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication15PX140301160501Circle: Day, Week, Month4N/A
PX140301_Number_Prescriptions_Unable_To_TranscribePX140301170000Number unable to transcribe:4N/A
PX140301_Name_Of_OTC_Medication1PX140301180100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication1PX140301180200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication1PX140301180201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication1PX140301180300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication1PX140301180301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication1PX140301180400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication1PX140301180500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication1PX140301180501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication2PX140301190100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication2PX140301190200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication2PX140301190201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication2PX140301190300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication2PX140301190301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication2PX140301190400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication2PX140301190500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication2PX140301190501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication3PX140301200100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication3PX140301200200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication3PX140301200201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication3PX140301200300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication3PX140301200301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication3PX140301200400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication3PX140301200500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication3PX140301200501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication4PX140301210100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication4PX140301210200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication4PX140301210201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication4PX140301210300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication4PX140301210301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication4PX140301210400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication4PX140301210500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication4PX140301210501Circle: Day, Week, Month4N/A
PX140301_Units_OTC_Medication5PX140301220201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication5PX140301220300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication5PX140301220301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication5PX140301220400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication5PX140301220500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication5PX140301220501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication6PX140301230100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication6PX140301230200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication6PX140301230201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication6PX140301230300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication6PX140301230301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication6PX140301230400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication6PX140301230500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication6PX140301230501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication7PX140301240100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication7PX140301240200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication7PX140301240201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication7PX140301240300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication7PX140301240301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication7PX140301240400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication7PX140301240500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication7PX140301240501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication8PX140301250100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication8PX140301250200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication8PX140301250201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication8PX140301250300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication8PX140301250301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication8PX140301250400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication8PX140301250500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication8PX140301250501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication9PX140301260100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Name_Of_OTC_Medication5PX140301220100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication5PX140301220200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Strength_OTC_Medication9PX140301260200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication9PX140301260201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication9PX140301260300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication9PX140301260301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication9PX140301260400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication9PX140301260500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication9PX140301260501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication10PX140301270100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication10PX140301270200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication10PX140301270201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication10PX140301270300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication10PX140301270301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication10PX140301270400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication10PX140301270500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication10PX140301270501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication11PX140301280100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication11PX140301280200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication11PX140301280201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication11PX140301280300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication11PX140301280301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication11PX140301280400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication11PX140301280500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication11PX140301280501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication12PX140301290100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication12PX140301290200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication12PX140301290201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication12PX140301290300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication12PX140301290301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication12PX140301290400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication12PX140301290500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication12PX140301290501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication13PX140301300100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication13PX140301300200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication13PX140301300201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication13PX140301300300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication13PX140301300301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication13PX140301300400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication13PX140301300500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication13PX140301300501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication14PX140301310100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication14PX140301310200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication14PX140301310201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication14PX140301310300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication14PX140301310301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication14PX140301310400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication14PX140301310500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication14PX140301310501Circle: Day, Week, Month4N/A
PX140301_Name_Of_OTC_Medication15PX140301320100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_OTC_Medication15PX140301320200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_OTC_Medication15PX140301320201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_OTC_Medication15PX140301320300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_OTC_Medication15PX140301320301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_OTC_Medication15PX140301320400PRN Medicine?4N/A
PX140301_Average_Number_Pills_OTC_Medication15PX140301320500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_OTC_Medication15PX140301320501Circle: Day, Week, Month4N/A
PX140301_Number_OTC_Unable_To_TranscribePX140301330000Number unable to transcribe:4N/A
PX140301_CommentsPX140301340000Comments about medications4N/A
PX140301_Brought_MedicationsPX140301010000Have you brought this bag with you? Are these all the medications that you have taken in the past two weeks?4Variable Mapping
PX140301_Name_Of_Prescription_Medication1PX140301020100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication1PX140301020200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication1PX140301020201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication1PX140301020300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication1PX140301020301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication1PX140301020400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication1PX140301020500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication1PX140301020501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication2PX140301030100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication2PX140301030200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication2PX140301030201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication2PX140301030300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication2PX140301030301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication2PX140301030400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication2PX140301030500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication2PX140301030501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication3PX140301040100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication3PX140301040200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication3PX140301040201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication3PX140301040300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication3PX140301040301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication3PX140301040400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication3PX140301040500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication3PX140301040501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication4PX140301050100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication4PX140301050200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication4PX140301050201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication4PX140301050300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication4PX140301050301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication4PX140301050400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication4PX140301050500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication4PX140301050501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication5PX140301060100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication5PX140301060200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication5PX140301060201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication5PX140301060300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication5PX140301060301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication5PX140301060400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication5PX140301060500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication5PX140301060501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication6PX140301070100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication6PX140301070200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication6PX140301070201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication6PX140301070300Number Prescribed4N/A
PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication6PX140301070301Circle: Day, Week, Month4N/A
PX140301_PRN_Medicine_Prescription_Medication6PX140301070400PRN Medicine?4N/A
PX140301_Average_Number_Pills_Prescription_Medication6PX140301070500On the average during the last two weeks, how many of these pills did you take a day/week/month4N/A
PX140301_Average_Taken_DayWeek_Month_Prescription_Medication6PX140301070501Circle: Day, Week, Month4N/A
PX140301_Name_Of_Prescription_Medication7PX140301080100Print the first 20 letters only-Please print clearly.4N/A
PX140301_Strength_Prescription_Medication7PX140301080200Strength (mg, IU, etc.). Write the decimal one of the digits.4N/A
PX140301_Units_Prescription_Medication7PX140301080201Record the units of the strength of prescription medication4N/A
PX140301_Number_Prescribed_Prescription_Medication7PX140301080300Number Prescribed4N/A