MS App Interview PwMS

MS App Interview PwMS

 

 

answer must be an email address

 

answer must be numeric

 

required5 Would you feel comfortable with an online video meeting (through your smart phone, tablet, or computer webcam)?

required5 Would you feel comfortable with an online video meeting (through your smart phone, tablet, or computer webcam)?

required6 Has a doctor ever told you that you have high cholesterol (hyperlipidemia)?

required6 Has a doctor ever told you that you have high cholesterol (hyperlipidemia)?

answer must be numeric

 

If yes, you have been diagnosed with high cholesterol (hyperlipidemia) are you currently receiving treatment? If you are not diagnosed, please skip to question 7.

If yes, you have been diagnosed with high cholesterol (hyperlipidemia) are you currently receiving treatment? If you are not diagnosed, please skip to question 7.

required7 Has a doctor ever told you that you have high blood pressure (hypertension)?

required7 Has a doctor ever told you that you have high blood pressure (hypertension)?

answer must be numeric

 

If yes, you have been diagnosed with high blood pressure (hypertension) are you currently receiving treatment? If you are not diagnosed, please skip to question 8.

If yes, you have been diagnosed with high blood pressure (hypertension) are you currently receiving treatment? If you are not diagnosed, please skip to question 8.

required8 Has a doctor ever told you that you have heart trouble (such as angina, congestive heart failure, or coronary artery disease)?

required8 Has a doctor ever told you that you have heart trouble (such as angina, congestive heart failure, or coronary artery disease)?

answer must be numeric

 

If yes, you have been diagnosed with heart trouble (such as angina, congestive heart failure, or coronary artery disease) are you currently receiving treatment? If you are not diagnosed, please skip to question 9.

If yes, you have been diagnosed with heart trouble (such as angina, congestive heart failure, or coronary artery disease) are you currently receiving treatment? If you are not diagnosed, please skip to question 9.

required9 Has a doctor ever told you that you have disease of arteries in the legs (peripheral vascular disease)?

required9 Has a doctor ever told you that you have disease of arteries in the legs (peripheral vascular disease)?

answer must be numeric

 

If yes, you have been diagnosed with disease of arteries in the legs (peripheral vascular disease) are you currently receiving treatment? If you are not diagnosed, please skip to question 10.

If yes, you have been diagnosed with disease of arteries in the legs (peripheral vascular disease) are you currently receiving treatment? If you are not diagnosed, please skip to question 10.

required10 Has a doctor ever told you that you have lung trouble (asthma, emphysema, chronic bronchitis, or COPD)?

required10 Has a doctor ever told you that you have lung trouble (asthma, emphysema, chronic bronchitis, or COPD)?

answer must be numeric

 

If yes, you have been diagnosed with lung trouble (asthma, emphysema, chronic bronchitis, or COPD) are you currently receiving treatment? If you are not diagnosed, please skip to question 11.

If yes, you have been diagnosed with lung trouble (asthma, emphysema, chronic bronchitis, or COPD) are you currently receiving treatment? If you are not diagnosed, please skip to question 11.

required11 Has a doctor ever told you that you have diabetes mellitus?

required11 Has a doctor ever told you that you have diabetes mellitus?

answer must be numeric

 

If yes, you have been diagnosed with diabetes mellitus are you currently receiving treatment? If you are not diagnosed, please skip to question 12.

If yes, you have been diagnosed with diabetes mellitus are you currently receiving treatment? If you are not diagnosed, please skip to question 12.

required12 Has a doctor ever told you that you have cancer of the breast?

required12 Has a doctor ever told you that you have cancer of the breast?

answer must be numeric

 

If yes, you have been diagnosed with cancer of the breast are you currently receiving treatment? If you are not diagnosed, please skip to question 13.

If yes, you have been diagnosed with cancer of the breast are you currently receiving treatment? If you are not diagnosed, please skip to question 13.

required13 Has a doctor ever told you that you have cancer of the colon (large bowel)?

required13 Has a doctor ever told you that you have cancer of the colon (large bowel)?

answer must be numeric

 

If yes, you have been diagnosed with cancer of the colon (large bowel) are you currently receiving treatment? If you are not diagnosed, please skip to question 14.

If yes, you have been diagnosed with cancer of the colon (large bowel) are you currently receiving treatment? If you are not diagnosed, please skip to question 14.

required14 Has a doctor ever told you that you have cancer of the rectum?

required14 Has a doctor ever told you that you have cancer of the rectum?

answer must be numeric

 

If yes, you have been diagnosed with cancer of the rectum, are you currently receiving treatment? If you are not diagnosed, please skip to question 15.

If yes, you have been diagnosed with cancer of the rectum, are you currently receiving treatment? If you are not diagnosed, please skip to question 15.

required15 Has a doctor ever told you that you have cancer of the lung?

required15 Has a doctor ever told you that you have cancer of the lung?

answer must be numeric

 

If yes, you have been diagnosed with cancer of the lung, are you currently receiving treatment? If you are not diagnosed, please skip to question 16.

If yes, you have been diagnosed with cancer of the lung, are you currently receiving treatment? If you are not diagnosed, please skip to question 16.

required16 Has a doctor ever told you that you have skin cancer?

required16 Has a doctor ever told you that you have skin cancer?

 

answer must be numeric

 

If yes, you have been diagnosed with skin cancer, are you currently receiving treatment? If you are not diagnosed, please skip to question 17.

If yes, you have been diagnosed with skin cancer, are you currently receiving treatment? If you are not diagnosed, please skip to question 17.

required17 Has a doctor ever told you that you have other cancers?

required17 Has a doctor ever told you that you have other cancers?

 

answer must be numeric

 

If yes, you have been diagnosed with other cancers, are you currently receiving treatment? If you are not diagnosed, please skip to question 18.

If yes, you have been diagnosed with other cancers, are you currently receiving treatment? If you are not diagnosed, please skip to question 18.

required18 Has a doctor ever told you that you have inflammation of the eye (uveitis)?

required18 Has a doctor ever told you that you have inflammation of the eye (uveitis)?

answer must be numeric

 

If yes, you have been diagnosed with inflammation of the eye (uveitis), are you currently receiving treatment? If you are not diagnosed, please skip to question 19.

If yes, you have been diagnosed with inflammation of the eye (uveitis), are you currently receiving treatment? If you are not diagnosed, please skip to question 19.

required19 Has a doctor ever told you that you have glaucoma?

required19 Has a doctor ever told you that you have glaucoma?

answer must be numeric

 

If yes, you have been diagnosed with glaucoma, are you currently receiving treatment? If you are not diagnosed, please skip to question 20.

If yes, you have been diagnosed with glaucoma, are you currently receiving treatment? If you are not diagnosed, please skip to question 20.

required20 Has a doctor ever told you that you have cataracts?

required20 Has a doctor ever told you that you have cataracts?

answer must be numeric

 

If yes, you have been diagnosed with cataracts, are you currently receiving treatment? If you are not diagnosed, please skip to question 21.

If yes, you have been diagnosed with cataracts, are you currently receiving treatment? If you are not diagnosed, please skip to question 21.

required21 Has a doctor ever told you that you have migraines?

required21 Has a doctor ever told you that you have migraines?

answer must be numeric

 

If yes, you have been diagnosed with migraines, are you currently receiving treatment? If you are not diagnosed, please skip to question 22.

If yes, you have been diagnosed with migraines, are you currently receiving treatment? If you are not diagnosed, please skip to question 22.

required22 Has a doctor ever told you that you have thyroid disease (such as Graves' disease or Hashimoto's thyroiditis, but not thyroid cancer)?

required22 Has a doctor ever told you that you have thyroid disease (such as Graves' disease or Hashimoto's thyroiditis, but not thyroid cancer)?

answer must be numeric

 

If yes, you have been diagnosed with thyroid disease (such as Graves' disease or Hashimoto's thyroiditis, but not thyroid cancer), are you currently receiving treatment? If you are not diagnosed, please skip to question 23.

If yes, you have been diagnosed with thyroid disease (such as Graves' disease or Hashimoto's thyroiditis, but not thyroid cancer), are you currently receiving treatment? If you are not diagnosed, please skip to question 23.

required23 Has a doctor ever told you that you have vitamin B12 deficiency (pernicious anemia)?

required23 Has a doctor ever told you that you have vitamin B12 deficiency (pernicious anemia)?

answer must be numeric

 

If yes, you have been diagnosed with vitamin B12 deficiency (pernicious anemia), are you currently receiving treatment? If you are not diagnosed, please skip to question 24.

If yes, you have been diagnosed with vitamin B12 deficiency (pernicious anemia), are you currently receiving treatment? If you are not diagnosed, please skip to question 24.

required24 Has a doctor ever told you that you have lupus (systemic lupus erythematosus, SLE)?

required24 Has a doctor ever told you that you have lupus (systemic lupus erythematosus, SLE)?

answer must be numeric

 

If yes, you have been diagnosed with lupus (systemic lupus erythematosus, SLE), are you currently receiving treatment? If you are not diagnosed, please skip to question 25.

If yes, you have been diagnosed with lupus (systemic lupus erythematosus, SLE), are you currently receiving treatment? If you are not diagnosed, please skip to question 25.

required25 Has a doctor ever told you that you have Sjögren syndrome?

required25 Has a doctor ever told you that you have Sjögren syndrome?

answer must be numeric

 

If yes, you have been diagnosed with Sjögren syndrome, are you currently receiving treatment? If you are not diagnosed, please skip to question 26.

If yes, you have been diagnosed with Sjögren syndrome, are you currently receiving treatment? If you are not diagnosed, please skip to question 26.

required26 Has a doctor ever told you that you have inflammatory bowel disease (Crohn's disease, ulcerative colitis)?

required26 Has a doctor ever told you that you have inflammatory bowel disease (Crohn's disease, ulcerative colitis)?

answer must be numeric

 

If yes, you have been diagnosed with inflammatory bowel disease (Crohn's disease, ulcerative colitis), are you currently receiving treatment? If you are not diagnosed, please skip to question 27.

If yes, you have been diagnosed with inflammatory bowel disease (Crohn's disease, ulcerative colitis), are you currently receiving treatment? If you are not diagnosed, please skip to question 27.

required27 Has a doctor ever told you that you have rheumatoid arthritis?

required27 Has a doctor ever told you that you have rheumatoid arthritis?

answer must be numeric

 

If yes, you have been diagnosed with rheumatoid arthritis, are you currently receiving treatment? If you are not diagnosed, please skip to question 28.

If yes, you have been diagnosed with rheumatoid arthritis, are you currently receiving treatment? If you are not diagnosed, please skip to question 28.

required28 Has a doctor ever told you that you have degenerative arthritis (osteoarthritis)?

required28 Has a doctor ever told you that you have degenerative arthritis (osteoarthritis)?

answer must be numeric

 

If yes, you have been diagnosed with arthritis (osteoarthritis), are you currently receiving treatment? If you are not diagnosed, please skip to question 29.

If yes, you have been diagnosed with arthritis (osteoarthritis), are you currently receiving treatment? If you are not diagnosed, please skip to question 29.

required29 Has a doctor ever told you that you have osteoporosis (bone disease causing thin bones - leading to fractures of the hip, wrist, and spine)?

required29 Has a doctor ever told you that you have osteoporosis (bone disease causing thin bones - leading to fractures of the hip, wrist, and spine)?

answer must be numeric

 

If yes, you have been diagnosed with osteoporosis (bone disease causing thin bones - leading to fractures of the hip, wrist, and spine), are you currently receiving treatment? If you are not diagnosed, please skip to question 30.

If yes, you have been diagnosed with osteoporosis (bone disease causing thin bones - leading to fractures of the hip, wrist, and spine), are you currently receiving treatment? If you are not diagnosed, please skip to question 30.

required30 Have you ever had hip replacement surgery?

required30 Have you ever had hip replacement surgery?

answer must be numeric

 

If yes, you have had hip replacement(s), are you currently receiving treatment? If you have not had a hip replacement surgery, please skip to question 31.

If yes, you have had hip replacement(s), are you currently receiving treatment? If you have not had a hip replacement surgery, please skip to question 31.

required31 Have you ever had a knee replacement surgery?

required31 Have you ever had a knee replacement surgery?

answer must be numeric

 

If yes, you have had knee replacement(s), are you currently receiving treatment? If you have not had knee a replacement, please skip to question 32.

If yes, you have had knee replacement(s), are you currently receiving treatment? If you have not had knee a replacement, please skip to question 32.

required32 Has a doctor ever told you that you have fibromyalgia?

required32 Has a doctor ever told you that you have fibromyalgia?

answer must be numeric

 

If yes, you have been diagnosed with fibromyalgia, are you currently receiving treatment? If you are not diagnosed, please skip to question 33.

If yes, you have been diagnosed with fibromyalgia, are you currently receiving treatment? If you are not diagnosed, please skip to question 33.

required33 Has a doctor ever told you that you have anemia or other blood disease?

required33 Has a doctor ever told you that you have anemia or other blood disease?

answer must be numeric

 

If yes, you have been diagnosed with anemia or other blood disease, are you currently receiving treatment? If you are not diagnosed, please skip to question 34.

If yes, you have been diagnosed with anemia or other blood disease, are you currently receiving treatment? If you are not diagnosed, please skip to question 34.

required34 Has a doctor ever told you that you have kidney disease?

required34 Has a doctor ever told you that you have kidney disease?

answer must be numeric

 

If yes, you have been diagnosed with kidney disease, are you currently receiving treatment? If you are not diagnosed, please skip to question 35.

If yes, you have been diagnosed with kidney disease, are you currently receiving treatment? If you are not diagnosed, please skip to question 35.

required35 Has a doctor ever told you that you have open sore or ulcer in the lining of the stomach, esophagus, duodenum (peptic ulcer disease)?

required35 Has a doctor ever told you that you have open sore or ulcer in the lining of the stomach, esophagus, duodenum (peptic ulcer disease)?

answer must be numeric

 

If yes, you have been diagnosed with open sore or ulcer in the lining of the stomach, espohagus, duodenum (peptic ulcer disease), are you currently receiving treatment? If you are not diagnosed, please skip to question 36.

If yes, you have been diagnosed with open sore or ulcer in the lining of the stomach, espohagus, duodenum (peptic ulcer disease), are you currently receiving treatment? If you are not diagnosed, please skip to question 36.

required36 Has a doctor ever told you that you have liver problems (such as cirrhosis)?

required36 Has a doctor ever told you that you have liver problems (such as cirrhosis)?

answer must be numeric

 

If yes, you have been diagnosed with liver problems (such as cirrhosis), are you currently receiving treatment? If you are not diagnosed, please skip to question 37.

If yes, you have been diagnosed with liver problems (such as cirrhosis), are you currently receiving treatment? If you are not diagnosed, please skip to question 37.

required37 Has a doctor ever told you that you have irritable bowel syndrome?

required37 Has a doctor ever told you that you have irritable bowel syndrome?

answer must be numeric

 

If yes, you have been diagnosed with irritable bowel syndrome, are you currently receiving treatment? If you are not diagnosed, please skip to question 38.

If yes, you have been diagnosed with irritable bowel syndrome, are you currently receiving treatment? If you are not diagnosed, please skip to question 38.

required38 Has a doctor ever told you that you have epilepsy (seizure disorder)?

required38 Has a doctor ever told you that you have epilepsy (seizure disorder)?

answer must be numeric

 

If yes, you have been diagnosed with epilepsy (seizure disorder), are you currently receiving treatment? If you are not diagnosed, please skip to question 39.

If yes, you have been diagnosed with epilepsy (seizure disorder), are you currently receiving treatment? If you are not diagnosed, please skip to question 39.

required39 Has a doctor ever told you that you have depression?

required39 Has a doctor ever told you that you have depression?

answer must be numeric

 

If yes, you have been diagnosed with depression, are you currently receiving treatment? If you are not diagnosed, please skip to question 40.

If yes, you have been diagnosed with depression, are you currently receiving treatment? If you are not diagnosed, please skip to question 40.

required40 Has a doctor ever told you that you have an anxiety disorder?

required40 Has a doctor ever told you that you have an anxiety disorder?

answer must be numeric

 

If yes, you have been diagnosed with an anxiety disorder, are you currently receiving treatment? If you are not diagnosed, please skip to question 41.

If yes, you have been diagnosed with an anxiety disorder, are you currently receiving treatment? If you are not diagnosed, please skip to question 41.

required41 Has a doctor ever told you that you have bipolar disorder (manic depression)?

required41 Has a doctor ever told you that you have bipolar disorder (manic depression)?

answer must be numeric

 

If yes, you have been diagnosed with bipolar disorder (manic depression), are you currently receiving treatment? If you are not diagnosed, please skip to question 42.

If yes, you have been diagnosed with bipolar disorder (manic depression), are you currently receiving treatment? If you are not diagnosed, please skip to question 42.

required42 Has a doctor ever told you that you have schizophrenia?

required42 Has a doctor ever told you that you have schizophrenia?

answer must be numeric

 

If yes, you have been diagnosed with schizophrenia, are you currently receiving treatment? If you are not diagnosed, please skip to question 43.

If yes, you have been diagnosed with schizophrenia, are you currently receiving treatment? If you are not diagnosed, please skip to question 43.

answer must be numeric

 

required44 Please read the choices listed below and choose the one that best describes your own situation. This scale focuses mainly on how well you walk. Not everyone will find a description that reflects their condition exactly, but please mark the one category that describes your situation the closest.

required44 Please read the choices listed below and choose the one that best describes your own situation. This scale focuses mainly on how well you walk. Not everyone will find a description that reflects their condition exactly, but please mark the one category that describes your situation the closest.