XT001_ INTRODUCTION TO EXIT INTERVIEW PYTANIE NIE JEST ZADAWANE W POLSCE W 2006 ROKU. WCIŚNIJ Ctrl+R BY PRZEJŚĆ DALEJ. 1.

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Joanna Marciniak
8 lat temu
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1 Share w2 Exit Questionnaire version XT001_ INTRODUCTION TO EXIT INTERVIEW 1. Kontynuuj XT006_ PROXY RESPONDENT'S SEX 1. Mężczyzna 2. Kobieta XT002_ RELATIONSHIP TO THE DECEASED IF XT002_ (RELATIONSHIP TO THE DECEASED) = > XT003_ OTHER RELATIVE IF XT002_ (RELATIONSHIP TO THE DECEASED) = > XT004_ OTHER NO-RELATIVE XT005_ HOW OFTEN CONTACT LAST TWELVE MONTHS XT007_ YEAR OF BIRTH PROXY ( ) XT008_ MONTH OF DECEASE

Kobieta XT002_ RELATIONSHIP TO THE DECEASED IF XT002_ (RELATIONSHIP TO THE DECEASED) = > XT003_ OTHER

2 1. Styczeń 2. Luty 3. Marzec 4. Kwiecień 5. Maj 6. Czerwiec 7. Lipiec 8. Sierpień 9. Wrzesień 10. Październik 11. Listopad 12. Grudzień XT009_ YEAR OF DECEASE XT010_ AGE AT THE MOMENT OF DECEASE ( ) XT011_ THE MAIN CAUSE OF DEATH IF XT011_ (THE MAIN CAUSE OF DEATH) = > XT012_ OTHER CAUSE OF DEATH IF XT011_ (THE MAIN CAUSE OF DEATH) <> > XT013_ HOW LONG BEEN ILL BEFORE DECEASE XT014_ PLACE OF DYING IF XT014_ (PLACE OF DYING) = >

.120) XT011_ THE MAIN CAUSE OF DEATH IF XT011_ (THE MAIN CAUSE OF DEATH) = > XT012_ OTHER CAUSE OF DEATH IF

3 XT045_ OTHER PLACE OF DYING XT015_ TIMES IN HOSPITAL LAST YEAR BEFORE DYING IF XT015_ (TIMES IN HOSPITAL LAST YEAR BEFORE DYING) > > XT016_ TOTAL TIME IN HOSPITAL LAST YEAR BEFORE DYING XT017_ INTRODUCTION EXPENSES MEDICAL CARE 1. Kontynuuj LOOP cnt:= 1 TO 8 IF cnt < 3 OR cnt > 5 OR XT015_ (TIMES IN HOSPITAL LAST YEAR BEFORE DYING) <> > XT018_ HAD TYPE OF MEDICAL CARE IN THE LAST TWELVE MONTHS 1. Tak 5. Nie IF XT018_ (HAD TYPE OF MEDICAL CARE IN THE LAST TWELVE MONTHS) = 1. Tak XT019_ COSTS OF TYPE OF MEDICAL CARE IN THE LAST TWELVE MONTHS ( ) ENDLOOP

Kontynuuj LOOP cnt:= 1 TO 8 IF cnt < 3 OR cnt > 5 OR XT015_ (TIMES IN HOSPITAL LAST YEAR BEFORE DYING) <> > XT018_ HAD TYPE OF MEDICAL CARE

4 XT020_ INTRODUCTION DIFFICULTIES DOING ACTIVITIES IF XT020_IntroDiffADL.CARDINAL > 0 AND NOT > IN XT020_(INTRODUCTION DIFFICULTIES DOING ACTIVITIES) XT022_ ANYONE HELPED WITH ADL 1. Tak 5. Nie IF XT022_ (ANYONE HELPED WITH ADL) = 1. Tak XT023_ WHO HAS HELPED WITH ADL XT024_ TIME THE DECEASED RECEIVED HELP XT025_ HOURS OF HELP NECESSARY DURING TYPICAL DAY (0..24) XT026_ THE DECEASED HAD A WILL 1. Tak 5. Nie XT027_ THE BENEFICIARIES OF THE ESTATE IF > IN XT027_(THE BENEFICIARIES OF THE ESTATE) XT028_ OTHER RELATIVE BENEFICIARY

Nie IF XT022_ (ANYONE HELPED WITH ADL) = 1.

5 IF > IN XT027_(THE BENEFICIARIES OF THE ESTATE) XT029_ OTHER NON-RELATIVE BENEFICIARY XT030_ THE DECEASED OWNED HOME 1. Tak 5. Nie IF XT030_ (THE DECEASED OWNED HOME) = 1. Tak XT031_ VALUE HOME AFTER MORTGAGES ( ) XT032_ WHO INHERITED THE HOME OF THE DECEASED IF > IN XT032_(WHO INHERITED THE HOME OF THE DECEASED) XT051_ OTHER RELATIVE IF > IN XT032_(WHO INHERITED THE HOME OF THE DECEASED) XT052_ OTHER NO-RELATIVE IF > IN XT032_(WHO INHERITED THE HOME OF THE DECEASED)

.50000000) XT032_ WHO INHERITED THE HOME OF THE DECEASED IF > IN XT032_(WHO INHERITED THE HOME OF THE DECEASED) XT051_

6 XT053_ FIRST NAMES CHILDREN XT033_ THE DECEASED OWNED ANY LIFE INSURANCE POLICIES 1. Tak 5. Nie IF XT033_ (THE DECEASED OWNED ANY LIFE INSURANCE POLICIES) = 1. Tak XT034_ VALUE OF ALL LIFE INSURANCE POLICIES ( ) XT035_ BENEFICIARIES OF THE LIFE INSURANCE POLICIES IF > IN XT035_(BENEFICIARIES OF THE LIFE INSURANCE POLICIES) XT054_ OTHER RELATIVE IF > IN XT035_(BENEFICIARIES OF THE LIFE INSURANCE POLICIES) XT055_ OTHER NO-RELATIVE IF > IN XT035_(BENEFICIARIES OF THE LIFE INSURANCE POLICIES) XT056_ FIRST NAMES CHILDREN

.50000000) XT035_ BENEFICIARIES OF THE LIFE INSURANCE POLICIES IF > IN XT035_(BENEFICIARIES OF THE LIFE INSURANCE POLICIES) XT054_

7 XT036_ INTRODUCTION TYPES OF ASSETS 1. Kontynuuj LOOP cnt:= 1 TO 5 XT037_ THE DECEASED OWNED TYPE OF ASSETS 1. Tak 5. Nie IF XT037_ (THE DECEASED OWNED TYPE OF ASSETS) = 1. Tak XT038_ VALUE TYPE OF ASSETS ( ) ENDLOOP XT039_ NUMBER OF CHILDREN THE DECEASED HAD AT THE END IF XT039_ (NUMBER OF CHILDREN THE DECEASED HAD AT THE END) > 1 AND NOT > IN XT027_(THE BENEFICIARIES OF THE ESTATE) XT040_ TOTAL ESTATE DIVIDED AMONG THE CHILDREN XT041_ THE FUNERAL WAS ACCOMPANIED BY A RELIGIOUS CEREMONY 1. Tak 5. Nie

.50000000) ENDLOOP XT039_ NUMBER OF CHILDREN THE DECEASED HAD AT THE END IF XT039_ (NUMBER OF CHILDREN THE DECEASED HAD AT THE

8 XT042_ THANKS FOR THE INFORMATION 1. Kontynuuj XT043_ INTERVIEW MODE XT044_ INTERVIEWER ID

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