In general how is your health
Health compared to year ago
How much body pain
Physical/health problems interfere
Height in inches
Weight in pounds
Describe your weight
Trying to lose weight
Exercise to lose weight
Diet to lose weight
Vomit/Laxative to lose weight
Diet pills to lose weight
Nothing to lose weight
How lose weight don't know
Servings of fruit/veggies
How often wear seatbelt
Ride motorcycle in past 12 mnths.
Wear helmet on motorcycle
Ride bicycle in past 12 mnths.
Wear helmet on bicycle
Day carry weapon
Use herbal remedies
Dr. tell you to use herbs
How often exercise
How long exercise
Rode in a car driven by someone who had been drinking
Drove after having three or more drinks
Ever tried marijuana
Days use pot in last 30
When use pot, how many times
Use pot regularly
Ever tried cocaine or crack
Past month, times used cocaine or crack
Ever tried hallucinogens
Past month, times used hallucinogens
Ever tried amphetamines
Past month, times used amphetamines
Ever tried ritalin
Past month, times used ritalin
Ever tried heroin, opium, or other narcotics
Past month, times used narcotics
Smoke or use tobacco now
Type of tobacco used
Frequency of smoking(amt/day)
Could go back, stop smoking
Ever consider quit smoking
Ever tried to quit smoking
Past 2 weeks: how many times 5 + drinks
Past month, times used marijuana
Ever regularly smoked cigarettes or used tobacco
Past year, sought counseling for stress
Handling the stress
Sex
Marital status
Ever engaged in sexual intercourse
Age first engaged in sexual intercourse
Number of sexual partners last year
Last sexual intercourse, contraceptive used
Used birth control pills
Used intrauterine device
Used diaphragm
Used foam or other spermicide
Used condoms
Used withdrawal
Used rhythm method
Used norplant
Used sterlization
Used morning after, plan B, emergency
Used cervical cap
Used depo-provera
Used lunelle
Used other contraceptive
Enter here to exit
Refused contraceptive
Don't know contraceptive
No answer contraceptive
Ever had sexually transmitted disease
Had Chlamydia
Had Warts/Condyloma etc.
Had Gonorrhea
Had Herpes, HSV
Had Trichomonas
Had HIV/AIDS
Had Other STD
Refused STD
Don't know STD
No answer STD
Ever been/gotten someone pregnant
Pregnancies intended or accidental
Pregnancies while student at the UO
Emotionally abusive relationship this year
Physically abusive relationship this year
Sexually abusive relationship this year
Past year, forced to have sexual intercourse
Alcohol or drugs involved in rape
Sexual orientation
Had a Pap smear test in the past 3 years
Past month, days sick enough to miss class/work
Considered/dropped out due to health problems
Considered/dropped out due to medical expenses
Ever been diagnosed with ADHD/ADD
Currently being treated for ADHD/ADD with medication
Know anyone attempted suicide
Know anyone committed suicide
Ever seriously thought about suicide
Past 12 months, ever seriously consider suicide
Past 12 months, made suicide attempts
Times used the Health Center past year
Health improve because of your visit
Use services again if needed
Why not used services past year
SHC can improve services
Cost of SHC compared to other health services
Currently covered by health insurance
Who pays your health insurance
Often found unable to afford needed health care
All UO students be required to have health insurance
Prefer increase in prepaid/increased charges
Willing to pay $25 per term more for cost of care not available at HC
Seen UHC Web Page
Seen 'Well Now' in Emerald
Class status
Member of athletics team
Age
Living arrangement
Member of a fraternity/sorority
Race
International student
Financial aid
Pell grant
Currently working for pay
major
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