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Fall 2013 Japan Foreign National Residents Nosebleed Survey II
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1. BASIC INFORMATION
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2. HISTORY OF PAST EPISODE(S) AND TREATMTENT(S)
Case A. Past episode(s) of nosebleeds
Q1: What year(s) in the past 5 years have you experienced nosebleeds equivalent to that you experienced this year (2013)?
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Q2: Answer only if the above year(s) apply: Have you gotten any medical attention during the year(s) you specified above?
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Case B. Past episode(s) of symptom(s) other than nosebleeds
Q3: What year(s) in the past 5 years have you experienced symptoms other than nosebleeds equivalent to what you experienced this year(2013)?
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Q4: Answer only if the above year(s) apply: Have you gotten any medical attention during the year(s) you specified above?
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Q2 cont'd... (Past episode(s) of nosebleeds)
Q2-1: Those who answered "Yes" in Q2, how was your visit to the doctor?
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Q2-2: Please describe the nature of your episode and/or treatment. (if any)
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Q3 cont'd... (Past episode(s) of symptom(s) other than nosebleeds)
Q3-1: Those who answered "Yes" in Q3, how was your visit to the doctor?
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Q3-2: Please describe the nature of your episode and/or treatment. (if any)
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3. Current Treatment and Progress
Case A. Current episode(s) of nosebleeds
Q1: Have you seen a doctor for your nosebleeds?
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Case B. Current episode(s) of symptom(s) other than nosebleeds
Q2: Have you seen a doctor for your symptom(s) other than nosebleeds?
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Case A. Current episode(s) of nosebleeds
Q1 cont'd... (Seen a nose doctor)
Q1-1: Those who answered "Nose doctor" in Q1, how was your visit to the doctor?
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Q1-2: If you got any treatment at all, please describe the nature of your episode and/or treatment. (if any)
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Q1 cont'd... (Seen a physician)
Q2-1: Those who answered "physician" in Q1, how was your visit to the doctor?
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Q2-2: If you got any treatment at all, please describe the nature of your episode and/or treatment. (if any)
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Q1 cont'd... (Seen both a nose doctor and a physician)
Q3-1: Those who answered "nose doctor and physician" in Q1, how was your visit to the doctors?
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Q3-2: If you got any treatment at all, please describe the nature of your episode and/or treatment. (if any)
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Q1 cont'd... (Did NOT see any doctor)
Q3-1:Those who answered "did NOT see any doctor" in Q1, how did your episode(s) progress?
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Q3-2: Those who answered "other methods" or "but are recovering" above, what kind of methods did you use to recover?
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Case B. Current episode(s) of symptom(s) other than nosebleeds
Q2 cont'd... (Seen a physician)
Q5-1: Those who answered "physician" in Q2, how was your visit to the doctor?
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Q5-2: If you got any treatment at all, please describe the nature of your episode and/or treatment. (if any)
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Q2 cont'd... (Seen other department(s))
Q5-3: Those who answered "other departments" in Q2, how was your visit to the doctor?
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Q5-4: If you got any treatment at all, please describe the nature of your episode and/or treatment. (if any)
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Q2 cont'd... (Did NOT see any doctor)
Q5-5:Those who answered "did NOT see any doctor" in Q1, how did your episode(s) progress?
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Q5-6: Those who answered "original method" or "but are recovering" above, what kind of methods did you use to recover?
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3. Comments/Requests to Medical Institutions, etc. (optional)
Please leave a comment if you have anything to say about the treatment you got, or a treatment you would prefer.
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4. Rating of This Survey(optional)
On the scale of 1-10, how would you rate the practicality of this survey?
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Please leave your candid, final comment on this survey
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