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Survey Form

Survey Form

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survey
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Published by: Cherry Ann Guevarra Garcia on Aug 07, 2013
Copyright:Attribution Non-commercial

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08/07/2013

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Survey Form

I.D. No. ____________
Community : _______________________________
Name : ______ Sex : 1 - Male 2 - Female
Age : _______ Education (yrs) : _________
Occupation : 1 - White-collared
2 - Blue-collared
3 - None
Weight (kg) : _________ Height (cm) : _______
Systolic : __________ Waist-Hip Ratio : _______
Diastolic : _________ Body Mass Index : _______
Physical Activity : 1 - Sedentary
2 - Light
3 - Moderate
4 - Vigorous
Family History of Hypertension : 1 - With
2 - Without

Survey Form


I.D. No. ____________
Community : _______________________________
Name : ______ Sex : 1 - Male 2 - Female
Age : _______ Education (yrs) : _________
Occupation : 1 - White-collared
2 - Blue-collared
3 - None
Weight (kg) : _________ Height (cm) : _______
Systolic : __________ Waist-Hip Ratio : _______
Diastolic : _________ Body Mass Index : _______
Physical Activity : 1 - Sedentary
2 - Light
3 - Moderate
4 - Vigorous
Family History of Hypertension : 1 - With
2 - Without

Survey Form


I.D. No. ____________
Community : _______________________________
Name : ______ Sex : 1 - Male 2 - Female
Age : _______ Education (yrs) : _________
Occupation : 1 - White-collared
2 - Blue-collared
3 - None
Weight (kg) : _________ Height (cm) : _______
Systolic : __________ Waist-Hip Ratio : _______
Diastolic : _________ Body Mass Index : _______
Physical Activity : 1 - Sedentary
2 - Light
3 - Moderate
4 - Vigorous
Family History of Hypertension : 1 - With
2 - Without

Survey Form


I.D. No. ___________
Community : _______________________________
Name : ______ Sex : 1 - Male 2 - Female
Age : _______ Education (yrs) : _________
Occupation : 1 - White-collared
2 - Blue-collared
3 - None
Weight (kg) : _________ Height (cm) : _______
Systolic : __________ Waist-Hip Ratio : _______
Diastolic : _________ Body Mass Index : _______
Physical Activity : 1 - Sedentary
2 - Light
3 - Moderate
4 - Vigorous
Family History of Hypertension : 1 - With
2 - Without


BIOSTAT 201 Survey Forms

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