Scribd
Upload
743 views2 pages

Robotfoto (Nurse)

This document contains a corpus of data including a personal demographics and health status survey for residents of a nursing home. The personal demographics section collects information like name, date of birth, gender, age, civil status, religion, nationality, education level, address and past occupations. The health status section asks about any medical conditions, current medications, allergies, drug or tobacco use, and alcohol consumption. It also collects data on years of stay in the nursing home and typical number of patients handled per shift.

Uploaded by

analyn_page
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
743 views2 pages

Robotfoto (Nurse)

This document contains a corpus of data including a personal demographics and health status survey for residents of a nursing home. The personal demographics section collects information like name, date of birth, gender, age, civil status, religion, nationality, education level, address and past occupations. The health status section asks about any medical conditions, current medications, allergies, drug or tobacco use, and alcohol consumption. It also collects data on years of stay in the nursing home and typical number of patients handled per shift.

Uploaded by

analyn_page
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Corpus Data:

Appendix A
University of Santo Tomas
College of Nursing
Espana, Manila
I.
A. Personal Demographics
Your Name: ______________________________________________________
Your Date of Birth: _________________________________________________
Your Birthplace: ___________________________________________________
Your Gender: ( ) Male ( ) Female
Your Age: ( ) 20-25
( ) 26-30
( ) 31-35
( ) 36-40
( ) 41-45
( ) 45 or more
Your Civil Status:
( ) Single ( ) Married ( )Divorced ( ) Widow ( ) Separated ( )Annulled
Your Religion: ________________
Your Nationality: ______________
Your Educational Attainment: ______________
( ) High School Level

( ) College Level

( ) High School Graduate

( ) College Graduate

Your School where you graduate:


___________________________________________________________
Your past occupations:
___________________________________________________________
Your Address:
___________________________________________________________

II. Health Status


Presence of any medical condition/s (check all that apply):
( ) Hypertension

( ) Diabetes Mellitus

( ) Asthma

( ) Tuberculosis

( ) Arthritis

( ) Cancer

( ) HIV

( ) AIDS

( ) Others, please specify: ________________


Are you currently medications? ( ) Yes ( ) No
If yes, please specify: _____________
Do you have allergies? ( ) Yes ( ) No
If yes, please specify: _____________
Have you taken any form of illicit drugs? ( ) Yes ( ) No
Do you smoke cigarette or tobacco? ( ) Yes ( ) No
If yes, how many sticks per day? ______
Do you drink alcoholic beverages? ( ) Yes ( ) No
III. Background of Stay in Nursing Home
Years of stay in nursing home
( ) 3-5 years ( ) 6-8 years

( ) 9-11 years ( ) 12 14 years ( ) 15 or more

Number of patients handling per shift


( ) 1-5 ( ) 6-10 ( ) 11-15 Other/s _____

Corpus Data: Appendix A University of Santo Tomas College of Nursing Espana, Manila I. A. Personal Demographics Your Name:
II. Health Status Presence of any medical condition/s (check all that apply): ( ) Hypertension ( ) Diabetes Mellitus ( )

You might also like