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Highest level of educ
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Marital status
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Household size
?
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{#}
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Num household members <14Y
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{#}
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Routine doctor's visits &or check-ups cancelled since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Routine doctor's visits &or check-ups postponed since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Problems accessing medication since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Treatment sessions postponed by doctor or patient since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Treatment sessions cancelled by doctor or patient since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Routine doctor's visits &or check-ups cancelled in the last 12Mo:Find:12Mo:^Patient:Ord:
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Routine doctor's visits &or check-ups postponed in the last 12Mo:Find:12Mo:^Patient:Ord:
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Problems accessing medication in last 12Mo:Find:12Mo:^Patient:Ord:
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Treatment sessions postponed by doctor or patient in the last 12Mo:Find:12Mo:^Patient:Ord:
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Treatment sessions cancelled by doctor or patient in the last 12Mo:Find:12Mo:^Patient:Ord:
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Employment status current
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Work Hs per W nRate
?
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h/wk
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Monthly household net income nRate
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/mo
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Financial problems since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Received any financial or material aid since the beginning of the pandemic:Find:Pt:^Patient:Ord:
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Financial problems in last 12 Mo:Find:12Mo:^Patient:Ord:
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Received any financial or material aid in last 12 Mo:Find:12Mo:^Patient:Ord:
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How often have you recently looked for information on COVID-19:Find:Pt:^Patient:Ord:
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What do you think is your current risk of infection or re-infection:Score:Pt:^Patient:Qn:
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{score}
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What do you think is your current risk that, in case of infection or re-infection, you will experience severe complications or even death:Score:Pt:^Patient:Qn:
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{score}
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How often do you wash your hands with hand-soap or hydro-alcoholic solutions:Find:Pt:^Patient:Ord:
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How often do you keep a distance of at least 2 meters from others:Find:Pt:^Patient:Ord:
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Stay at home to avoid social contact:Find:Pt:^Patient:Ord:
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Wear face mask in public:Find:Pt:^Patient:Ord:
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Has been offered COVID-19 vaccine:Find:Pt:^Patient:Ord:
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Accepted or will accept COVID-19 vaccination once offered:Find:Pt:^Patient:Ord:
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Reasons for not accepting COVID-19 vaccine:Find:Pt:^Patient:Ord:
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