Student A: the odd numbers (Level 5) 1. Does someone in your family smoke?

yes no If so (=if yes), have they ever tried to quit? yes no

3. Do you have a cold, a sore throat, or a fever today? yes no If so, how long have you had it? (=When did it start?) Answer: S/he has had it since (day or date: ) 5. Was someone in your family ill last week? yes no If so (=if yes), what was the matter with them? __________ 7. Did you eat at a fast-food restaurant last week? yes no
(MacDonalds, Burger King, Jack in the Box)

If so (=if yes), what did you order? _______________ How much did it cost? $_______ 9. Is someone in your family pregnant? yes no If so, when is their baby due? _____________ 11. Does someone in your family have high blood pressure? ( , hypertensin, ) yes no If so (=if yes), do they take medication for it? yes no

Student B: the even numbers 2. Have you ever seen a doctor or dentist in the U.S.? yes no If so, how much did it cost the last time you went to the doctor or dentist? $_______ Did you pay for it, or did your insurance pay? __s/he paid __insurance paid 4. Have you ever had your arm or leg in a cast? yes no If so (=if yes), how did you break it? ___________________ , caries, ) yes no 6. Do you have any cavities? ( When do you brush your teeth? (below) __after breakfast __after lunch __after dinner , ) insurance? yes no Do you have dental ( 8. Do you have problems with your back? yes no Has anyone in your family ever had a back operation? yes no 10. Do you walk up the stairs at school, or do you take the elevator? __walks ___takes the elevator 12. Do you exercise three times a week? yes no Have you ever been a gym member? ( , miembro, ) yes no

13. Have you ever taken Chinese medicine? yes no If so, did it work? (=Did it help you feel better?) yes no 15. Did you get a flu shot last year? yes no Did you catch the flu last year? yes no If so, how many days did you have to stay home? __ 17. Does someone in your family have problems hearing? yes no If so, do they wear a hearing aid? yes no 19. Do you take aspirin or Tylenol when you have a headache? yes no If not, what do you do when you have a headache? S/he _______________________________ 21. Have you ever been on an IV? yes no If so, what was the matter? ______________ How long did you stay in the hospital? _________

14. Can people in your country smoke in restaurants? yes no If so, is the government going to change it? yes no 16. Can you tell me how much thirty-seven degrees Celsius equals in Fahrenheit? 37C = ___ F 18. Have you ever taken antibiotics? ( , ) yes no If so, did they work? (=Did they make you feel better?) yes no 20. Have you ever needed to call an ambulance? yes no If so, was it for you or for someone else? __for him/her __for another person 22. How many hours do you sleep every night? ___ Is that enough, or would you like to get more sleep? __Its enough. __S/he would like more. 23. Are you usually easy-going? (=a relaxed, calm person)

__yes

, , acomodadizo, relajado,
__no, not really

34Int101206a Roland Trego 10/12/06 rev. 3/23/2014 10:18 AM