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Scientific Data Documentation
Physician's Exam, Ages 6 months - 74 years (1976-1980)
DSN: CC37.HANES2.PHYSEXAM


ABSTRACT

 Description of Survey

 A detailed description of the design, content, questionnaires, and operation
 of NHANES II is provided in the following report: Plan and Operation of the
 Second Health and Nutrition Examination Survey, 1976-1980, DHHS Pub. No.
 (PHS) 81-1317 Series 1, No. 15, Public Health Service, Superintendent of
 Documents, U.S. Government Printing Office, Washington, D.C. 20402. The stock
 number is 017-022-00752-5 and the cost is $5.50.  One copy is provided with
 the documentation herein, and a general summary of the data collection
 techniques and content is given in Appendix A.
TARGET POPULATION

 NHANES II was conducted on a nationwide probability sample of approximately
 28,000 persons, ages 6 months-74 years, from the civilian, noninstitutional-
 ized population of the United States. The survey started in February 1976 and
 was completed in February 1980. The NHANES II sample was selected so that
 certain population groups thought to be at high risk of malnutrition (persons
 with low incomes, preschool children and the elderly) were oversampled.
 Adjusted sampling weights were then computed for 76 age, sex,and race
 categories in order to inflate the sample in such a manner as to closely
 reflect the estimated civilian noninstitutionalized U.S. population ages 6
 months-74 years at the midpoint of the survey (March 1, 1978).
DATA COLLECTION TECHNIQUES AND CONTENT

 The plan developed with respect to the content of NHANES II called for the
 following:
    A.  Questionnaires completed in the household:
        (1)  Household questionnaire:  For each household member, questions
             referred to family relationships;certain demographic items such
             as age, sex, and race; selected housing information;occupation,
             income, education, veteran status; and an indication of
             participation in food stamp programs.
        (2)  Medical history questionnaires:
             (a)  For each sample person ages 6 months-11 years
                The questionnaire included items on birth weight,
                prematurity,congenital conditions, medication, neurological
                conditions, lead poisoning, accidents, hospital care,
                disability, diarrhea, pica, vision, and a variety of chronic
                conditions.  In addition, data were collected on allergies,
                kidney and bladder disease, anemia, speech and hearing, lung
                and chest conditions, and participation in food programs.
             (b)  For each sample person ages 12-74 years
                The questionnaire included items on medication; hospital
                care; tuberculosis; a variety of acute and chronic diseases;
                tobacco usage, physical activity; weight; height; vision
                disability, exposure to pesticides; gastrointestinal
                problems; and for females; a menstrual and pregnancy
                history.  In addition, data were collected on anemia,
                diabetes, respiratory condition, hearing and speech, liver
                and gallbladder conditions, kidney and bladder disease,
                allergies, hypertension, cardiovascular conditions, stroke,
                arthritis (stressing middle and upper back and neck
                problems), and participation in food programs.
        Questionnaires and tests administered in the mobile examination
        center:
        (3)  Dietary Questionnaires
           (a)  For each examined person, a 24-Hour Recall was administered
                by trained dietary interviewers.  Specific and quantitative
                detail of every food or drink consumed during the previous
                day was recorded and calculated, thus providing estimates of
                calories, protein, carbohydrates, fat, unsaturated fats,
              cholesterol, and specific vitamins and minerals consumed.
           (b)  For each examined person, a Food Frequency interview was
                administered to ascertain usual patterns of food consumption.
                Daily and/or weekly consumption of foods within 26 subgroups
                were recorded.  In addition, data were collected on usual
                vitamin-mineral supplement usage.
           (c)  For each person ages 12-74 years, a Dietary Supplement form
                was self-administered and reviewed.  This form provided
                information on special diets, recent medications and barriers
                to purchasing groceries or eating foods; it does not provide
                information on vitamin/mineral or other supplements to the
                diet.
        (4)  Medication/Vitamin Usage Form provided information on the past
             week's usage of any medicines; vitamins or minerals for al
             examined persons.
        (5)  Behavior Questionnaire elicited data on behavior which may be
             associated with coronary heart disease for examined persons
             ages 25-74.
             B.  Examination by physician
                 A physician performed and recorded the results of a medical
                 examination giving special attention to specified findings
                 related to nutrition, to hearing, to the thyroid gland,and
                 to the cardiovascular, respiratory, neurological and
                 musculoskeletal systems.
             C.  Special clinical procedures and tests
                 A specially trained health technician carried out the
                 following on examined persons in the designated age ranges:
                 1.  Spirometry trials of examined persons ages 6-24 years,
                   were digitized and recorded on magnetic tape.  Various
                   pulmonary function indicators such as FVC (forced vital
                   capacity), FEV1 (forced expiratory volume in one second),
                   and peak flow rate were subsequently derived from these
                   data.
               2.  Electrocardiograms Electrocardiographic signals of
                   examined persons ages 25-74 years were digitized and
                   recorded on magnetic tape providing normative data of
                   amplitude, duration, interval and axis measurements and
                   permitting interpretations of heart disease according to
                   the Minnesota classification code.
               3.  Body Measurements were made on all examinees and included
                   standing height, body weight, triceps and subscapular
                   skinfolds, and several other anthropometric measurements.
               4.  Puretone audiometry Tests were carried out on examined
                   persons between the ages of 4 and 19 years, permitting
                   determination of threshold levels of hearing for
                   frequencies of 500, 1000, 2000, and 4000 Hertz for right
                   and left ears.
               5.  Speech recording, involving use of tape recording of the
                   subject's repetition of specially developed sentences,was
                   carried out on examined persons between the ages of 4 and
                   6 years, permitting interpretations as an indication of
                   problems with articulation and language development.
               6.  Allergy tests, involving skin tests (prick test) with
                   eight common allergens (housedust, alternaria, cat fur,
                   dog fur, ragweed, oak, rye grass, and Bermuda grass).The
                   tests were made on examined persons between the ages of 6
                   and 74 years, to obtain degrees of skin reaction.
             D.  X-Rays
                 For examined persons ages 25-74 years, two x-rays were made.
                 No x-rays were taken of pregnant women and no lumbar x-rays
                 were taken on women under 50 years of age.
               1.  X-ray of cervical and lumbar spine, were taken to provide
                   evidence of osteoarthritis and degenerative disc disease,
                   and
               2.  X-ray of chest, to be used in the diagnosis of respiratory
                   diseases and to serve as a measure of left ventricular
                   enlargement.
            E.  Urine tests
               Tests as follows were performed on casual samples of urine:
               1.  N-Multistix tests for qualitative protein, glucose,
                   ketones, bilirubin, blood, urobilinogen, pH, and
                   bacteriuria (nitrite test) were done for examined persons
                   ages 6-74 years.
               2.  Urinary sediments, including red cells, white cells, and
                   casts, were measured for a subsample of examined adults
                   ages 20-74 years.
               3.  Gonorrhea cultures, of urinary sediments were performed
                   for male and female examined persons ages 12-40 years.
                   However, of those females who received the Glucose
                   Tolerance Test (GTT) only those ages 20-24 years had the
                   gonorrhea test performed.
               4.  Analyses for pesticide residue and metabolite levels,were
                   carried out on a subsample of examined persons ages 12-74
                   years, including measures of the body burdens from
                   exposure to alkyl phosphate residues and metabolites,
                   carbamate residues, phenolic compound residues and
                   malathion metabolites.
           F.  Tests on blood samples
               Samples of blood provide a broad range of information related
               to health and nutrition.  The particular tests performed
               varied with the specific target condition and age group as
               described in the Series 1, No.15 program description (page
               39).
               1.  Glucose tolerance test (GTT)
                   This test involved collection of blood specimens while in
                 a fasting state, as well as at one and two hours after
                 glucose challenge.  The test was performed on a specified
                 subsample of examined adults to provide estimates of the
                 prevalence of diabetes.
               2.  Tests related to liver function
                   (a)  Post-prandial liver bile acid test.  This test
                    measures the ability of the liver to remove bile
                    acids from the blood following consumption of a food
                    preparation which induces eventual addition of bile
                          acids to the blood via contraction of the
                          gallbladder.
                  (b)  Liver biochemistries performed include bilirubin,
                       SGOT, and alkaline phosphatase tests.
                 3.  Anemia-related laboratory tests
                     The tests made to characterize anemia consisted of
                     protoporphyrin,iron,total iron binding capacity (TIBC),
                     zinc, copper, red cell folates, serum folates, serum
                     ferritin, B12, and the determination of abnormal
                     hemoglobin.
                 4.  Other nutritional biochemistries
                     These tests include albumin,Vitamin A and Vitamin C.
                 5.  Serum lipids
                     Because of their important relevance to cardiovascular
                     disease, determinations were made of cholesterol,
                     triglycerides, and high density lipoprotein (HDL).
                 6.  Biochemistries for body burden from environmental
                     exposures
                     Determinations were made of body burden levels of lead
                     and pesticide residues and metabolites.Tests were also
                     performed for carboxyhemoglobin which reflects
                     environmental exposure to carbon monoxide and the
                     individual's smoking habits.
                 7.  Hematology
                     The hematology included determinations of hemoglobin,
                     hematocrit,red blood cell count,white blood cell count
                     and differential leukocyte analysis, and red blood cell
                     morphology and hemoglobin phenotyping.
                 8.  Kidney function
                   The only quantitative test for kidney function performed
                   on blood samples was the serum creatinine test.
               9.  Syphilis
                   The serology determinations for syphilis included
                   qualitative and quantitative ART, a FTA-ABS and MHA-TP.
USE OF NHANES DATA

 NCHS requests the cooperation of recipients of data tapes in certain actions
 related to their use:

    1.  Any publication based on the data should acknowledge the National
        Center for Health Statistics (NCHS) as the original source.It should
        include a disclaimer which credits the authors for any analyses,
        interpretations, or conclusions, and not NCHS, which is responsible
        only for the data.

    2.  Consumers who wish to publish a technical description of the data
        should make a reasonable effort to ensure that the description is not
        inconsistent with that published by NCHS.This does not mean, however,
        that NCHS will review such descriptions.

    3.  The National Center for Health Statistics would appreciate receiving
        reprints of journal articles or other publications based upon find-
        ings from the NHANES II survey.  Please forward copies to:

              Division of Health Examination Statistics
              National Center for Health Statistics
              Center Building, Room 2-58,
              3700 East-West Highway
              Hyattsville, Maryland   20782
EDITING OF THE DATA SETS

 The data users' tapes have been subjected to a great deal of careful editing.
 Some of the continuous data items have extremely high or low values and it
 has been verified that they do in fact appear that way on the original inter-
 view documents; that is, it has been verified that the values have not been
 incorrectly keyed.Within each data tape numerous consistency checks have been
 performed.  However, due to the large volume of data collected in the survey,
 it is likely that a small number of errors or discrepancies remain undetected.
 The Division of Health Examination Statistics, NCHS would appreciate if any
 such errors are detected that they be brought to our attention so that errata
 sheets can be issued to previous purchasers and corrections made if new data
 tapes are created.
USE OF SAMPLE WEIGHTS

 NHANES II uses a multistage sample designed to represent the civilian
 noninstitutionalized population of the United States,6 months-74 years of age.
 Since the sample is not a simple random one, it is necessary to incorporate
 the person's sample weight for proper analysis of the data.The sample weight
 is a composite of the individual selection probability, adjustments for
 nonresponese, and poststratification adjustments.

 NHANES II provides information on 20,322 interviewed and examined individuals.
 In addition to the general examination components, several more detailed
 examinations were performed on subsamples of the population.  Therefore,
 instead of there being one sample weight per person,there are several sample
 weights for each person.  If a person was not selected for a particular
 subsample, their associated subsample weight is zero.  When analyzing the
 special subsamples, the analyst must be careful to select the appropriate
 sampling weight from the weights found in tape locations 282-317. For a more
 complete description of how the sample weights are calculated, see the
 detailed note section of this documentation.
SAMPLE DESIGN, VARIANCE ESTIMATION, AND HYPOTHESIS TESTING

 The data collected in the Second National Health and Nutrition Examination
 Survey (NHANES II) were obtained through a complex sample design involving
 both clustering and stratification.Because of the complex design and the
 ratio adjustments applied to the sample weights (see previous section on use
 of sample weights), the direct application of standard statistical analysis
 methods for variance estimation and hypothesis testing may be very misleading.
 The modification of statistical analysis procedures to incorporate the
 effects of complex survey designs is an important area of research;however,
 the current methodologies appropriate for the analysis of data from such
 surveys have not been made readily available in the standard packaged
 statistical software.

 There are computer programs available which do provide the capability of
 variance estimation for complex sample designs.  The balanced repeated
 replication approach 1/ is utilized in &REPERR-&PSALMS-OSIRIS.IV 2/ to
 calculate the variance-covariance matrix.SESUDAAN, SURREGR 3/ and SUPERCARP
 4/ are programs that calculate the variance-covariance matrix using the
 linearization approach 5/ (Taylor series expansion).

 In order to provide the user with the capability of estimating the complex
 sample variances in the NHANES II data using the above procedures, we have
 provided Strata and Pseudo Primary Sampling Unit (PSU) codes on all data
 tapes in positions 324-326. These variables and the sample weights are
 necessary for the calculation of variances.

 Even though the overall number of examined persons in this survey is quite
 large for statistical inference purposes, subclass analyses can lead to
 estimaters that are unstable, particularly estimates of variances.
 Consequently, analyses of subclasses require that the user pay particular
 attention to the coefficient of variation for the estimates of means,
 proportions and totals.In addition, small sample sizes, or a small number
 of PSU's used in the variance calculations may produce unstable estimates
 of the variances using the above computer programs.

 An NCHS Series 2 publication discussing these issues is in publication.6/


 REFERENCES

 1.  National Center for Health Statistics:  Replication an Approach to the
     Analysis of Data from Complex Surveys by P.J. McCarthy.  Vital and Health
     Statistics Series 2-No. 14. DHEW Pub. No.(PHS) 79-1269. Public Health
     Service.  Washington, D.C.  U.S. Government Printing Office, 1966.
 2.  Survey Research Center Computer Support Group, OSIRIS IV User's Manual,
     Institute for Social Research, 1979.
 3.  Holt, M.M.: SURREGR: Standard errors of regression coefficients from
     sample survey data. (unpublished) Research Triangle Institute, NC, 1977.
 4.  Hidiruglou, M.A.,Fuller,W.A.,Hickman, R.D.:(SUPERCARP) Survey Section,
     Statistical Laboratory,Iowa State University. Ames, Iowa. Sixth Edition.
     October 1980.
 5.  Woodruff, R.S.: A simple method for approximating the variance of a
     complicated estimate. JASA 66:411-414, 1971.
 6.  National Center for Health Statistics: A General Statistical Methodology
     for the Analysis of Data from a Complex Survey: NHANES I by J.R. Landis,
     J.H. Lepkowski, S.A. Stehouwer, and S.A. Eklund. Vital and Health
     Statistics, Series 2. (In publication)
GENERAL NOTES, DEMOGRAPHIC INFORMATION, NHANES II

 An advance letter, announcing the forthcoming arrival of an interviewer from
 the U.S.Bureau of the Census,was mailed to each household that fell into the
 NHANES II probability sample.  The interviewer subsequently visited the
 household to ascertain its composition and to administer a questionnaire,the
 primary purpose of which was to obtain demographic information.  The
 questionnaire was administered to each potential sample person in each
 household that was available and competent enough to respond to questions.In
 the event that a potential sample person was not at home at the time of
 interview, any responsible adult in the household was asked to respond to
 the questions for the absent person.
DEMOGRAPHIC DATA SUMMARY - NHANES II

 Tape Positions 1-33
                                                                Tape Positions

 Sample Sequence Number                                                 1- 5
 Catalog Number (5371-for Demographic Data only)                        6- 9
 Data user work area                                                      10
 Size of place                                                            11
 SMSA-not SMSA                                                            12
 Data user work area                                                   13-23
 Type of living quarters                                                  24
 Land usage                                                               25
 If rural, asked does this place have 10 acres or more?                   26
 If 10 acres or more, asked if in the last 12 months did sales
   of farm produce and livestock amount to $50 or more?                   27
 If 10 acres or more, asked to $250 or more?                              28
 Data user work area                                                      29
 Total number of persons in household                                  30-31
 Total number of sample persons in household                           32-33

 Tape Positions 34-90

                               Sample Person Data
                                                                Tape Positions
 Data user work area                                                      34
 Family relationship                                                      35
 Data user work area                                                      36
 Family unit number                                                    37-41
 Data user work area                                                   42-44
 Age-months (at interview)                                             45-46
 Age-years (at interview)                                              47-48
 Data user work area                                                   49-50
 Date of birth-month                                                   51-52
 Date of birth-year                                                    53-54
 Sex                                                                      55
 Race                                                                     56
 In what state was he/she born?                                        57-58
 Is he/she married, widowed, divorced, separated or
   never married?                                                         59
 Natural origin or ancestry                                            60-61
 Education level                                                       62-63
 Grade completed                                                          64
 What was he/she doing during most of the past 12 months?                 65
 What was he/she doing?                                                   66
 Did he/she work at a job or business at any time during the
   past three months?                                                     67
 Did he/she work full or part-time when working?                          68
 Was he/she working within last two weeks not counting work
   around the house?                                                      69
 Even though he/she did not work, does he/she have a job or
   business?                                                              70
 Was he/she looking for work or on layoff from a job?                     71
 Which, looking for work or on layoff from a job?                         72
 What kind of industry or business is this?                           73- 75
 What kind of work was he/she doing?                                  76- 78
 Was he/she in private company or business or individual for
   wages, salary or commission?                                           79
 Did he/she ever serve in the armed forces of the U.S.?                   80
 When did he/she serve?                                                   81
 Data user work area                                                  82- 90

 Tape Positions 91-246

                                 Household Data
                                                                Tape Positions
 How many rooms are in this...? Count the kitchen, but not the bathroom   91
 How many bedrooms are in this...?                                        92
 Ask only of unrelated household members.  Do you have complete
   kitchen facilities in your living quarters, that is a kitchen
   sink with piped water, a refrigerator and a range or cookstove?        93
 Do you have access to complete kitchen facilities in this
   house?                                                                 94
 Do you have access to a range or cookstove?                              95
 Do you have access to a refrigerator?                                    96
 Do you have access to a sink with piped water?                           97
 Is there piped water in this house (these living quarters)?              98
 Is there both hot and cold water?                                        99
 Are these kitchen facilities used by anyone not living in
   this household?                                                       100
 What is the main type of heating system you have?                   101-102
 Do you have air conditioning?                                           103
 How many motor vehicles are owned or regularly used for
   transportation by members of your family?                             104
 Is any language other than English spoken by family members
   living here?                                                          105
 What language?                                                          106
 Which of these income groups represents your total combined
   family income for the past 12 months?                             107-108
 During the past 12 months, how much money did you and
   all members of your family receive in wages or salaries
   before deductions (under $7,000 only)?                            109-112
 Social security or railroad retirement?                                 113
 Data user work area                                                     114
 If yes, how much?                                                   115-118
 Welfare payments or other public assistance?                            119
 Data user work area                                                     120
 If yes, how much?                                                   121-124
 Unemployment compensation or workmen's compensation?                    125
 Data user work area                                                     126
 If yes, how much?                                                   127-130
 Government employee pension or private pensions?                        131
 Data user work area                                                     132
 If yes, how much?                                                   133-136
 Dividends, interest or rent?                                            137
 Data user work area                                                     138
 If yes, how much?                                                   139-142
 Net income from their own business (nonfarm)
   professional practice, or partnership?                                143
 Data user work area                                                     144
 If yes, how much?                                                   145-148
 Net income from a farm?                                                 149
 Data user work area                                                     150
 If yes, how much?                                                   151-154
 Veteran's payments?                                                     155
 Data user work area                                                     156
 If yes, how much?                                                   157-160
 Alimony, child support or other support from persons not
   in household?                                                         161
 Data user work area                                                     162
 If yes, how much?                                                   163-166
 Any other income?                                                       167
 Data user work area                                                     168
 If yes, how much?                                                   169-172
 Total amount                                                        173-176
 Check Item B                                                            177
 Are you certified to participate in the food stamp program?             178
 Are you buying food stamps now?                                         179
 What is the main reason you are not participating in the
   program?                                                              180
 Are you certified for commodity distribution program?                   181
 Are you receiving commodity foods now for your family?                  182
 Why aren't you participating in the program?                            183
 Date of exam                                                        184-189
 Age in years (at examination)                                       190-191
 Data user work area                                                 192-205
 Race-sex recode for sample persons                                      206
 Farm, nonfarm recode for sample person                                  207
 Interview status                                                        208
 Region                                                                  209
 Poverty index                                                       210-212
 Data user work area                                                 213-246

 Tape Positions 247-281

                             Head of Household Data
                                                                Tape Positions
 Age in years                                                        247-248
 Data user work area                                                 249-250
 Date of birth-month                                                 251-252
 Date of birth-year                                                  253-254
 Sex                                                                     255
 Race                                                                    256
 In what state was he/she born?                                      257-258
 Is he/she married, widowed, divorced, separated or
   never married?                                                        259
 Natural origin or ancestry?                                         260-261
 Education level                                                     262-263
 Grade completed                                                         264
 What was he/she doing during most of the past 12 months?                265
 What was he/she doing?                                                  266
 Did he/she work at a job or business at any time during the
   past three months?                                                    267
 Did he/she work full or part-time when working?                         268
 Was he/she working within last two weeks not counting work
   around the house?                                                     269
 Even though he/she did not work, does he/she have a job or
   business?                                                             270
 Was he/she looking for work or on layoff from a job?                    271
 Which?, looking for work or on layoff from a job?                       272
 Type of industry or business                                        273-275
 What kind of work was he/she doing?                                 276-278
 Was he/she in private company or business or individual for
   wages, salary or commission?                                          279
 Did he/she ever serve in the armed forces of the U.S.?                  280
 When did he/she serve?                                                  281

 Tape Positions 282-350

                                 Sample Weights
                                                                Tape Positions
 Examined final weight                                               282-287
 Medical history interview final weight                              288-293
 Glucose Tolerance Test final examined weight                        294-299
 Lead final examined weight                                          300-305
 Carboxyhemoglobin final examined weight                             306-311
 Bile acids final examined weight                                    312-317
 Data user work area                                                 318-323
 Strata code                                                         324-325
 Pseudo PSU code                                                         326
 Poverty, Nonpoverty segments                                            327
  (Not coded on Intake, Recall, Anthro and Glucose tapes)
 Data user work area                                                 328-350
1USE OF SPECIAL TERMS, DEMOGRAPHIC DATA, NHANES II

 The term "data user work area" refers to blank areas in the data tape which
 are reserved for the user as needed.

 The term "blank, but applicable",is used to indicate a data item that was to
 have a response for a sample person but none was given. The terms "blank" and
 "Not applicable"refer to data items where the sample person was not supposed
 to respond to the question or receive the examination component.

 To more fully understand the questionnaire skip patterns and the
 categorizations used,see the Plan and Operation of the Second National Health
 and Nutrition Examination Survey document included with this documentation.
 All the questionnaires are included in this document.


RECORD LAYOUT, DEMOGRAPHIC DATA

 Tape Locations 1-50

          NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY - NHANES II
                              DEMOGRAPHIC DATA


  TAPE                                               NHANES II DATA SOURCE
  LOC.   ITEM DESCRIPTION & CODES                           OR NOTES


 001-   Sample Sequence Number
 005    00001-27796

 006-   Catalog Number
 009    5371

 010    Data User Work Area

 011    Size of Place                                  See Detailed Notes

        1 - Urbanized area with 3,000,000 or
            more
        2 - Urbanized area 1,000,000 to
            2,999,999
        3 - Urbanized area with 250,000 to
            999,999
        4 - Urbanized area under 250,000
        5 - Urban place 25,000 or more outside
            urbanized area
        6 - Urban place 10,000-24,999 outside
            urbanized area
        7 - Urban place 2,500 to 9,999 outside
            urbanized area
        8 - Rural

 012    SMSA-Not SMSA                                   See Detailed Notes

        1 - In SMSA, in central city
        2 - In SMSA, not in central city
        4 - Not in SMSA

 013-   Data User Work Area
 023

 024    Type of living quarters

        1 - Housing unit
        2 - Other unit

 025    Land Usage

        1 - Urban
        2 - Rural

 026    If rural, asked does this place have
        10 acres or more?

        1 - Yes
        2 - No
        9 - Not Applicable

 027    If 10 acres or more, asked if in the
        last 12 months did sales of farm produce
        and livestock amount to $50 or more?

        1 - Yes
        2 - No
        9 - Not Applicable

 028    If less than 10 acres, asked if in the
        last 12 months did sales or farm produce
        and livestock amount to $250 or more?

        1 - Yes
        2 - No
        9 - Not Applicable

 029    Data User Work Area

 030-   Total Number Of Persons In Household
 031
        01 - 15 - As given

 032-   Total Number Of Sample Persons In
 033    Household

        01 - 06 - As Given

        Sample Person Data

 034    Data User Work Area

 035    Family Relationship

        1 - Head one person living alone or
            with non-relatives
        2 - Head 2 or more related persons in
            family
        3 - Wife
        4 - Child
        5 - Other relative
        6 - Foster child
        7 - Husband

 036    Examination Status

        1 - Examined

 037-   Family Unit Code                               See Detailed Notes
 041
        00001-21050 - As Given

 042-   Data User Work Area
 044

 045-   Age-Months                                        At Interview
 046
        06-11 Months
        Blank, if greater than 11 months

 047-   Age-Years                                         At Interview
 048
        01 - 74 Years
             00, If less than 12 months

 049-   Data User Work Area
 050

 Tape Locations 51-100

 051-   Date-Of-Birth-Month
 052
        01 - 12 Month

 053-   Date-Of-Birth-Year
 054
        01 - 79 Year

 055    Sex

        1 - Male
        2 - Female

 056    Race                                            See Detailed Notes

        1 - White
        2 - Black
        3 - Other

 057-   In what state was he/she born?                  See Detailed Notes
 058
        01 - 97
        88 - Blank, but applicable

 059    Is he/she married, widowed, divorced,
        separated, or never married?

        1 - Under 17
        2 - Married
        3 - Widowed
        4 - Divorced
        5 - Separated
        6 - Never married
        8 - Blank, but applicable

 060-   Natural Origin or Ancestry
 061
        01 - Countries of Central or South
             America
        02 - Chicano
        03 - Cuban
        04 - Mexican
        05 - Mexicano
        06 - Mexican-American
        07 - Puerto Rican
        08 - Other Spanish
        09 - Other European, such as German,
             French, English, Irish
        10 - Black, Negro or Afro-American
        11 - American Indian or Alaskan Native
        12 - Asian or Pacific Islander Such as
             Chinese, Japanese, Korean,
             Philippino, Samoan
        13 - Another Group Not Listed
        88 - Blank, but applicable

 062-   Highest Grade Of School Attended
 063
        00 - None (regardless of age)
        21 - 28 - Elementary Grades (1-8)
        31 - 34 - High School (1-4)
        41 - 45 - College (1-5+)
        88 - Blank, but applicable

 064    Grade Completed

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 065    What was he/she doing during most of
        the past 12 months?

        1 - Working
        2 - Keeping house
        3 - Something else
        8 - Blank, but applicable
        Blank

 066    What was he/she doing?

        1 - Layoff
        2 - Retired
        3 - Student
        4 - Ill
        5 - Staying home
        6 - Looking for work
        7 - Unable to work
        8 - Blank, but applicable
        0 - Other
        Blank

 067    Did he/she work at a job or business at
        any time during the past three months?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 068    Did he/she work full or part-time when
        working?

        1 - Full time
        2 - Part time
        8 - Blank, but applicable
        Blank

 069    Was he/she working within last two
        weeks not counting work around the
        house?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 070    Even though he/she did not work does
        he/she have a job or business?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 071    Was he/she looking for work or on
        layoff from a job?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 072    Which looking for work or on layoff
        from a job?

        1 - Looking
        2 - Layoff
        3 - Both
        8 - Blank, but applicable
        Blank

 073-   What kind of industry or business is              See Detailed Notes
 075    this?

        017 - 998 (last digit 7, 8, 9)
        000 - Blank, but applicable
        Blank

 076-   What kind of work was he/she doing?               See Detailed Notes
 078

        001 - 992 - Occupation (last digit
                    0-6)
        000 - Blank, but applicable
        Blank

 079    Was he/she in private company or
        business or working for individual for
        wages, salary or commission?

        1 - Private
        2 - A Federal government employee
        3 - A State government employee
        4 - A local government employee
        5 - Incorporated-Own
        6 - Self-employed (or farm)
        7 - Working without pay in family
            business or farm
        8 - Never worked
        0 - Blank, but applicable
        Blank

 080    Did he/she ever serve in the armed
        forces of the U.S.?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 081    When did he/she serve?

        1 - Vietnam
        2 - Korean War
        3 - World War II
        4 - World War I
        5 - Post Vietnam
        6 - Other Service
        8 - Blank, but applicable
        9 - Do not know
        Blank

 082-   Data User Work Area
 090

        Household Data

 091    How many rooms are in this..?  Count
        the kitchen, but not the bath.

        1 - 8 Rooms
        9 - 9 Or More Rooms

 092    How many bedrooms are in this - ?

        0 - 7 Bedrooms - More than 7 bedrooms
                         coded as 7

 093    Ask only of unrelated household members.
        Do you have complete kitchen facilities
        in your living quarters, that is a
        kitchen sink with piped water, a
        refrigerator and a range or cookstove?

        1 - Yes
        2 - No
        Blank

 094    Do you have access to complete kitchen
        facilities in this house?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 095    Do you have access to a range or
        cookstove?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 096    Do you have access to a refrigerator?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 097    Do you have access to a sink with
        piped water?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 098    Is there piped water in this house
        (these living quarters)?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 099    Is there both hot and cold water?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 100    Are these kitchen facilities used by
        anyone not living in this household?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 Tape Locations 101-150

 101-   What is the main type of heating system
 102    you have?

        11 - Steam or hot water system
        12 - Central warm air furnace with
             ducts to individual rooms or
             central heat pump (forced air)

        13 - Built in electric units
             (permanently installed in wall,
             ceiling or baseboard
        14 - Floor, wall or pipeless furnace
        15 - Circulating, radiant or room
             heaters, with flue or vent,
             burning gas, oil, or kerosene
        16 - Circulating, radiant, or room
             heaters (not portable) without
             flue or vent burning gas, oil or
             kerosene
        17 - Fireplace or stoves burning coal,
             wood or coke
        18 - Portable room heaters of any kind
        19 - Some other type
        20 - None, unit is not heated
        88 - Blank, but applicable

 103    Do you have air conditioning?

        1 - Yes, individual room unit
        2 - Yes, central air conditioning
        3 - No
        8 - Blank, but applicable

 104    How many motor vehicles are owned or
        regularly used for transportation by
        members of your family?

        0 - None
        1 - 8 Vehicles (more than 8 coded as 8)
        9 - Blank, but applicable

 105    Is any language other than English
        spoken by family members living here?

        1 - Yes
        2 - No
        8 - Blank, but applicable

 106    What language?

        0 - German
        1 - Italian
        2 - French
        3 - Polish
        4 - Russian
        5 - Spanish
        6 - Chinese
        7 - Other language
        8 - Blank, but applicable
        9 - Not applicable

 107-   Which of these income groups represents          See Detailed Notes
 108    your total combined family income for
        the past 12 months?

        11 - Under $1,000
        12 - $1,000-1,999
        13 - $2,000-2,999
        14 - $3,000-3,999
        15 - $4,000-4,999
        16 - $5,000-5,999
        17 - $6,000-6,999
        18 - $7,000-9,999
        19 - $10,000-14,999
        20 - $15,000-19,999
        21 - $20,000-24,999
        22 - $25,000 and over
        88 - Blank, but applicable

 109-   During the past 12 months, how much
 112    money did you and all members of your
        family receive in wages or salaries
        before deductions?

        0000 - 6999 Amount
        8888 - Blank, but applicable
        Blank

 113    Social security or railroad
        retirement?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 114    Data User Work Area

 115-   If yes, how much?
 118
        0038 - 6828 Amount
        8888 - Blank, but applicable
        Blank

 119    Welfare payments or other public
        assistance?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 120    Data User Work Area

 121-   If yes, how much?
 124
        0012 - 6800 Amount
        8888 - Blank, but applicable
        Blank

 125    Unemployment Compensation or Workman's
        Compensation

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 126    Data User Work Area

 127-   If yes, how much?
 130
        0015 - 5640 Amount
        8888 - Blank, but applicable
        Blank

 131    Government Employee Pension or Private
        Pensions?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 132    Data User Work Area

 133-   If yes, how much?
 136
        0036 - 6000 Amount
        8888 - Blank, but applicable
        Blank

 137    Dividends, Interest or Rent?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 138    Data User Work Area

 139-   If yes, how much?
 142
        0001 - 5200 Amount
        8888 - Blank, but applicable
        Blank

 143    Net income from their own business
        (nonfarm) professional practice, or
        partnership?

        1 - Yes
        2 - No
        3 - Loss
        8 - Blank, but applicable
        Blank

 144    Data User Work Area

 145-   If yes, how much?
 148
        0001 - 6800 Amount
        8888 - Blank, but applicable
        Blank

 149    Net income from a farm?

        1 - Yes
        2 - No
        3 - Loss
        8 - Blank, but applicable
        Blank

 150    Data User Work Area

 Tape Locations 151-205

 151-   If yes, how much?
 154
        0000 - 6500 Amount
        8888 - Blank, but applicable
        Blank

 155    Veterans payments?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 156    Data User Work Area

 157-   If yes, how much?
 160
        0060 - 6000 Amount
        8888 - Blank, but applicable
        Blank

 161    Alimony, child support or other support
        from persons not in household?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 162    Data User Work Area

 163-   If yes, how much?
 166
        0020 - 6900 Amount
        8888 - Blank, but applicable
        Blank

 167    Any other income?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 168    Data User Work Area

 169-   If yes, how much?
 172
        0003 - 6403 Amount
        8888 - Blank, but applicable
        Blank

 173-   Total Amount                                      Q 21 & 22
 176
        0000 - 6999 Amount
        8888 - Blank, but applicable
        Blank

 177    Check Item B

        2 - Food stamps available
        4 - Both - Food Stamps and
            commodities

 178    Are you certified to participate in
        the food stamp program?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Don't know

 179    Are you buying food stamps now?

        1 - Yes, Regularly
        2 - Yes, Occasionally
        3 - No
        8 - Blank, but applicable
        Blank

 180    What is the main reason you are not
        participating in the program?

        1 - No need
        2 - Not enough money at the time
        3 - No transportation
        4 - Pride
        5 - Other
        8 - Blank, but applicable
        Blank

 181    Are you certified for commodity
        distribution program?

        1 - Yes
        2 - No
        9 - Do not know
        Blank

 182    Are you receiving commodity foods now
        for your family?

        1 - Yes, regularly
        2 - Yes, occasionally
        3 - No
        Blank

 183    Why aren't you participating in the
        program?

        1 - No need
        2 - No transportation
        3 - Pride
        4 - Other
        8 - Blank, but applicable
        Blank

 184-   Date of Exam Month                                Control Record
 185
        01 - 12

 186-   Date of Exam Day                                  Control Record
 187
        00 - 31

 188-   Date of Exam Year                                 Control Record
 189
        76 - 80

 190-   Age Years                                         At Examination
 191
        01 - 75 Years
        00 - If less than 12 months or non-
             examined

 192-   Data User Work Area
 205

 Tape Locations 206-250

 206    Race Sex Recode For Sample Person                See Detailed Notes

        1 - Male, White
        2 - Male, Black
        3 - Male, Other
        4 - Female, White
        5 - Female, Black
        6 - Female, Other

 207    Farm, Non-Farm Recode For Sample Person           See Detailed Notes

        1 - Farm
        2 - Non-Farm

 208    Interview Status

        1 - Interviewed

 209    Region                                            See Detailed Noted

        1 - Northeast
        2 - Midwest
        3 - South
        4 - West

 210-   Poverty Index (x.xx)                            See Detailed Notes
 212
        001 - 880 - As Given
        999 - Unknown

 213-   Data User Work Area
 246

        Head of Household Data

 247-   Age Years
 248
        15 - 99 Years (more than 100 coded
                as 99)

 249-   Data User Work Area
 250

 Tape Locations 251-305

 251-   Date-Of-Birth-Month
 252
        01 - 12 Month
        88 - Blank, but applicable

 253-   Date-Of-Birth-Year
 254
        00 - 99 Year

 255    Sex

        1 - Male
        2 - Female

 256    Race                                              See Detailed Notes

        1 - White
        2 - Black
        3 - Other

 257-   In what state was he/she born?                    See Detailed Notes
 258
        01 - 97
        88 - Blank, but applicable

 259    Is he/she married, widowed, divorced,
        separated, or never married?

        1 - Under 17
        2 - Married
        3 - Widowed
        4 - Divorced
        5 - Separated
        6 - Never married
        8 - Blank, but applicable

 260-   Natural Origin or Ancestry?
 261
        01 - Countries of Central or South
             America
        02 - Chicano
        03 - Cuban
        04 - Mexican
        05 - Mexicano
        06 - Mexican-American
        07 - Puerto Rican
        08 - Other Spanish
        09 - Other European, such as German,
             French, English, Irish
        10 - Black, Negro or Afro-American
        11 - American Indian or Alaskan Native
        12 - Asian or Pacific Islander Such as
             Chinese, Japanese, Korean,
             Philippino, Samoan
        13 - Another Group Not Listed
        88 - Blank, but applicable

 262-   Highest Grade Attended
 263
        00 - None (regardless of age)
        21 - 28 - Elementary Grades (1-8)
        31 - 34 - High School (1-4)
        41 - 45 - College (1-5+)
        88 - Blank, but applicable

 264    Grade Completed

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 265    What was he/she doing during most of
        the past 12 months?

        1 - Working
        2 - Keeping house
        3 - Something else
        8 - Blank, but applicable
        Blank

 266    What was he/she doing?

        1 - Layoff
        2 - Retired
        3 - Student
        4 - Ill
        5 - Staying home
        6 - Looking for work
        7 - Unable to work
        8 - Blank, but applicable
        0 - Other
        Blank

 267    Did he/she work at job or business
        during past three months?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 268    Did he/she work full or part-time when
        working?

        1 - Full time
        2 - Part time
        8 - Blank, but applicable
        Blank

 269    Did he/she work at any time the last
        two weeks not counting work around
        the house?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 270    Even though he/she did not work, does
        he/she have a job or business?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 271    Was he/she looking for work or on
        layoff from a job?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 272    Which, looking for work or on layoff
        from a job?

        1 - Looking
        2 - Layoff
        3 - Both
        8 - Blank, but applicable
        Blank

 273-   Type of industry or business?                     See Detailed Notes
 275

        017 - 998 (last digit 7, 8, 9)
        000 - Blank, but applicable
        Blank

 276-   What kind of work was he/she doing?               See Detailed Notes
 278

        001 - 992 - Occupation (last digit
                    0-6)
        000 - Blank, but applicable
        Blank

 279    Was he/she in private company or
        business or working for individual for
        wages, salary or commission?

        1 - Private
        2 - A Federal government employee
        3 - A State government employee
        4 - A local government employee
        5 - Incorporated-Own
        6 - Self-employed (or farm)
        7 - Working without pay in family
            business or farm
        8 - Never worked
        0 - Blank, but applicable
        Blank

 280    Did he/she ever serve in the armed
        forces of the U.S.?

        1 - Yes
        2 - No
        8 - Blank, but applicable
        Blank

 281    When did he/she serve?

        1 - Vietnam
        2 - Korean War
        3 - World War II
        4 - World War I
        5 - Post Vietnam
        6 - Other Service
        8 - Blank, but applicable
        9 - Do not know
        Blank

        SEE DETAILED NOTES FOR POSITIONS
        282-326

 282-   Examined Final Weight
 287
        001218 - 079634

 288-   Medical History Interview Final Weight
 293
        001171 - 071969

 294-   Glucose Tolerance Test Final Examined
 299    Weight

        003502 - 084477
        000000

 300-   Lead Final Examined Weight
 305
        001218 - 084115
        000000

 Tape Locations 306-350

 306-   Carboxyhemoglobin Final Examined Weight
 311
        002546 - 110759
        000000

 312-   Bile Acids Final Examined Weight
 317
        003519 - 087638
        000000

 318-   Data User Work Area
 323

 324-   STRATA
 325
        01 - 32

 326    PSEUDO Primary Sampling Unit

        1 OR 2

 328    Poverty/Non-Poverty Segments

        1-Non-Poverty
        2-Poverty

 328-   Data User Work Area
 350


DETAILED NOTES, DEMOGRAPHIC DATA

 Size of Place

 Size of place classification was derived from the 1970 census. According to
 the definition used in the 1970 census, the urban population was comprised of
 all persons living in (a) places of 2,500 inhabitants or more incorporated as
 cities, boroughs (except Alaska),villages and towns (except towns in New York,
 New England States,and Wisconsin),but excluding those persons living in the
 rural portions of extended cities; (b) unincorporated places of 2,500
 inhabitants or more; and (c) other territories included in urbanized areas.
 the remaining population was classified as rural.

 Urban areas are further classified by population size for places within
 urbanized areas and other places outside urbanized areas.

 SMSA

 Except in New England,a standard metropolitan statistical area is basically a
 county or a group of contiguous counties which contains at least one city of
 50,000 inhabitants or more, or "twin cities" with a combined population of at
 least 50,000. In addition to the county or counties containing such a city or
 cities, contiguous counties are included in an SMSA if, according to the 1970
 census, they are socially and economically integrated with the central city.
 Each SMSA must include at least one central city,and the complete title of an
 SMSA identifies the central city or cities. In New England, SMSA's consist of
 towns and cities, rather than counties.

 Family Unit Code

 All related sample persons in the same family unit have the same computer
 generated family unit code.  This will enable analysis of individual family
 units.

 Race

 The race of the respondent was marked by observation and the interviewers
 were instructed to assume the race of all related persons was the same as the
 respondent unless otherwise learned.The race categories were "White","Black"
 or "Other".  If the appropriate category could not be marked by observation,
 then race was asked.  Interviewers were instructed to record persons who
 responded with something other than White or Black,such as Japanese,Chinese,
 American Indian, Korean, Hindu, Eskimo, etc., as "Other"; and to include
 Mexicans,Puert Ricans and other persons of Latin American descent in "White",
 unless definitely Black, American Indian, or of other non-white race.

 Tape Positions 57-58 and 257-258

                                  United States
 Name of Place                                                           Code

 Alabama                                                                  01
 Alaska                                                                   02
 Arizona                                                                  04
 Arkansas                                                                 05
 California                                                               06
 Colorado                                                                 08
 Connecticut                                                              09
 Delaware                                                                 10
 District of Columbia                                                     11
 Florida                                                                  12
 Georgia                                                                  13
 Hawaii                                                                   15
 Idaho                                                                    16
 Illinois                                                                 17
 Indiana                                                                  18
 Iowa                                                                     19
 Kansas                                                                   20
 Kentucky                                                                 21
 Louisiana                                                                22
 Maine                                                                    23
 Maryland                                                                 24
 Massachusetts                                                            25
 Michigan                                                                 26
 Minnesota                                                                27
 Mississippi                                                              28
 Missouri                                                                 29
 Montana                                                                  30
 Nebraska                                                                 31
 Nevada                                                                   32
 New Hampshire                                                            33
 New Jersey                                                               34
 New Mexico                                                               35
 New York                                                                 36
 North Carolina                                                           37
 North Dakota                                                             38
 Ohio                                                                     39
 Oklahoma                                                                 40
 Oregon                                                                   41
 Pennsylvania                                                             42
 Rhode Island                                                             44
 South Carolina                                                           45
 South Dakota                                                             46
 Tennessee                                                                47
 Texas                                                                    48
 Utah                                                                     49
 Vermont                                                                  50
 Virginia                                                                 51
 Washington                                                               53
 West Virginia                                                            54
 Wisconsin                                                                55
 Wyoming                                                                  56

                       Outlying Areas of the United States

 Name of Place                         Code             Description

 American Samoa                       60    U.S. territory in the Pacific
 Canal Zone                           61    Territory in Panama leased by U.S.
 Canton and Enderbury Islands         62    Under common US-UK administration
 Guam                                 66    U.S. territory in the Pacific
 Johnston Atoll                             U.S. territory in the Pacific,
                                              includes Sand Island
 Midway Islands                        71    U.S. territory in the Pacific
 Puerto Rico                           72    Commonwealth associated with the
                                                U.S.
 Swan Islands                           74    U.S. territory in the Caribbean
 Trust Territories of the Pacific       75    U.S. administered, includes
   Islands                                    Caroline, Mariana, and Marshall
                                              Island Groups
 U.S. Miscellaneous Caribbean           76   Includes Navassa Islands, Quito
   Islands                                     Sueno Bank, Roncador Cay,
                                               Serrana Bank, Serranilla Bank
 U.S. Miscellaneous Pacific             77   Includes Kingman Reef, Howland,
   Islands                                     Baker and Jarvis Islands,
                                               Palmyra Atoll
 Virgin Islands                         78   U.S. territory in the Caribbean
 Wake Island                            79   U.S. territory in the Pacific

                                Foreign Countries

 North America                          91
 South America                          92
 Europe                                 93
 Africa                                 94
 Asia                                   95
 Australasia                            96
 Pacific Islands                        97



 Industry and Occupation Codes

 A person's occupation may be defined as his principal job or business. For
 this survey purpose, the principal job or business of a respondent is defined
 in one of the following ways:  If the person worked during the two-week
 interview period or had a job or business, the question concerning his
 occupation (or work) applies to his job during that period.If the respondent
 held more than one job, the question is directed to the one at which he spent
 the most time.  It refers to the one he considers most important when equal
 time is spent at each job.  A person who has not begun work at a new job, is
 looking for work, or is on layoff from work is questioned about his last
 full-time civilian job.A full-time job is defined as one at which the person
 spent 35 or more hours per week and which lasted two consecutive weeks or
 more. A person who has a job to which he has not yet reported and has never
 had a previous job or business is classified as a "new worker".

 The 1970 census of population Alphabetical Index of Industries and Occupa-
 tion was used in the coding of both the industry and occupation. Library of
 Congress Number 74-612012.  For sale by the Superintendent of Documents,U.S.
 Government Printing Office, Washington, D.C. 20402.  $3.00.  Stock Number
 0301-2283.

 Family Income Group

 The respondent was handed a card with 12 income ranges listed as Group A to
 Group L and asked "Which of these income groups represents your total com-
 bined family income for the past 12 months,that is,yours, your ...'s, etc?
 include income from all sources such as wages,salaries,social security or
 retirement benefits, help from relatives, rent from property and so forth."

 If the respondent answered Group A through G,that is with an income less than
 $7,000,then questions 21 and 22 detailing exact sources and amounts of income
 were asked; otherwise, these questions were skipped.

 No effort was made to reconcile amounts reported in detailed questions 21 and
 22 with the categorical response to the family income group question.  During
 the survey time period, no adjustments to the income groups or $7,000 value
 were made to account for inflation.

 Land

 Land used for farming purposes (Code 1 in Tape Position 207) was identified
 as being rural land (Code 2 in Tape Position 25) consisting of 10 or more
 acres (Code 1 in Tape Position 26) with crop sales amounting to $50 or more
 (Code 1 in Tape Position 27), or rural land (Code 2 in Tape Position 25)
 consisting of less than 10 acres(Code 2 in Tape Position 26)with crop sales
 amounting to $250 or more (Code 1 in Tape Position 28).All other land is
 classified as nonfarm (Code 2 in Tape Position 207).

 Region

 The United States was divided into four broad geographic regions of
 approximately equal population. Those regions, which deviate somewhat from
 the groups used by the Bureau of Census, are as follows:

     Region                            States Included

     Northeast                         Maine, Vermont, New Hampshire,
                                       Massachusetts, Connecticut, Rhode
                                       Island, New York, New Jersey, and
                                       Pennsylvania

     South                             Delaware, Maryland, District of
                                       Columbia, West Virginia, Virginia,
                                       Kentucky, Tennessee, North Carolina,
                                       South Carolina, Georgia, Florida,
                                       Alabama, Mississippi, Louisiana, and
                                       Arkansas

     Midwest                         Ohio, Illinois, Indiana, Michigan,
                                     Wisconsin, Minnesota, Iowa, Missouri

     West                            Washington, Oregon, California, Nevada,
                                     New Mexico, Arizona, Texas, Oklahoma,
                                     Kansas, Nebraska, North Dakota, South
                                     Dakota, Idaho, Utah, Colorado, Montana,
                                     Wyoming, Alaska, Hawaii


 Poverty Index

 Income status was determined by the Poverty Income Ratio (PIR).  Poverty
 statistics published in the Census Bureau reports 1-5 were based on the
 poverty index developed by the Social Security Administration (SSA) in 1964.
 (For a detailed discussion of the SSA poverty standards, see reference 6.)
 Modifications in the definition of poverty were adopted in 1969.7 The stand-
 ard data series in poverty for statistical use by all executive departments
 and establishments has been established.8

 The two components of the PIR are the total income of the household (numera-
 tors the median of the income group for incomes $7,000 and above; the sum of
 the porponent parts of the income questions for incomes under $7,000) and a
 multiple of the total income necessary to maintain a family with given
 characteristics on a nutritionally adequate food plan3 (denominator). The
 dollar value of the denominator of the PIR is constructed from a food plan
 (economy plan) necessary to maintain minimum recommended daily nutritional
 requirements.The economy plan is designated by the Department of Agriculture
 for "emergency or temporary use when funds are low."

 For families of three or more persons,the poverty level was set at three
 times the cost of the economy food plan.For smaller families and persons
 living alone,the cost of the economy food plan was adjusted by the relatively
 higher fixed expenses of these smaller households.

 The denominator or poverty income cutoff adjusts the family poverty income
 maintenance requirements by the family size, the sex of the family head, the
 age of the family head in families with one or two members, and the place of
 residence (farm, nonfarm).Annual revisions of the poverty income cutoffs are
 based on the changes in the average cost of living as reflected in the
 Consumer Price Index.

 As shown in the tables, the annual income considered to be the poverty level
 increases as the family size increases.  A family with any combination of
 characteristics and with the same income as shown in the table has been
 designated as having a PIR or poverty level of 1.0. The same family with
 twice the income found in the table would have a PIR of 2.0. Ratios of less
 than 1.0 can be described as "below poverty",ratios greater than or equal to
 1.0, as "at or above poverty".

 Poverty thresholds are computed on a national basis only. No attempt has been
 made to adjust these thresholds for regional,state,or other variations in the
 cost of living (except for the farm, nonfarm difference).None of the noncash
 public welfare benefits such as food stamp bonuses are included in the income
 of the low income families receiving these benefits.PIR has been adjusted by
 year (see tables) and accounts in some part for inflation.

 1   U.S. Bureau of the Census, Current Population Reports, Series P-60, No.
     107, "Money Income and Poverty Status of Families and Persons in the
     United States: 1976" (Advance Report) U.S. Government Printing Office,
     Washington, D.C., 1977.
 2   U.S. Bureau of the Census, Current Population Reports, Series P-60, No.
     116, "Money Income and Poverty Status of Families and Persons in the
     United States: 1977" (Advance Report) U.S. Government Printing Office,
     Washington, D.C., 1978.
 3   U.S. Bureau of the Census, Current Population Reports, Series P-60, No.
     120, "Money Income and Poverty Status of Families and Persons in the
     United States: 1978" (Advance Report), U.S. Government Printing Office,
     Washington, D.C., 1979.
 4   U.S. Bureau of the Census, Current Population Reports, Series P-60, No.
     125, "Money Income and Poverty Status of Families and Persons in the
     United States: 1979" (Advance Report), U.S. Government Printing Office,
     Washington, D.C., 1980.
 5   U.S. Bureau of the Census, Current Population Reports, Series P-60, No.
     127, "MoneyIncome and Poverty Status of Families and Persons in the
     United States: 1980"(Advance Data from the March 1981 Current Population
     Survey), U.S. Government Printing Office, Washington, D.C., 1981.
 6   Orshansky, M.: "Counting the Poor: Another Look at the Poverty Profile",
     Social Security Bulletin, January 1965; "Who's Who Among the Poor: A
     demographic View of Poverty", Social Security Bulletin, July 1965.
 7   U.S. Bureau of the Census, Current Population Reports, Series P-23,
     No. 28 "Special Studies", U.S. Government Printing Office, Washington,
     D.C., August 12, 1969.
 8   Circular No. A-46,Transmitted Memorandum No. 9,Executive Office of the
     President, Bureau of the Budget, August 29, 1969, and Exhibit L (rev.).

Table 15

   Weighted Average Thresholds-Poverty Cutoffs in 1976, by Size of
          Family and Sex of Head, By Farm-Nonfarm Residence

                                                         NONFARM
 SIZE OF FAMILY UNIT            Total       Total     Male Head   Female Head
                               (Dollars)   (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated
   Individual). . . . . . . . .    2 877       2 884       3 016        2 788
   14 to 64 Years . . . . . . .    2 954       2 959       3 069        2 840
   65 Years And Over. . . . . .    2 720       2 730       2 758        2 722

 2 Persons. . . . . . . . . . .    3 688       3 711       3 721        3 660
   Head 14 to 64 Years. . . . .    3 806       3 826       3 846        3 733
   Head 65 Years and Over . . .    3 417       3 445       3 447        3 428

 3 Persons. . . . . . . . . . .    4 515       4 540       4 565        4 414
 4 Persons. . . . . . . . . . .    5 786       5 815       5 818        5 790
 5 Persons. . . . . . . . . . .    6 838       6 876       6 884        6 799
 6 Persons. . . . . . . . . . .    7 706       7 760       7 766        7 709
 7 Persons Or More. . . . . . .    9 505       9 588       9 622        9 375

                                                            FARM

 SIZE OF FAMILY UNIT                       Total     Male Head   Female Head
                                          (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated Individual). . . . .     2 438        2 532        2 348
   14 to 64 Years . . . . . . . . . . . .     2 542        2 608        2 413
   65 Years And Over. . . . . . . . . . .     2 322        2 344        2 313

 2 Persons. . . . . . . . . . . . . . . .     3 128        3 133        3 033
   Head 14 to 64 Years. . . . . . . . . .     3 267        3 271        3 159
   Head 65 Years and Over . . . . . . . .     2 928        2 928        2 922

 3 Persons. . . . . . . . . . . . . . . .     3 858        3 864        3 734
 4 Persons. . . . . . . . . . . . . . . .     4 950        4 953        4 840
 5 Persons. . . . . . . . . . . . . . . .     5 870        5 871        5 847
 6 Persons. . . . . . . . . . . . . . . .     6 585        6 584        6 607
 7 Persons Or More. . . . . . . . . . . .     8 072        8 068        8 428

Table 15

    Weighted Average Thresholds-Poverty Cutoffs in 1977, by Size of
           Family and Sex of Head, By Farm-Nonfarm Residence

                                                          NONFARM

 SIZE OF FAMILY UNIT            Total       Total     Male Head   Female Head
                               (Dollars)   (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated
   Individual). . . . . . . . .    3 067       3 075       3 214        2 969
   14 to 64 Years . . . . . . .    3 147       3 152       3 267        3 023
   65 Years And Over. . . . . .    2 895       2 906       2 936        2 898

 2 Persons. . . . . . . . . . .    3 928       3 951       3 961        3 907
   Head 14 to 64 Years. . . . .    4 054       4 072       4 095        3 981
   Head 65 Years and Over . . .    3 637       3 666       3 670        3 646

 3 Persons. . . . . . . . . . .    4 806       4 833       4 860        4 708
 4 Persons. . . . . . . . . . .    6 157       6 191       6 195        6 162
 5 Persons. . . . . . . . . . .    7 279       7 320       7 329        7 238
 6 Persons. . . . . . . . . . .    8 208       8 261       8 268        8 197
 7 Persons Or More. . . . . . .   10 137      10 216      10 249        9 995

                                                            FARM

 SIZE OF FAMILY UNIT                       Total     Male Head   Female Head
                                          (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated Individual). . . . .     2 588        2 672        2 498
   14 to 64 Years . . . . . . . . . . . .     2 709        2 776        2 569
   65 Years And Over. . . . . . . . . . .     2 475        2 495        2 563

 2 Persons. . . . . . . . . . . . . . . .     3 318        3 325        3 176
   Head 14 to 64 Years. . . . . . . . . .     3 466        3 474        3 278
   Head 65 Years and Over . . . . . . . .     3 128        3 131        3 079

 3 Persons. . . . . . . . . . . . . . . .     4 093        4 110        3 893
 4 Persons. . . . . . . . . . . . . . . .     5 273        5 274        5 213
 5 Persons. . . . . . . . . . . . . . . .     6 247        6 247        6 237
 6 Persons. . . . . . . . . . . . . . . .     7 026        7 026        7 040
 7 Persons Or More. . . . . . . . . . . .     8 708        8 706        8 738

Table A-3

    Weighted Average Thresholds at the Poverty Level in 1978, by Size
           of Family and Sex of Head, By Farm-Nonfarm Residence

                                                          NONFARM
 SIZE OF FAMILY UNIT                                     Male        Female
                                   Total       Total       Head1     Head1


 1 Person (Unrelated
   Individual). . . . . . . . .   $3,302      $3,311      $3,460       $3,196
   14 to 64 Years . . . . . . .    3,386       3,392       3,516        3,253
   65 Years And Over. . . . . .    3,116       3,127       3,159        3,118

 2 Persons. . . . . . . . . . .    4,225       4,249       4,258        4,206
   Head 14 to 64 Years. . . . .    4,363       4,383       4,407        4,286
   Head 65 Years and Over . . .    3,917       3,944       3,948        3,923

 3 Persons. . . . . . . . . . .    5,178       5,201       5,231        5,065
 4 Persons. . . . . . . . . . .    6,628       6,662       6,665        6,632
 5 Persons. . . . . . . . . . .    7,833       7,880       7,888        7,806
 6 Persons. . . . . . . . . . .    8,825       8,891       8,895        8,852
 7 Persons Or More. . . . . . .   10,926      11,002      11,038       10,765

                                                            FARM
 SIZE OF FAMILY UNIT                                     Male        Female
                                              Total        Head1     Head1


 1 Person (Unrelated Individual). . . . .    $2,795       $2,898       $2,690
   14 to 64 Years . . . . . . . . . . . .     2,913        2,987        2,764
   65 Years And Over. . . . . . . . . . .     2,661        2,685        2,650

 2 Persons. . . . . . . . . . . . . . . .     3,578        3,582        3,497
   Head 14 to 64 Years. . . . . . . . . .     3,731        3,737        3,614
   Head 65 Years and Over . . . . . . . .     3,352        3,354        3,313

 3 Persons. . . . . . . . . . . . . . . .     4,413        4,430        4,216
 4 Persons. . . . . . . . . . . . . . . .     5,681        5,683        5,622
 5 Persons. . . . . . . . . . . . . . . .     6,714        6,714        6,700
 6 Persons. . . . . . . . . . . . . . . .     7,541        7,543        7,462
 7 Persons Or More. . . . . . . . . . . .     9,373        9,386        8,813

 1 For one person (i.e., unrelated individual), sex of the individual.

Table 17

    Weighted Average Thresholds-Poverty Cutoffs in 1979, by Size and
               Type of Family, By Farm-Nonfarm Residence

                                                          NONFARM
                                                       Families With
 SIZE OF FAMILY UNIT               Total       Total   Female HHLDR,
                                                     No Husband1   All Other
                                                       Present     Families2
                               (Dollars)   (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated
   Individual). . . . . . . . .    3 683       3 689       3 556        3 855
   14 to 64 Years . . . . . . .    3 773       3 778       3 619        3 912
   65 Years And Over. . . . . .    3 472       3 479       3 469        3 515

 2 Persons. . . . . . . . . . .    4 702       4 725       4 669        4 737
   Head 14 to 64 Years. . . . .    4 858       4 878       4 762        4 905
   Head 65 Years and Over . . .    4 364       4 390       4 362        4 394

 3 Persons. . . . . . . . . . .    5 763       5 784       5 624        5 820
 4 Persons. . . . . . . . . . .    7 386       7 412       7 381        7 416
 5 Persons. . . . . . . . . . .    8 736       8 775       8 690        8 785
 6 Persons. . . . . . . . . . .    9 849       9 914       9 843        9 922
 7 Persons Or More. . . . . . .   12 212      12 280      12 037       12 322

                                                            FARM
                                                       Families With
                                                       Female HHLDR,
                                                     No Husband   All Other
 SIZE OF FAMILY UNIT                        Total      Present1    Families2
                                          (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated Individual). . . . .     3 138        3 001        3 236
   14 to 64 Years . . . . . . . . . . . .     3 254        3 076        3 324
   65 Years And Over. . . . . . . . . . .     2 963        2 948        2 988

 2 Persons. . . . . . . . . . . . . . . .     3 987        3 917        3 991
   Head 14 to 64 Years. . . . . . . . . .     4 156        4 027        4 163
   Head 65 Years and Over . . . . . . . .     3 730        3 686        3 732

 3 Persons. . . . . . . . . . . . . . . .     4 917        4 680        4 928
 4 Persons. . . . . . . . . . . . . . . .     6 329        6 261        6 332
 5 Persons. . . . . . . . . . . . . . . .     7 492        7 509        7 492
 6 Persons. . . . . . . . . . . . . . . .     8 424        8 309        8 428
 7 Persons Or More. . . . . . . . . . . .    10 533       10 178       10 547

 1 Includes female unrelated individuals.
 2 Includes male unrelated individuals.

Table 17

    Weighted Average Thresholds-Poverty Cutoffs in 1980, by Size and
               Type of Family, By Farm-Nonfarm Residence

                                                          NONFARM
                                                       Families With
 SIZE OF FAMILY UNIT               Total       Total   Female HHLDR,
                                                     No Husband1   All Other
                                                       Present     Families2
                               (Dollars)   (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated
   Individual). . . . . . . . .    4 184       4 190       4 037        4 379
   14 to 64 Years . . . . . . .    4 286       4 290       4 109        4 441
   65 Years And Over. . . . . .    3 941       3 949       3 938        3 990

 2 Persons. . . . . . . . . . .    5 338       5 363       5 316        5 373
   Head 14 to 64 Years. . . . .    5 518       5 537       5 415        5 568
   Head 65 Years and Over . . .    4 954       4 983       4 946        4 988

 3 Persons. . . . . . . . . . .    6 539       6 565       6 388        6 605
 4 Persons. . . . . . . . . . .    8 385       8 414       8 382        8 418
 5 Persons. . . . . . . . . . .    9 923       9 966       9 878        9 976
 6 Persons. . . . . . . . . . .   11 215      11 269      11 227       11 274
 7 Persons Or More. . . . . . .   13 883      13 955      13 767       13 986

                                                            FARM
                                                       Families With
                                                       Female HHLDR,
                                                      No Husband   All Other
 SIZE OF FAMILY UNIT                         Total      Present1    Families2
                                           (Dollars)   (Dollars)    (Dollars)

 1 Person (Unrelated Individual). . . . .    3 539        3 392        3 680
   14 to 64 Years . . . . . . . . . . . .    3 693        3 492        3 773
   65 Years And Over. . . . . . . . . . .    3 359        3 347        3 392

 2 Persons. . . . . . . . . . . . . . . .    4 502        4 302        4 513
   Head 14 to 64 Years. . . . . . . . . .    4 714        4 497        4 721
   Head 65 Years and Over . . . . . . . .    4 233        4 185        4 237

 3 Persons. . . . . . . . . . . . . . . .    5 573        5 271        5 587
 4 Persons. . . . . . . . . . . . . . . .    7 170        7 152        7 170
 5 Persons. . . . . . . . . . . . . . . .    8 472        8 373        8 474
 6 Persons. . . . . . . . . . . . . . . .    9 613        9 168        9 625
 7 Persons Or More. . . . . . . . . . . .    11 915       12 133       11 389

 1 Includes female unrelated individuals.
 2 Includes male unrelated individuals.

 Tape Positions 282-323

 A multistage estimation procedure was used to calculate the various NHANES
 II subsample sample weights that are necessary to use in any analysis of the
 data.The procedure has three basic components:(1) inflation by reciprocals
 of the probabilities of selection, (2) adjustment for nonresponse, and (3)
 poststratification ratio adjustment by age-sex-race. A brief description
 of each component is as follows:

     Inflation by reciprocals of the sampling probabilities.Since the survey
     utilized a three-stage sample design, there were three probabilities of
     selection:  (1) the probability of selecting the PSU,(2) the probability
     of selecting a segment (housing unit),and (3) the probability of select-
     ing a sample person.

     Adjustment for nonresponse.  Estimates from the NHANES II data were
     adjusted to account for sample persons who were not examined.  The
     estimates were inflated by a multiplication factor calculated within five
     selected income groups, three age groups, four regions, and standard
     metropolitan statistical area (SMSA) or non-SMSA.  The numerator of these
     factors was the sum of the weights for sample persons resulting from the
     reciprocal of the probability of selection, and the denominator was the
     sum of the weights for examined persons also resulting from the
     reciprocals of  the sampling probabilities.

 Poststratification by age-sex-race.  The estimates were ratio adjusted within
 each of 76 age-sex-race cells to an independent estimate,provided by the U.S.
 Bureau of the Census, of the population of each cell as of March 1, 1978,
 (approximate mid-point of the survey).  The ratio adjustment was a
 multiplication factor of which the numerator was the U.S.population and the
 denominator was the sum of the weights adjusted for nonresponse for examined
 persons.  This ratio estimation process makes the sample more closely
 representative of the civilian, noninstitutionalized population of the U.S.

 Potential bias of nonresponse.Usually a sizeable number of sample persons who
 initially are willing to complete the household information and some of the
 medical history questionnaire subsequently will not participate in the
 examination.This creates the potential for bias if these persons differ from
 other sample persons with respect to the variables being studied. Intense
 efforts were undertaken during NHANES II to develop and implement standard
 procedures and inducements that would reduce the number of nonrespondents
 and thereby reduce the potential for bias.

 The user needs to be aware of and should explore the potential bias for
 nonresponse in any analysis of the NHANES II data.


GENERAL MEDICAL EXAMINATION DATA SUMMARY - NHANES II

 Tape Positions 401-499
                                                                     Tape
                                                                   Positions

 Catalog number.................................................... 401-404

 Physician's examination form blank.................................... 407

 Pulse............................................................. 408-410

 BLOOD PRESSURE

 Systolic blood pressure........................................... 411-413
 Diastolic blood pressure.......................................... 414-416
 Cuff          ........................................................ 417

 Examiner number................................................... 418-419

 HEAD, EYES, EARS, NOSE, AND THROAT

 Dry, staring hair..................................................... 421
 Dyspigmented hair..................................................... 422
 Easily pluckable hair................................................. 423
 Abnormal texture or loss of curl...................................... 424
 Circumcorneal injection............................................... 425
 Conjunctival injection................................................ 426
 Angular      aritis................................................... 427
 Pupils and   is....................................................... 428
 Xerosis............................................................. . 429
 Lesions of cornea (other)............................................. 430
 Bitot's       ........................................................ 431
 Conjugate    e........................................................ 432
 Keratomalacia....................................................... . 433
 Strabismus.......................................................... . 434
 Xerophthalmia....................................................... . 435
 Conjunctiva  other)................................................... 436
 Lids and sclera (other)............................................... 437
 Angular lesions of lips............................................... 438
 Angular scars of lips................................................. 439
 Cheilosis........................................................... . 440
 Filiform papillary atrophy of tongue.................................. 441
 Fungiform papillary hypertrophy of tongue............................. 442
 Geographic   ngue..................................................... 443
 Fissures of  ongue.................................................... 444
 Serrations or swelling of tongue...................................... 445
 Scarlet beefy tongue.................................................. 446
 Magenta      e........................................................ 447
 Bleeding      ........................................................ 448
 Diffuse marginal inflammation......................................... 449
 Swollen red  apillae.................................................. 450
 Recession........................................................... . 451
 Naso-labial  borrhea.................................................. 452
 Visible enlarged parotids............................................. 453
 Bossing of   ull...................................................... 454

 EXTERNAL EAR

 Right         ........................................................ 456
 Left          ........................................................ 457
 Operative scar - Left................................................. 458
 Operative scar - Right................................................ 459
 Pierced ears - Left................................................... 462
 Pierced ears - Right.................................................. 463

 AUDITORY CANAL

 Right auditory canal.................................................. 464
 Left auditory canal................................................... 465
 Occluded -   ght...................................................... 466
 Occluded -   ft....................................................... 467
 Occluded by - Right................................................... 468
 Occluded by - Right................................................... 469

 DRUM

 Right         ........................................................ 470
 Left          ........................................................ 471
 Dull/Transparent - Right.............................................. 472
 Dull/Transparent - Left............................................... 473
 Bulging/Retracted - Right............................................. 474
 Bulging/Retracted - Left.............................................. 475
 Calcium plaques - Right............................................... 476
 Calcium plaques - Left................................................ 477
 Red -         ........................................................ 478
 Red -         ........................................................ 479
 Fluid -       ........................................................ 480
 Fluid -       ........................................................ 481
 Scars -       ........................................................ 482
 Scars -       ........................................................ 483
 Perforated - Right.................................................... 484
 Perforated - Left..................................................... 485

 Nares

 Right         ........................................................ 488
 Left          ........................................................ 489
 Obstruction - Right................................................... 490
 Obstruction - Left.................................................... 491
 Deviated septum - Right............................................... 492
 Deviated septum - Left................................................ 493
 Swollen turbinates - Right............................................ 494
 Swollen turbinates - Left............................................. 495
 Chronic inflammation - Right.......................................... 496
 Chronic inflammation - Left........................................... 497
 Polyps -     t........................................................ 498
 Polyps -      ........................................................ 499

 Tape Positions 502-591

 NECK

 Neck................................................................ . 502
 Adenopathy.......................................................... . 503
 Tracheal     ation.................................................... 504

 THYROID EVALUATION

 WHO          ation.................................................... 506

 OTHER THYROID FINDINGS

 Other thyroid findings................................................ 507
 Tenderness.......................................................... . 508
 Nodule.............................................................. . 509
 Isthmus............................................................. . 510

 CHEST EVALUATION

 Findings/No  indings.................................................. 512
 Beading of   bs....................................................... 513
 Follicular hyperkeratosis of upper back............................... 514
 Wheezing on auscultation - diffuse.................................... 515
 Wheezing on auscultation - focal...................................... 516
 Decreased breath sounds (diffuse)..................................... 517
 Masses       t)....................................................... 518
 Auscultation........................................................ . 519

 Right Chest - Upper Lobe

 Diminished breath sounds.............................................. 520
 Bronchial breath sounds............................................... 521
 Rales............................................................... . 522
 Rhonchi............................................................. . 523
 Wheeze.............................................................. . 524

 Right Chest - Middle Lobe

 Diminished breath sounds.............................................. 525
 Bronchial breath sounds............................................... 526
 Rales............................................................... . 527
 Rhonchi............................................................. . 528
 Wheeze.............................................................. . 529

 Right Chest - Lower Lobe

 Diminished breath sounds.............................................. 530
 Bronchial breath sounds............................................... 531
 Rales............................................................... . 532
 Rhonchi............................................................. . 533
 Wheeze.............................................................. . 534

 Left Chest - Upper Lobe

 Diminished breath sounds.............................................. 535
 Bronchial breath sounds............................................... 536
 Rales............................................................... . 537
 Rhonchi............................................................. . 538
 Wheeze.............................................................. . 539

 Left Chest - Lower Lobe

 Diminished breath sounds.............................................. 540
 Bronchial breath sounds............................................... 541
 Rales............................................................... . 542
 Rhonchi............................................................. . 543
 Wheeze.............................................................. . 544

 Heart

 P.M.I............................................................... . 546
 Interspace.......................................................... . 547
 Midclavicular line.................................................... 548
 Thrills............................................................. . 549
 Thrills -    tolic.................................................... 550
 Thrills -    stolic................................................... 551
 First heart  ound..................................................... 552
 Second heart sound.................................................... 553
 Murmurs............................................................. . 554
 Systolic     ur(s).................................................... 555
 Diastolic    mur(s)................................................... 556
 Apex -       ic....................................................... 557
 Apex -       lic...................................................... 558
 Midprecordium - systolic.............................................. 559
 Midprecordium - diastolic............................................. 560
 Left base -  ystolic.................................................. 561
 Left base -  iastolic................................................. 562
 Right base - Systolic................................................. 563
 Right base - Diastolic................................................ 564
 Origin -     al....................................................... 565
 Origin -     ic....................................................... 566
 Origin -     uspid.................................................... 567
 Origin -     onic..................................................... 568
 Origin - Atrial septal defect......................................... 569
 Origin - Ventricular septal defect.................................... 570
 Origin -     r........................................................ 571
 Origin.............................................................. . 572
 Other cardiac or cardiovascular findings.............................. 573
 Edema............................................................... . 574
 Cyanosis............................................................ . 575
 Irregular    se....................................................... 576
 Neck vein    tension.................................................. 578

 PULSE - ARTERIAL EVALUATION

 Palpatation

 Right         ........................................................ 579
 Right         ........................................................ 580
 Right dorsalis pedis.................................................. 581
 Left          ........................................................ 582
 Left          ........................................................ 583
 Left dorsalis pedis................................................... 584

 Pulsations

 Right         ........................................................ 585
 Right         ........................................................ 586
 Right dorsalis pedis.................................................. 587
 Left          ........................................................ 589
 Left          ........................................................ 590
 Left dorsalis pedis................................................... 591

 Tape Positions 593-699

 ABDOMINAL EVALUATION AND KIDNEY

 Findings/No  indings.................................................. 593
 Hepatomegaly........................................................ . 594
 Splenomegaly........................................................ . 595
 Uterine      gement................................................... 596
 Inguinal     ia....................................................... 597
 Femoral      a........................................................ 598
 Umbilical    nia...................................................... 599
 Pot           ........................................................ 600
 Mass(es)............................................................ . 601
 Areas............................................................. 606-610
 Surgical     s........................................................ 612
 Area.............................................................. 613-617
 Costovertebral tenderness............................................. 619

 JOINTS

 Findings/No  indings.................................................. 620

 Shoulder

 Tender.............................................................. . 621
 Swelling............................................................ . 622
 Deformity........................................................... . 623
 Pain on      n........................................................ 624
 Other............................................................... . 625

 Elbow

 Tender.............................................................. . 626
 Swelling............................................................ . 627
 Deformity........................................................... . 628
 Pain on      n........................................................ 629
 Other............................................................... . 630

 Wrist

 Tender.............................................................. . 631
 Swelling............................................................ . 632
 Deformity........................................................... . 633
 Pain on      n........................................................ 634
 Other............................................................... . 635

 Metacarpophalangael

 Tender -     t........................................................ 636
 Tender -      ........................................................ 637
 Swelling -   ght...................................................... 638
 Swelling -   ft....................................................... 639
 Deformity -  ight..................................................... 640
 Deformity -  eft...................................................... 641
 Pain on Motion - Right................................................ 642
 Pain on Motion - Left................................................. 643
 Other -       ........................................................ 644
 Other -       ........................................................ 645

 Proximal Interphalangeal

 Tender -     t........................................................ 646
 Tender -      ........................................................ 647
 Swelling -   ght...................................................... 648
 Swelling -   ft....................................................... 649
 Deformity -  ight..................................................... 650
 Deformity -  eft...................................................... 651
 Pain on Motion - Right................................................ 652
 Pain on Motion - Left................................................. 653
 Other -       ........................................................ 654
 Other -       ........................................................ 655

 Distal Interphalangeal

 Tender -     t........................................................ 656
 Tender -      ........................................................ 657
 Swelling -   ght...................................................... 658
 Swelling -   ft....................................................... 659
 Deformity -  ight..................................................... 660
 Deformity -  eft...................................................... 661
 Heberden's nodes - Right.............................................. 662
 Heberden's nodes - Left............................................... 663
 Pain on Motion - Right................................................ 664
 Pain on Motion - Left................................................. 665
 Other -       ........................................................ 666
 Other -       ........................................................ 667

 Ankle

 Tender.............................................................. . 668
 Swelling............................................................ . 669
 Deformity........................................................... . 670
 Pain on      n........................................................ 671
 Other............................................................... . 672

 Feet

 Tender.............................................................. . 673
 Swelling............................................................ . 674
 Deformity........................................................... . 675
 Pain on      n........................................................ 676
 Other............................................................... . 677

 Knees

 Tender.............................................................. . 678
 Swelling............................................................ . 679
 Deformity........................................................... . 680
 Pain on      n........................................................ 681
 Other............................................................... . 682

 Hips

 Tender.............................................................. . 683
 Swelling............................................................ . 684
 Deformity........................................................... . 685
 Pain on      n........................................................ 686
 Other............................................................... . 687

 Back

 No           indings.................................................. 688
 Scoliosis........................................................... . 689
 Kyphosis............................................................ . 690
 Lordosis............................................................ . 691
 Tenderness - Sciatic notch............................................ 692
 Tenderness - Sacroiliac............................................... 693

 Limitation of Motion

 Thoracic     e........................................................ 695
 Lumbar spine, Right lateral flexion................................... 696
 Lumbar spine, Left lateral flexion.................................... 697
 Full         n........................................................ 698
 Pain on      n........................................................ 699

 Tape Positions 700-778

 Pain on flexion - Location

 Cervical - Severity of pain........................................... 700
 Thoracic............................................................ . 701
 Low           ........................................................ 702
 Diffuse............................................................. . 703
 Uncertain........................................................... . 704

 Pain on extension - Location

 Cervical - Severity of pain........................................... 705
 Thoracic............................................................ . 706
 Low           ........................................................ 707
 Diffuse............................................................. . 708
 Uncertain........................................................... . 709

 Pain on right lateral bending - Location

 Thoracic............................................................ . 710
 Low           ........................................................ 711
 Diffuse............................................................. . 712
 Uncertain........................................................... . 713

 Pain on left lateral bending - Location

 Thoracic............................................................ . 714
 Low           ........................................................ 715
 Diffuse............................................................. . 716
 Uncertain........................................................... . 717

 Pain on right rotation - Location

 Thoracic............................................................ . 718
 Low           ........................................................ 719
 Diffuse............................................................. . 720
 Uncertain........................................................... . 721

 Pain on left rotation - Location

 Thoracic............................................................ . 722
 Low           ........................................................ 723
 Diffuse............................................................. . 724
 Uncertain........................................................... . 725

 STRAIGHT LEG RAISING TEST

 Right         ........................................................ 726
 Left          ........................................................ 727

 Increase on ankle dorsiflexion

 Right         ........................................................ 728
 Left          ........................................................ 729

 MUSCULOSKELETAL EVALUATION

 Findings/No  indings.................................................. 731
 Bowed         ........................................................ 732
 Knock         ........................................................ 733
 Epiphysial enlargement, wrists........................................ 734
 Abduction of hips..................................................... 735

 NEUROLOGICAL EVALUATION

 Findings/No  indings.................................................. 737
 Absent knee  erks..................................................... 738
 Absent ankle jerks.................................................... 739
 Positive Chvostek sign................................................ 740
 Apathy.............................................................. . 741
 Marked       rritability.............................................. 742

 SKIN EVALUATION

 Findings/No  indings.................................................. 744
 Follicular hyperkeratosis, arms....................................... 745
 Hyperpigmentation, hands and face..................................... 746
 Dry or scaling skin................................................... 747
 Perifolliculosis.................................................... . 748
 Petechiae........................................................... . 749
 Mosiac        ........................................................ 750
 Pellagrous   rmatitis................................................. 751
 Ecchymoses.......................................................... . 752
 Edema............................................................... . 753

 EXAMINER'S SUBJECTIVE IMPRESSION OF NUTRITIONAL STATUS

 Normal/Abnormal nutrition............................................. 755
 Obesity............................................................. . 756

 BLOOD PRESSURE

 Cuff          ........................................................ 757
 Time - Hour....................................................... 758-759
 Time - Minutes.................................................... 760-761
 Time -        ........................................................ 762
 Systolic - Recumbent.............................................. 763-765
 Diastolic - Recumbent............................................. 768-770
 Systolic - Sitting................................................ 771-773
 Diastolic - Sitting............................................... 774-776
 Examiner No....................................................... 777-778

 Tape Positions 780-871

 SUMMARY OF DIAGNOSTIC IMPRESSIONS

 Severity............................................................ . 780
 Certainty........................................................... . 781
 ICDA Code a....................................................... 782-785
 Severity............................................................ . 786
 Certainty........................................................... . 787
 ICDA Code b....................................................... 788-791
 Severity............................................................ . 792
 Certainty........................................................... . 793
 ICDA Code c....................................................... 794-797
 Severity............................................................ . 798
 Certainty........................................................... . 799
 ICDA Code d....................................................... 800-803
 Severity............................................................ . 804
 Certainty........................................................... . 805
 ICDA Code e....................................................... 806-809
 Severity............................................................ . 810
 Certainty........................................................... . 811
 ICDA Code f....................................................... 812-815
 Severity............................................................ . 816
 Certainty........................................................... . 817
 ICDA Code g....................................................... 818-821
 Severity............................................................ . 822
 Certainty........................................................... . 823
 ICDA Code h....................................................... 824-827
 Severity............................................................ . 828
 Certainty........................................................... . 829
 ICDA Code i....................................................... 830-833
 Severity............................................................ . 834
 Certainty........................................................... . 835
 ICDA Code j....................................................... 836-839
 Severity............................................................ . 840
 Certainty........................................................... . 841
 ICDA Code k....................................................... 842-845
 Severity............................................................ . 846
 Certainty                                                              847
 ICDA Code l....................................................... 848-851
 Severity............................................................ . 852
 Certainty........................................................... . 853
 ICDA Code m....................................................... 854-857
 Severity............................................................ . 858
 Certainty........................................................... . 859
 ICDA Code n....................................................... 860-863
 Severity............................................................ . 864
 Certainty........................................................... . 865
 ICDA Code o....................................................... 866-869
 Examiner Number................................................... 870-871


RECORD LAYOUT, PHYSICIAN EXAMINATION DATA

 Tape Positions 401-450

          NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY - NHANES II
                           Physician Examination Data
 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

 401-404   Catalog number

           5302                                       20,322

 405-406   Blank                                      20,322

     407   Physician's examination form blank                  See detailed
                                                               notes
           1 form is blank                                14
           blank                                      20,308

 408-410   Pulse                                               All ages
                                                               See detailed
           033-200 beats per minute                   19,995   notes
           888 blank but applicable                      313
           blank                                          14

 411-413   Systolic blood pressure                             Age 6 years
                                                               and over
           065-300 mm Hg                              16,109   See detailed
           888 blank but applicable                       88   notes
           blank                                       4,125

 414-416   Diastolic blood pressure

           035-150 mm Hg                              16,055
           888 blank but applicable                      142
           blank                                       4,125

     417   Cuff width

           1 Adult                                    14,462   See detailed
           2 Child                                     1,598   notes
           8 blank but applicable                        137
           blank                                       4,125

 418-419   Examiner number

           30-49 physician number                     16,193
           88 blank but applicable                         4
           blank                                       4,125

           HEAD, EYES, EARS, NOSE, AND THROAT

     420   1 findings                                 15,713   See detailed
           2 no findings                               4,593   notes
           8 blank but applicable                          2
           blank                                          14

     421   Dry, staring hair

           1 yes                                           4
           blank                                      20,318

     422   Dyspigmented hair

           1 yes                                           0
           blank                                      20,322

     423   Easily pluckable hair

           1 yes                                           2
           blank                                      20,320

     424   Abnormal texture or loss of curl

           1 yes                                           5
           blank                                      20,317

     425   Circumcorneal injection

           1 yes                                          30
           blank                                      20,292

     426   Conjunctival injection

           1 yes                                       1,319
           blank                                      19,003

     427   Angular blepharitis

           1 yes                                          15
           blank                                      20,307

     428   Pupils and iris

           1 yes                                          73
           blank                                      20,249

     429   Xerosis

           1 yes                                           4
           blank                                      20,318

     430   Lesions of cornea (other)

           1 yes                                          42
           blank                                      20,280

     431   Bitot's spots

           1 yes                                           4
           blank                                      20,318

     432   Conjugate gaze

           1 yes                                           6
           blank                                      20,316

     433   Keratomalacia

           1 yes                                           2
           blank                                      20,320

     434   Strabismus

           1 yes                                          79
           blank                                      20,243

     435   Xerophthalmia

           1 yes                                           3
           blank                                      20,319

     436   Conjunctiva (other)

           1 yes                                         152
           blank                                      20,170

     437   Lids and sclera (other)

           1 yes                                          23
           blank                                      20,299

     438   Angular lesions of lips

           1 yes                                          33
           blank                                      20,289

     439   Angular scars of lips

           1 yes                                          17
           blank                                      20,305

     440   Cheilosis

           1 yes                                          49
           blank                                      20,273

     441   Filiform papillary atrophy of tongue

           1 yes                                          89
           blank                                      20,233

     442   Fungiform papillary hypertrophy of tongue

           1 yes                                         971
           blank                                      19,351

     443   Geographic tongue

           1 yes                                         138
           blank                                      20,184

     444   Fissures of tongue

           1 yes                                         939
           blank                                      19,383

     445   Serrations or swelling of tongue

           1 yes                                       1,002
           blank                                      19,320

     446   Scarlet beefy tongue

           1 yes                                          26
           blank                                      20,296

     447   Magenta tongue

           1 yes                                           4
           blank                                      20,318

     448   Bleeding gums

           1 yes                                           5
           blank                                      20,317

     449   Diffuse marginal inflammation

           1 yes                                         142
           blank                                      20,180

     450   Swollen red papillae

           1 yes                                         101
           blank                                      20,221
 
 Tape Positions 451-501

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     451   Recession

           1 yes                                         535
           blank                                      19,787

     452   Naso-labial seborrhea

           1 yes                                           9
           blank                                      20,313

     453   Visible enlarged parotids

           0 yes                                          20
           blank                                      20,302

     454   Bossing of skull

           1 yes                                          28
           blank                                      20,294

     455   Blank                                      20,322

           EXTERNAL EAR

     456   Right ear                                           See detailed
                                                               notes
           1 no findings                              16,261
           2 findings                                  4,044
           8 blank but applicable                          3
           blank                                          14

     457   Left ear                                            See detailed
                                                               notes
           1 no findings                              15,966
           2 findings                                  4,339
           8 blank but applicable                          3
           blank                                          14

     458   Operative scar - Left mastoid

           1 yes                                          20
           blank                                      20,302

     459   Operative scar - Right mastoid

           1 yes                                          17
           blank                                      20,305

 460-461   Blank                                      20,322

     462   Pierced ears - Left

           1 yes                                       4,028
           blank                                      16,294

     463   Pierced ears - Right

           1 yes                                       4,325
           blank                                      15,997

           AUDITORY CANAL

     464   Right auditory canal                                See detailed
                                                               notes
           1 no findings                              17,914
           2 findings                                  2,391
           8 blank but applicable                          3
           blank                                          14

     465   Left auditory canal                                 See detailed
                                                               notes
           1 no findings                              17,977
           2 findings                                  2,328
           8 blank but applicable                          3
           blank                                          14

     466   Occluded - Right

           1 partially                                   793
           2 completely                                1,409
           8 blank but applicable                        189
           blank                                      17,931

     467   Occluded - Left

           1 partially                                   756
           2 completely                                1,381
           8 blank but applicable                        191
           blank                                      17,994

     468   Occluded by - Right

           1 cerumen                                   2,072
           2 other                                       206
           8 blank but applicable                        113
           blank                                      17,931

     469   Occluded by - Left

           1 cerumen                                   2,020
           2 other                                       197
           8 blank but applicable                        111
           blank                                      17,994

           DRUM

     470   Right drum                                          See detailed
                                                               notes
           1 no findings                              17,537
           2 findings                                  1,329
           3 not visible                               1,439
           8 blank but applicable                          3
           blank                                          14

     471   Left drum                                           See detailed
                                                               notes
           1 no findings                              17,439
           2 findings                                  1,487
           3 not visible                               1,379
           8 blank but applicable                          3
           blank                                          14

     472   Dull/Transparent - Right

           1 dull (opaque)                               407
           2 transparent                                   5
           blank                                      19,910

     473   Dull/Transparent - Left

           1 dull (opaque)                               470
           2 transparent                                   6
           blank                                      19,846

     474   Bulging/Retracted - Right

           1 bulging                                       6
           2 retracted                                    92
           blank                                      20,224

     475   Bulging/Retracted - Left

           1 bulging                                       7
           2 retracted                                   136
           blank                                      20,179

     476   Calcium plaques - Right

           1 yes                                         117
           blank                                      20,205

     477   Calcium plaques - Left

           1 yes                                         130
           blank                                      20,192

     478   Red - Right

           1 red                                         184
           2 other discolorations                         41
           blank                                      20,097

     479   Red - Left

           1 red                                         238
           2 other discolorations                         43
           blank                                      20,041

     480   Fluid - Right

           1 fluid                                        18
           blank                                      20,314

     481   Fluid - Left

           1 fluid                                         9
           blank                                      20,313

     482   Scars - Right

           1 scars                                       508
           blank                                      19,814

     483   Scars - Left

           1 scars                                       524
           blank                                      19,798

     484   Perforated - Right

           1 with discharge                               23
           2 without discharge                            75
           blank                                      20,224

     485   Perforated - Left

           1 with discharge                               21
           2 without discharge                            58
           blank                                      20,243

 486-487   Blank                                      20,322

           NARES

     488   Right nares                                         See detailed
                                                               notes
           1 no findings                              18,061
           2 findings                                  2,244
           8 blank but applicable                          3
           blank                                          14

     489   Left nares                                          See detailed
                                                               notes
           1 no findings                              18,169
           2 findings                                  2,136
           8 blank but applicable                          3
           blank                                          14

     490   Obstruction - Right

           1 acute                                       143
           2 chronic                                      85
           blank                                      20,094

     491   Obstruction - Left

           1 acute                                       146
           2 chronic                                      86
           blank                                      20,090

           Other Significant Findings

     492   Deviated septum - Right

           1 yes                                         453
           blank                                      19,869

     493   Deviated septum - Left

           1 yes                                         267
           blank                                      20,055

     494   Swollen turbinates - Right

           1 yes                                       1,457
           blank                                      18,865

     495   Swollen turbinates - Left

           1 yes                                       1,532
           blank                                      18,790

     496   Chronic inflammation - Right

           1 yes                                         343
           blank                                      19,979

     497   Chronic inflammation - Left

           1 yes                                         345
           blank                                      19,977

     498   Polyps - Right

           1 yes                                          20
           blank                                      20,302

     499   Polyps - Left

           1 yes                                          17
           blank                                      20,305
 500-501   Blank                                      20,322

 Tape Positions 502-550

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

           NECK

     502   1 no findings                              19,805   See detailed
           2 findings                                    500   note
           8 blank but applicable                          3
           blank                                          14

     503   Adenopathy

           1 yes                                         492
           blank                                      19,830

     504   Tracheal deviation

           1 yes                                           8
           blank                                      20,314

     505   Blank                                      20,322

           THYROID EVALUATION

     506   WHO Classification

           1 Group 0                                  19,294   See detailed
           2 Group 1                                     826   notes
           3 Group 2                                      99
           4 Group 3                                      15
           8 blank but applicable                         74
           blank                                          14

           Other Thyroid Findings

     507   1 findings                                    117   See detailed
           2 no findings                              20,188   notes
           8 blank but applicable                          3
           blank                                          14

     508   Tenderness

           1 right                                         8
           2 left                                          0
           3 both                                          7
           blank                                      20,307

     509   Nodule

           1 right                                        55
           2 left                                         25
           3 both                                         15
           blank                                      20,227

     510   Isthmus

           1 right                                        22
           2 left                                          0
           3 both                                          0
           blank                                      20,300

     511   Blank                                      20,322

           CHEST EVALUATION

     512   1 findings                                    723   See detailed
           2 no findings                              19,570   notes
           8 blank but applicable                         15
           blank                                          14

     513   Beading of ribs

           1 yes                                           9
           blank                                      20,313

     514   Follicular hyperkeratosis of upper back

           1 yes                                          75
           blank                                      20,247

     515   Wheezing on auscultation - Diffuse                  See detailed
                                                               notes
           1 yes                                         193
           blank                                      20,129

     516   Wheezing on auscultation - Focal                    See detailed
                                                               notes
           1 yes                                          83
           blank                                      20,239

     517   Decreased breath sounds (diffuse)                   See detailed
                                                               notes
           1 yes                                         254
           blank                                      20,068

     518   Masses (breast)

           1 right                                        45
           2 left                                         50
           3 both                                         48
           blank                                      20,179

     519   Auscultation                                        See detailed
                                                               notes
           1 no findings                              19,145
           2 findings                                  1,148
           8 blank but applicable                         15
           blank                                          14

           Right Chest - Upper Lobe

     520   Breath sounds                                       See detailed
                                                               notes
           1 diminished breath sounds                    203
           2 absent breath sounds                          4
           blank                                      20,115

     521   Bronchial breath sounds

           1 yes                                         141
           blank                                      20,181

     522   Rales

           1 yes                                         101
           blank                                      20,221

     523   Rhonchi

           1 yes                                         105
           blank                                      20,217

     524   Wheeze

           1 yes                                         168
           blank                                      20,154

           Right Chest - Middle Lobe

     525   Breath sounds                                       See detailed
                                                               notes
           1 diminished breath sounds                    133
           2 absent breath sounds                          2
           blank                                      20,187

     526   Bronchial breath sounds

           1 yes                                         125
           blank                                      20,197

     527   Rales

           1 yes                                         106
           blank                                      20,216

     528   Rhonchi

           1 yes                                         110
           blank                                      20,212

     529   Wheeze

           1 yes                                         160
           blank                                      20,162

     530   Breath sounds                                       See detailed
                                                               notes
           1 diminished breath sounds                    152
           2 absent breath sounds                          5
           blank                                      20,165

     531   Bronchial breath sounds

           1 yes                                         155
           blank                                      20,167

     532   Rales

           1 yes                                         237
           blank                                      20,085

     533   Rhonchi

           1 yes                                         155
           blank                                      20,167

     534   Wheeze

           1 yes                                         192
           blank                                      20,130

           Left Chest - Upper Lobe

     535   Breath sounds                                       See detailed
                                                               notes
           1 diminished breath sounds                    199
           2 absent breath sounds                         10
           blank                                      20,113

     536   Bronchial breath sounds

           1 yes                                         135
           blank                                      20,187

     537   Rales

           1 yes                                         112
           blank                                      20,210

     538   Rhonchi

           1 yes                                         107
           blank                                      20,215

     539   Wheeze

           1 yes                                         170
           blank                                      20,143

           Left Chest - Lower Lobe

     540   Breath sounds                                       See detailed
                                                               notes
           1 diminished breath sounds                    139
           2 absent breath sounds                         11
           blank                                      20,172

     541   Bronchial breath sounds

           1 yes                                         159
           blank                                      20,163

     542   Rales

           1 yes                                         258
           blank                                      20,064

     543   Rhonchi

           1 yes                                         149
           blank                                      20,173

     544   Wheeze

           1 yes                                         190
           blank                                      20,132

     545   Blank                                      20,322

           HEART

     546   P.M.I. - Point of maximum impulse                   Age 18 years
                                                               and over
           1 felt                                      5,532   See detailed
           2 not felt                                  6,966   notes
           8 blank but applicable                          1
           blank                                       7,823

     547   Interspace

           4 th                                          640
           5 th                                        4,637
           6 th                                          227
           7 th                                            7
           blank                                      14,811

     548   Midclavicular line

           1 at                                        3,615
           2 inside                                    1,697
           3 outside                                     158
           blank                                      14,852

     549   Thrills

           1 absent                                   20,272
           2 present                                      33
           8 blank but applicable                          3
           blank                                          14

     550   Thrills - Systolic

           1 base                                         20
           2 apex                                          8
           blank                                      20,294

 Tape Positions 551-600

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     551   Thrills - Diastolic

           1 base                                         13
           2 apex                                          6
           blank                                      20,303

     552   First heart sound

           1 normal                                   19,365
           2 accentuated                                 144
           3 diminished                                  712
           8 blank but applicable                         87
           blank                                          14

     553   Second heart sound

           1 normal                                   19,287
           2 accentuated                                 245
           3 diminished                                  680
           8 blank but applicable                         96
           blank                                          14

     554   Murmurs                                             See detailed
                                                               notes
           1 none                                     19,120
           8 blank but applicable                          3
           blank                                       1,199

     555   Systolic murmur(s)

           1 functional                                  327
           2 organic                                     708
           8 blank but applicable                         27
           9 don't know                                   76
           blank                                      19,184

     556   Diastolic murmur(s)

           1 functional                                    2
           2 organic                                     103
           8 blank but applicable                         27
           9 don't know                                    2
           blank                                      20,188

           Location

     557   Apex - Systolic

           1 grade 1                                     107
           2 grade 2                                     180
           3 grade 3                                     163
           4 grade 4                                      61
           5 grade 5                                      12
           6 grade 6                                       3
           blank                                      19,796

     558   Apex - Diastolic

           1 grade 1                                       1
           2 grade 2                                      13
           3 grade 3                                      25
           4 grade 4                                       7
           5 grade 5                                       1
           6 grade 6                                       1
           blank                                      20,274

     559   Midprecordium - Systolic

           1 grade 1                                      63
           2 grade 2                                     157
           3 grade 3                                     121
           4 grade 4                                      25
           5 grade 5                                      10
           6 grade 6                                       2
           blank                                      19,944

     560   Midprecordium - Diastolic

           1 grade 1                                       0
           2 grade 2                                       3
           3 grade 3                                      23
           4 grade 4                                       5
           5 grade 5                                       0
           6 grade 6                                       2
           blank                                      20,289

     561   Left base - Systolic

           1 grade 1                                      58
           2 grade 2                                     131
           3 grade 3                                     131
           4 grade 4                                      31
           5 grade 5                                       7
           6 grade 6                                       1
           blank                                      19,963

     562   Left base - Diastolic

           1 grade 1                                       0
           2 grade 2                                       5
           3 grade 3                                      17
           4 grade 4                                       5
           5 grade 5                                       0
           6 grade 6                                       1
           blank                                      20,294

     563   Right base - Systolic

           1 grade 1                                      50
           2 grade 2                                     162
           3 grade 3                                     149
           4 grade 4                                      50
           5 grade 5                                      13
           6 grade 6                                       0
           blank                                      19,898

     564   Right base - Diastolic

           1 grade 1                                       1
           2 grade 2                                       3
           3 grade 3                                      10
           4 grade 4                                       8
           5 grade 5                                       0
           6 grade 6                                       0
           blank                                      20,300

     565   Origin - Mitral

           1 systolic                                    308
           2 diastolic                                    30
           3 both                                         20
           blank                                      19,964

     566   Origin - Aortic

           1 systolic                                    320
           2 diastolic                                    14
           3 both                                         27
           blank                                      19,961

     567   Origin - Tricuspid

           1 systolic                                     21
           2 diastolic                                     0
           3 both                                          0
           blank                                      20,301

     568   Origin - Pulmonic

           1 systolic                                     86
           2 diastolic                                     1
           3 both                                          1
           blank                                      20,234

     569   Origin - Atrial septal defect

           1 systolic                                     12
           2 diastolic                                     0
           3 both                                          1
           blank                                      20,309

     570   Origin - Ventricular septal defect

           1 systolic                                     79
           2 diastolic                                     0
           3 both                                          0
           blank                                      20,243

     571   Origin - Other

           1 systolic                                     24
           2 diastolic                                     1
           3 both                                          5
           blank                                      20,292

     572   Origin

           9 don't know                                  209
           blank                                      20,113

           Other Cardiac or Cardiovascular Findings

     573   1 no                                       19,636   See detailed
           2 yes                                         672   notes
           blank                                          14

     574   Edema

           1 yes                                         222
           blank                                      20,100

     575   Cyanosis

           1 yes                                          51
           blank                                      20,271

     576   Irregular pulse

           1 yes                                         415
           blank                                      19,907

     577   Blank                                      20,322

     578   Neck vein distension

           1 yes                                          53
           blank                                      20,269

           PULSE - ARTERIAL EVALUATION                         Age 18 years
                                                               and over
                                                               See detailed
                                                               notes
           Palpation

     579   Right radial

           1 normal                                   12,074
           2 sclerotic                                   324
           3 tortuous                                     19
           4 sclerotic and tortuous                       27
           5 absent                                       23
           8 blank but applicable                         32
           blank                                       7,823

     580   Right femoral

           1 normal                                   12,005
           2 sclerotic                                   323
           3 tortuous                                     15
           4 sclerotic and tortuous                       23
           5 absent                                       58
           8 blank but applicable                         75
           blank                                       7,823

     581   Right dorsalis pedis

           1 normal                                   11,279
           2 sclerotic                                   405
           3 tortuous                                     10
           4 sclerotic and tortuous                       23
           5 absent                                      659
           8 blank but applicable                        123
           blank                                       7,823

     582   Left radial

           1 normal                                   12,037
           2 sclerotic                                   330
           3 tortuous                                     17
           4 sclerotic and tortuous                       25
           5 absent                                       22
           8 blank but applicable                         68
           blank                                       7,823

     583   Left femoral

           1 normal                                   11,987
           2 sclerotic                                   327
           3 tortuous                                     15
           4 sclerotic and tortuous                       21
           5 absent                                       66
           8 blank but applicable                         83
           blank                                       7,823

     584   Left dorsalis pedis

           1 normal                                   10,815
           2 sclerotic                                   365
           3 tortuous                                     10
           4 sclerotic and tortuous                       22
           5 absent                                      686
           8 blank but applicable                        601
           blank                                       7,823

           Pulsations

     585   Right radial

           1 normal                                   12,150
           2 diminished                                  201
           3 bounding                                     86
           4 absent                                       28
           8 blank but applicable                         34
           blank                                       7,823

     586   Right femoral

           1 normal                                   12,042
           2 diminished                                  251
           3 bounding                                     87
           4 absent                                       59
           8 blank but applicable                         60
           blank                                       7,823

     587   Right dorsalis pedis

           1 normal                                   11,214
           2 diminished                                  404
           3 bounding                                     59
           4 absent                                      718
           8 blank but applicable                        104
           blank                                       7,823

     586   Blank                                      20,322

     589   Left radial

           1 normal                                   12,139
           2 diminished                                  205
           3 bounding                                     86
           4 absent                                       24
           8 blank but applicable                         45
           blank                                       7,823

     590   Left femoral

           1 normal                                   12,029
           2 diminished                                  249
           3 bounding                                     83
           4 absent                                       68
           8 blank but applicable                         70
           blank                                       7,823

     591   Left dorsalis pedis

           1 normal                                   11,187
           2 diminished                                  397
           3 bounding                                     60
           4 absent                                      740
           8 blank but applicable                        115
           blank                                       7,823

     592   Blank                                      20,322

           ABDOMINAL EVALUATION AND KIDNEY

    593    1 findings                                  5,294   See detailed
           2 no findings                              15,011   notes
           8 blank but applicable                          3
           blank                                          14

     594   Hepatomegaly

           1 yes                                         131
           blank                                      20,191

     595   Splenomegaly

           1 yes                                          21
           blank                                      20,301

     596   Uterine enlargement

           1 yes                                          64
           blank                                      20,258

     597   Inguinal hernia

           1 yes                                          90
           blank                                      20,232

     598   Femoral hernia

           1 yes                                           1
           blank                                      20,321

     599   Umbilical hernia

           1 yes                                         427
           blank                                      19,895

     600   Pot belly

           1 yes                                          59
           blank                                      20,263
 
 Tape Positions 601-650

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     601   Mass(es)

           1 yes                                          82
           blank                                      20,240

 602-605   Blank                                      20,322

 606-610   Areas                                               See detailed
                                                               notes
           Areas 1-9 indicated                            82
           00000 blank but applicable                      0
           blank                                      20,240

     611   Blank                                      20,322

           Surgical Scars

     612   1 yes                                       4,688
           blank                                      15,634

 613-617   Areas                                               See detailed
                                                               notes
           Areas 1-9 indicated                         4,688
           00000 blank but applicable                      0
           blank                                      15,634

     618   Blank                                      20,322

     619   Costovertebral tenderness

           1 yes                                          35
           blank                                      20,287

           JOINTS                                              Age 10 and
                                                               over
     620   1 findings                                 12,225   See detailed
           2 no findings                               2,831   notes
           8 blank but applicable                          4
           blank                                       5,262

           Shoulder

     621   Tender

           1 right                                        55
           2 left                                         38
           3 both                                         59
           blank                                      20,170

     622   Swelling

           1 right                                         5
           2 left                                          1
           3 both                                          9
           blank                                      20,307

     623   Deformity

           1 right                                         6
           2 left                                          4
           3 both                                          5
           blank                                      20,307

     624   Pain on motion

           1 right                                        90
           2 left                                         61
           3 both                                         91
           blank                                      20,080

     625   Other

           1 right                                        13
           2 left                                          9
           3 both                                          4
           blank                                      20,296

           Elbow

     626   Tender

           1 right                                        25
           2 left                                         13
           3 both                                         44
           blank                                      20,240

     627   Swelling

           1 right                                         5
           2 left                                          5
           3 both                                          7
           blank                                      20,305

     628   Deformity

           1 right                                        34
           2 left                                         17
           3 both                                          8
           blank                                      20,263

     629   Pain on motion

           1 right                                        34
           2 left                                         19
           3 both                                         46
           blank                                      20,223

     630   Other

           1 right                                         3
           2 left                                          3
           3 both                                          1
           blank                                      20,315

           Wrist

     631   Tender

           1 right                                        29
           2 left                                         12
           3 both                                         40
           blank                                      20,241

     632   Swelling

           1 right                                         8
           2 left                                          6
           3 both                                         14
           blank                                      20,294

     633   Deformity

           1 right                                        28
           2 left                                         12
           3 both                                         18
           blank                                      20,264

     634   Pain on motion

           1 right                                        27
           2 left                                         17
           3 both                                         49
           blank                                      20,229

     635   Other

           1 right                                         2
           2 left                                          3
           3 both                                          0
           blank                                      20,317

           Metacarpophalangael                              Number involved

     636   Tender - Right

           1-5 joints involved                            73
           blank                                      20,249

     637   Tender - Left

           1-5 joints involved                            66
           blank                                      20,256

     638   Swelling - Right

           1-5 joints involved                            62
           blank                                      20,260

     639   Swelling - Left

           1-5 joints involved                            55
           blank                                      20,267

     640   Deformity - Right

           1-5 joints involved                           125
           blank                                      20,197

     641   Deformity - Left

           1-5 joints involved                           113
           blank                                      20,209

     642   Pain on motion - Right

           1-5 joints involved                            65
           blank                                      20,257

     643   Pain on motion - Left

           1-5 joints involved                            64
           blank                                      20,258

     644   Other - Right

           1-5 joints involved                             5
           blank                                      20,317

     645   Other - Left

           1-5 joints involved                             5
           blank                                      20,317

           Proximal Interphalangeal                        Number involved

     646   Tender - Right

           1-5 joints involved                           106
           blank                                      20,216

     647   Tender - Left

           1-5 joints involved                            95
           blank                                      20,227

     648   Swelling - Right

           1-5 joints involved                           108
           blank                                      20,214

     649   Swelling - Left

           1-5 joints involved                            98
           blank                                      20,224

     650   Deformity - Right

           1-5 joints involved                           230
           blank                                      20,092

 Tape Positions 651-700

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     651   Deformity - Left

           1-5 joints involved                           198
           blank                                      20,124

     652   Pain on motion - Right

           1-5 joints involved                           102
           blank                                      20,220

     653   Pain on motion - Left

           1-5 joints involved                            92
           blank                                      20,220

     654   Other - Right

           1-5 joints involved                             4
           blank                                      20,318

     655   Other - Left

           1-5 joints involved                             4
           blank                                      20,318

           Distal Interphalangeal                           Number involved

     656   Tender - Right

           1-5 joints involved                            79
           blank                                      20,243

     657   Tender - Left

           1-5 joints involved                            70
           blank                                      20,252

     658   Swelling - Right

           1-5 joints involved                            59
           blank                                      20,263

     659   Swelling - Left

           1-5 joints involved                            52
           blank                                      20,270

     660   Deformity - Right

           1-5 joints involved                           175
           blank                                      20,147

     661   Deformity - Left

           1-5 joints involved                           151
           blank                                      20,171

     662   Heberden's nodes - Right

           1-5 joints involved                         1,395
           blank                                      18,927

     663   Heberden's nodes - Left

           1-5 joints involved                         1,277
           blank                                      19,045

     664   Pain on motion - Right

           1-5 joints involved                            65
           blank                                      20,257

     665   Pain on motion - Left

           1-5 joints involved                            62
           blank                                      20,260

     666   Other - Right

           1-5 joints involved                             6
           blank                                      20,316

     667   Other - Left

           1-5 joints involved                             7
           blank                                      20,315

           Ankle

     668   Tender

           1 right                                        30
           2 left                                         24
           3 both                                         55
           blank                                      20,213

     669   Swelling

           1 right                                        25
           2 left                                         23
           3 both                                         48
           blank                                      20,226

     670   Deformity

           1 right                                        37
           2 left                                         37
           3 both                                         37
           blank                                      20,211

     671   Pain on motion

           1 right                                        34
           2 left                                         19
           3 both                                         59
           blank                                      20,210

     672   Other

           1 right                                         6
           2 left                                          4
           3 both                                          4
           blank                                      20,308

           Feet

     673   Tender

           1 right                                        17
           2 left                                          9
           3 both                                         52
           blank                                      20,244

     674   Swelling

           1 right                                         7
           2 left                                          5
           3 both                                         28
           blank                                      20,282

     675   Deformity

           1 right                                        17
           2 left                                         14
           3 both                                        107
           blank                                      20,184

     676   Pain on motion

           1 right                                        13
           2 left                                         11
           3 both                                         51
           blank                                      20,247

     677   Other

           1 right                                         3
           2 left                                          2
           3 both                                          6
           blank                                      20,311

           Knees

     678   Tender

           1 right                                        83
           2 left                                         69
           3 both                                        149
           blank                                      20,021

     679   Swelling

           1 right                                        50
           2 left                                         43
           3 both                                         86
           blank                                      20,143

     680   Deformity

           1 right                                        35
           2 left                                         41
           3 both                                        174
           blank                                      20,072

     681   Pain on motion

           1 right                                       127
           2 left                                         93
           3 both                                        206
           blank                                      19,896

     682   Other

           1 right                                        24
           2 left                                         29
           3 both                                         76
           blank                                      20,193

           Hips

     683   Tender

           1 right                                        52
           2 left                                         33
           3 both                                         86
           blank                                      20,151

     684   Swelling

           1 right                                         2
           2 left                                          2
           3 both                                          9
           blank                                      20,309

     685   Deformity

           1 right                                        18
           2 left                                         13
           3 both                                         21
           blank                                      20,270

     686   Pain on motion

           1 right                                        79
           2 left                                         70
           3 both                                        151
           blank                                      20,022

     687   Other

           1 right                                        19
           2 left                                         13
           3 both                                         21
           blank                                      20,269

           BACK

     688   1 no findings                              17,389   See detailed
           2 findings                                  2,916   notes
           8 blank but applicable                          3
           blank                                          14

     689   Scoliosis

           1 yes                                         685
           blank                                      19,637

     690   Kyphosis

           1 yes                                         873
           blank                                      19,449

     691   Lordosis

           1 yes                                         264
           blank                                      20,058

     692   Tenderness - Sciatic notch

           1 right                                        42
           2 left                                         29
           3 both                                         49
           blank                                      20,203

     693   Tenderness - Sacroiliac

           1 right                                        58
           2 left                                         37
           3 both                                         76
           blank                                      20,151

     694   Blank                                      20,322

           Limitation of Motion

     695   Thoracic spine

           1 yes                                         858
           blank                                      19,464

     696   Lumbar spine, right lateral flexion

           1 yes                                         986
           blank                                      19,336

     697   Lumbar spine, left lateral flexion

           1 yes                                         977
           blank                                      19,345

     698   Full extension

           1 yes                                       1,011
           blank                                      19,311

           PAIN ON MOTION

     699   1 negative                                  2,024   See detailed
           2 positive                                    891   notes
           8 blank but applicable                          1
           blank                                      17,406

           Pain on flexion - Location

     700   Cervical - Severity of pain

           0 None                                         30
           1 doubtful                                     16
           2 minimal                                     112
           3 moderate                                    152
           4 maximal                                      14
           8 blank but applicable                        567
           blank                                      19,431

 Tape Positions 701-750

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     701   Thoracic

           1 yes                                          92
           blank                                      20,230

     702   Low Back

           1 yes                                         235
           blank                                      20,087

     703   Diffuse

           1 yes                                          96
           blank                                      20,226

     704   Uncertain

           1 yes                                           8
           blank                                      20,314

           Pain on extension - Location

     705   Cervical - Severity of pain

           0 none                                         24
           1 doubtful                                     15
           2 minimal                                     129
           3 moderate                                    168
           4 maximal                                      14
           8 blank but applicable                        541
           blank                                      19,431

     706   Thoracic

           1 yes                                          99
           blank                                      20,223

     707   Low Back

           1 yes                                         283
           blank                                      20,039

     708   Diffuse

           1 yes                                          93
           blank                                      20,229

     709   Uncertain

           1 yes                                           7
           blank                                      20,315

           Pain on right lateral bending - Location

     710   Thoracic

           1 yes                                          98
           blank                                      20,224

     711   Low Back

           1 yes                                         270
           blank                                      20,052

     712   Diffuse

           1 yes                                          85
           blank                                      20,237

     713   Uncertain

           1 yes                                           5
           blank                                      20,317

           Pain on left lateral bending - Location

     714   Thoracic

           1 yes                                          98
           blank                                      20,224

     715   Low Back

           1 yes                                         301
           blank                                      20,021

     716   Diffuse

           1 yes                                          82
           blank                                      20,240

     717   Uncertain

           1 yes                                           5
           blank                                      20,317

           Pain on right rotation - Location

     718   Thoracic

           1 yes                                         100
           blank                                      20,222

     719   Low Back

           1 yes                                         202
           blank                                      20,120

     720   Diffuse

           1 yes                                          80
           blank                                      20,242

     721   Uncertain

           1 yes                                           2
           blank                                      20,320

           Pain on left rotation - Location

     722   Thoracic

           1 yes                                          98
           blank                                      20,224

     723   Low Back

           1 yes                                         195
           blank                                      20,127

     724   Diffuse

           1 yes                                          80
           blank                                      20,242

     725   Uncertain

           1 yes                                           2
           blank                                      20,320

           STRAIGHT LEG RAISING TEST

     726   Right leg

           1 negative                                 19,888
           2 positive                                    312
           8 blank but applicable                        108
           blank                                          14

     727   Left leg

           1 negative                                 19,871
           2 positive                                    332
           8 blank but applicable                        105
           blank                                          14

           Increase on ankle dorsiflexion

     728   Right

           1 yes                                         208
           2 no                                       16,230
           8 blank but applicable                      3,870
           blank                                          14

     729   Left

           1 yes                                         224
           2 no                                       16,218
           8 blank but applicable                      3,866
           blank                                          14

     730   Blank                                      20,322

           MUSCULOSKELETAL EVALUATION                          See detailed
                                                               notes
     731   1 findings                                  1,567
           2 no findings                              18,738
           8 blank but applicable                          3
           blank                                          14

     732   Bowed legs

           1 yes                                         812
           blank                                      9,510

     733   Knock knees

           1 yes                                         755
           blank                                      19,567

     734   Epiphysial enlargement, wrists

           1 yes                                           1
           blank                                      20,321

     735   Abduction of hips (Ortoloni's maneuver)             Under age 3

           1 yes                                           0
           blank                                      20,322

     736   Blank                                      20,322

           NEUROLOGICAL EVALUATION                             See detailed
                                                               notes
     737   1 findings                                  2,027
           2 no findings                              18,278
           8 blank but applicable                          3
           blank                                          14

     738   Absent knee jerks

           1 yes                                         589
           blank                                      19,733

     739   Absent ankle jerks

           1 yes                                         707
           blank                                      19,615

     740   Positive Chvostek sign

           1 yes                                         998
           blank                                      19,324

     741   Apathy

           1 yes                                          33
           blank                                      20,289

     742   Marked hyperirritability

           1 yes                                          89
           blank                                      20,233

     743   Blank                                      20,322

           SKIN EVALUATION

     744   1 findings                                    671   See detailed
           2 no findings                              19,634   notes
           8 blank but applicable                          3
           blank                                          14

     745   Follicular hyperkeratosis, arms

           1 yes                                         137
           blank                                      20,185

     746   Hyperpigmentation, hands and face

           1 yes                                          60
           blank                                      20,262

     747   Dry or scaling skin

           1 yes                                         362
           blank                                      19,960

     748   Perifolliculosis

           1 yes                                          17
           blank                                      20,305

     749   Petechiae

           1 yes                                          60
           blank                                      20,262

     750   Mosaic skin

           1 yes                                           7
           blank                                      20,315

 Tape Positions 751-799

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     751   Pellagrous dermatitis

           1 yes                                           3
           blank                                      20,319

     752   Ecchymoses

           1 yes                                          67
           blank                                      20,255

     753   Edema

           1 yes                                          53
           blank                                      20,269

     754   Blank                                      20,322

           EXAMINER'S SUBJECTIVE IMPRESSION OF
           NUTRITIONAL STATUS

     755   1 normal nutrition                         17,754
           2 abnormal nutrition                        2,527
           8 blank but applicable                         27
           blank                                          14

     756   1 obesity                                   2,949
           2 no obesity                               17,337
           8 blank but applicable                         22
           blank                                          14

           BLOOD PRESSURE                                      See detailed
                                                               notes

           Cuff Width

     757   1 adult                                    14,478
           2 child                                     1,580
           8 blank but applicable                        139
           blank                                       4,125

           Time

 758-761   0001-1259                                  16,113
           8888 blank but applicable                      84
           blank                                       4,125

     762   1 AM                                        8,538   See detailed
           2 PM                                        7,524   notes
           8 blank but applicable                        135
           blank                                       4,125

           Blood Pressure

 763-765   Systolic - Recumbent                                Age 6 & over
           68-300 mm Hg                               16,084
           888 blank but applicable                      113
           blank                                       4,125

 766-767   Blank                                      20,322

 768-770   Diastolic - Recumbent
           35-150 mm Hg                               16,020
           888 blank but applicable                      177
           blank                                       4,125

 771-773   Systolic - Sitting
           65-300 mm Hg                               16,074
           888 blank but applicable                      123
           blank                                       4,125

 774-776   Diastolic - Sitting
           35-150 mm Hg                               16,035
           888 blank but applicable                      162
           blank                                       4,125

 777-778   Examiner no.
           02-88 Examiner Number                      16,196
           00 blank but applicable                         1
           blank                                       4,125

           SUMMARY OF DIAGNOSTIC IMPRESSIONS

     779   1 normal:  no abnormal findings             8,671   See detailed
           2 abnormal:  significant findings noted    11,632   notes
           8 blank but applicable                          5
           blank                                          14

           Code a

     780   Severity

           1 minimal                                   4,806
           2 moderate                                  5,304
           3 severe                                    1,360
           8 blank but applicable                        162
           blank                                       8,690

     781   Certainty

           0 Not at all certain - 9 Extremely
             certain                                  11,047
           "-" blank but applicable                      135
           blank                                       8,690

 782-785   ICDA code

           Code a                                     11,632
           8888 blank but applicable                       0
           blank                                       8,690

           Code b

     786   Severity

           1 minimal                                   2,382
           2 moderate                                  3,186
           3 severe                                      813
           8 blank but applicable                        110
           blank                                      13,831

     787   Certainty

           0 Not at all certain - 9 Extremely
             certain                                   6,439
           "-" blank but applicable                       52
           blank                                      13,831

 788-791   ICDA code

           Code b                                      6,491
           8888 blank but applicable                       0
           blank                                      13,831

           Code c

     792   Severity

           1 minimal                                   1,265
           2 moderate                                  1,905
           3 severe                                      462
           8 blank but applicable                         71
           blank                                      16,619

     793   Certainty

           0 Not at all certain - 9 Extremely
             certain                                   3,662
           "-" blank but applicable                       41
           blank                                      16,619

 794-797   ICDA code

           Code c                                      3,703
           8888 blank but applicable                       0
           blank                                      16,619

           Code d

     798   Severity

           1 minimal                                     659
           2 moderate                                  1,145
           3 severe                                      294
           8 blank but applicable                         34
           blank                                      18,190

     799   Certainty

           0 Not at all certain - 9 Extremely
             certain                                   2,106
           "-" blank but applicable                       26
           blank                                      18,190
 
 Tape Positions 800-851

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

 800-803   ICDA code

           Code d                                      2,132
           blank                                      18,190

           Code e

     804   Severity

           1 minimal                                     374
           2 moderate                                    635
           3 severe                                      176
           8 blank but applicable                         24
           blank                                      19,113

     805   Certainty

           0 Not at all certain - 9 Extremely
             certain                                   1,196
           '-' blank but applicable                       13
           blank                                      19,113

 806-809   ICDA code

           Code e                                      1,209
           8888 blank but applicable                       0
           blank                                      19,113

           Code f

     810   Severity

           1 minimal                                     180
           2 moderate                                    359
           3 severe                                       97
           8 blank but applicable                         16
           blank                                      19,670

     811   Certainty

           0 Not at all certain - 9 Extremely
             certain                                     643
           '-' blank but applicable                        9
           blank                                      19,670

 812-815   ICDA code

           Code f                                        652
           8 blank but applicable                          0
           blank                                      19,670

           Code g

     816   Severity

           1 minimal                                     102
           2 moderate                                    193
           3 severe                                       52
           8 blank but applicable                          8
           blank                                      19,967

     817   Certainty

           0 Not at all certain - 9 Extremely
             certain                                     349
           '-' blank but applicable                        6
           blank                                      19,967

 818-821   ICDA code

           Cde g                                        355
           8888 blank but applicable                  19,967

           Code h

     822   Severity

           1 minimal                                      48
           2 moderate                                     86
           3 severe                                       28
           8 blank but applicable                          4
           blank                                      20,156

     823   Certainty

           0 Not at all certain - 9 Extremely
             certain                                     164
           '-' blank but applicable                        2
           blank                                      20,156

 824-827   ICDA code

           Code h                                        166
           blank                                      20,156

           Code i

     828   Severity

           1 minimal                                      24
           2 moderate                                     45
           3 severe                                       17
           8 blank but applicable                          4
           blank                                      20,232

     829   Certainty

           0 Not at all certain - 9 Extremely
             certain                                      87
           '-' blank but applicable                        3
           blank                                      20,232

 830-833   ICDA code

           Code i                                         90
           8888 blank but applicable                       0
           blank                                      20,232

           Code j

     834   Severity

           1 minimal                                       5
           2 moderate                                     19
           3 severe                                       10
           8 blank but applicable                          1
           blank                                      20,287

     835   Certainty

           0 Not at all certain - 9 Extremely
             certain                                      34
           '-' blank but applicable                        1
           blank                                      20,287

 836-839   ICDA code

           Code j                                         35
           blank                                      20,287

           Code k

     840   Severity

           1 minimal                                       4
           2 moderate                                      6
           3 severe                                        3
           blank                                      20,309

     841   Certainty

           0 Not at all certain - 9 Extremely
             certain                                      13
           blank                                      20,309

 842-845   ICDA code

           Code k                                         13
           blank                                      20,309

           Code l

     846   Severity

           1 minimal                                       3
           2 moderate                                      1
           blank                                      20,318

     847   Certainty

           0 Not at all certain - 9 Extremely
             certain                                       4
           blank                                      20,318

 848-851   ICDA code

           Code l                                          4
           blank                                      20,318

           Code m

 Tape Positions 852-900

 POSITION  ITEM DESCRIPTION AND CODES                 COUNTS   SOURCE AND NOTES

     852   Severity

           2 moderate                                      2
           8 blank but applicable                          0
           blank                                      20,320

     853   Certainty

           0 Not at all certain - 9 Extremely
             certain                                       2
           '-' blank but applicable                        0
           blank                                      20,320

 854-857   ICDA code

           Code m                                          2
           blank                                      20,320

           Code n

     858   Severity

           blank                                      20,322

     859   Certainty

           blank                                      20,322

 860-863   ICDA code

           blank                                      20,322

           Code o

     864   Severity

           blank                                      20,322

     865   Certainty

           blank                                      20,322

 866-869   ICDA code

           blank                                      20,322

 870-871   Examiner number

           30-49 Physician number                     20,288
           88    blank but applicable                     20
           blank                                          14

 872-900   Blank                                      20,322


DETAILED NOTES, PHYSICIAN EXAMINATION DATA

 Physician's examination form blank

 Survey participants who completed other components of the examination but
 for whom the physician's examination form is blank are indicated with a
 "1" in this position.  Their records are blank in positions 408-900.

 Pulse

 Any pulse value less than 30 was changed to "888", blank but applicable.
 Pulse values greater than 150 were left as stated by the examiner;
 typically, values in the higher ranges were accompanied by comments
 such as  "crying baby".

 Blood Pressure

 At the beginning of the physical examination the physician took the
 sample person's blood pressure while the sample person was in a sitting
 position. The sample person's blood pressure was taken twice more at the
 end of the exam,  once while the sample person was recumbent and again
 while sitting.  The following guidelines, based on the American Heart
 Association's "Recommendations for Human Blood Pressure Determinations
 by Sphygmomanometers"  (Committee to Revise Standardization of High Blood
 Pressure Readings, New York, American Heart Association, October 1951)
 were generally observed:

     1.  The cuff was at least 20 percent wider than the diameter of
         the arm or covered approximately two-thirds of the arm.  (An
         adult 13 cm. cuff and a pediatric 9.5 cm. cuff were provided.)

     2.  The manometer was at eye level with the physician.

     3.  The meniscus of the mercury instruments was checked weekly for
         zero-level calibration.

     4.  While measuring, the rate of falling pressure was maintained 2-3
         mm. Hg per heartbeat, which was slow enough to detect the first
         and last sounds but sufficiently rapid to avoid intermittent
         trapping of blood between systolic and diastolic levels.

     5.  For diastolic pressure, the level was recorded at the point
         of complete cessation of Korotkoff's sounds or, if there was
         no cessation, the point of muffling.

     6.  Measurements were recorded to the nearest 2 mm. on the scale.

 Cuff Width

 Cuff width was not edited for consistency with measured arm girth for
 anthropometric data.

 Tape Positions 420-779

  Tape Positions 420, 456, 457, 464, 465, 470, 471, 488, 489, 502, 507,
                 512, 519, 546, 554, 573, 593, 620, 688, 699, 731, 737,
                 744, 779

 "Blank" in these findings/ no findings fields represents participants for
 whom demographic data exist but for whom there is no examination data;
 these participants have a "1" in position 407.

 "Blank but applicable" ("8") indicates a survey partially completed.  This
 field and the range of tape positions subordinate to this field were not
 completed on the form; "8" is imputed in this field and the subordinate
 positions are left blank.

 Ear Drum

 If the auditory canal was indicated as "completely occluded", a "not
 visible" finding was imputed for the ear drum.

 Thyroid Evaluation

 The World Health Organization (WHO) criteria used for grading goiter are:

 Group 0:  Persons without goiter.  By definition, these are persons whose
           thyroid glands are less than 4 to 5 times enlarged.

 Group 1:  Persons with palpable goiters.  The thyroid is considered to be
           more than 4 to 5 times enlarged although not visible with head in
           normal position.  Most of these will be readily visible with the
           head thrown back and the neck fully extended.

 Group 2:  Persons with visible goiters.  Persons with goiters which are
           easily visible with the head in normal position, but which
           are smaller than those in Group 3.  Palpation may be helpful
           in determining the mass of the gland, but is not needed for
           diagnosis.

 Group 3:  Persons with very large goitrs.  The goiters of persons in this
           category can be recognized at a considerable distance.  They are
           grossly disfigured and may be of such size as to cause mechanical
           difficulties with respiration and the wearing of clothes.

           (Perez, C., Scrimshaw, N.S., and Munoz, J.A., Technique of endemic
           goitre surveys.  In endemic Goitre; p. 369, see esp. p. 376, World
           Health Organization Monograph Series No. 44, Geneva, 1960.)

 Wheezing on auscultation

 No attempt was made to correlate on auscultation and decreased breath
 sounds with entries in section H.6, ascultation.

 Chest Evaluation

 If breath sounds were "absent", the description of the breath sounds
 were left blank.

 Heart Murmurs

 No attempt was made to correlate the location of murmur with a type of
 murmur or origin of murmur.

 Pulse - Palpation

 The form did not provide a place to record "absent palpation" in this
 section. Where "absent pulse" was recorded in the next question, "normal",
 "tortuous", or "blank" in this field were changed to a new code, "5", to
 indicate absent palpation.

 The form does not provide any place to record missing limbs.  Some
 observations on extremities may be missing because sample persons were
 amputees.  Although we know that there are amputees in the sample
 population,  the number is unknown.

 Area(s) of Mass(es) -- Positions 606-610

 If masses were present, the number(s) of the location(s), using the
 numbers on the body diagram, were recorded.  The number used was the
 one which located the center of the mass.

 Area(s) of Surgical Scar(s) -- Positions 613-617

 If scars were present the number(s) of the location(s), using the
 numbers on the body diagram, were recorded.  The number used was the
 one which located the center of the scar.

 Time - AM/PM

 If this section was left blank, but a corresponding time was entered,
 a AM/PM value is imputed if appropriate.  The rule followed is: between
 12:00 and 07:00 - "PM" is imputed; between 09:00 and 11:59 - "AM" is
 imputed; other ranges are ambiguous, and a value of "8", blank but
 applicable, is entered.

 ICDA Codes

 Physicians were instructed to record their findings of abnormal conditions
 on the examination form and to code these using the first 3 digits of the
 Eighth Revision of the International Classification of Diseases, Adapted
 for Use in the United States.  Identified conditions were coded at the
 end of medical examination forms.  Since the examination emphasized the
 cardiovascular, respiratory and musculoskeletal systems, codes relating
 to these systems are expected to be more frequent.


APPENDIX B - PHYSICIAN'S EXAMINATION PROCEDURES

 General

     HANES is designed to gather data for statistical analysis.  Rather than
 have a general clinical examination performed in the manner most familiar
 to the examining physician, we have a physical examination structured
 to gather data on physical conditions pertinent to nutrition and certain
 chronic diseases.  This section of the manual, which describes the method
 of performing the examination and specifies the method of recording
 findings, should be followed explicitly.
     Other chapters of the manual (Responsibilities of Examination Staff
 Members, and Emergency Medical Procedures) describe the other obligations
 and duties of the examining physician.

 Format for the Examination

     Certain procedures are to be deleted on the basis of age and are
 indicated on the examination form.

    Sitting
       Blood pressure and pulse
       HEENT
          Hair, skin, skull, glands
          Ears
          Nose
          Eyes
          Mouth
       Neck
          Nodes and trachea
       Chest (including heart)
          Inspect
          Auscult

    Reclining
       Heart
          Inspect
          Palpate
          Auscult
       Abdomen
          Inspect
          Percuss
          Palpate
       Arteries
       Musculoskeletal
          Knee
          Hip
          Straight leg raising
    Sitting
       Extremities
          Lower
          Upper
       Neurological
          DTR's
          Chvostek

    Standing
       Inguinal Hernia
       Musculoskeletal
          Back
          Knees
       Skin
       General appearance and behavior

    Supine and Sitting
       Blood pressure

 Examination Procedure

    1.  Blood pressure and pulse:  While the examinee is sitting, check his
        blood pressure and pulse in the right extremity. (Count the pulse
        for at least 30 seconds.)
    2.  HEENT examination:  Perform a routine HEENT.  Make a special note
        of characterizing the hair, checking the skin for seborrhea, the
        skull for bossing, and looking for parotid enlargement. Inspect the
        external ear and, with an otoscope, examine the auditory canal and
        tympanic membrane. Check each nostril for patency with inspiration
        during alternate unilateral occlusion and examine each nostril
        with an otoscope.  Check the eyes (lids, conjunctiva, cornea)
        and mouth (lips, tongue, buccal mucosa) for findings linked with
        malnutrition and other pathology.
    3.  Neck examination:  Observe the neck at rest for thyroid visibility
        during swallowing of small aliquots of water.  Repeat with the neck
        extended to judge thyroid size and contour.  Palpate the neck for
        thyroid contour & tenderness, lymph nodes, & tracheal deviation.
    4.  Chest examination:  Inspect the chest paying particular attention
        to the skin of the upper back and to the costochondral junctions
        for signs attributable to malnutrition.  Auscult the chest with
        care to cover representative areas for all lung segments.
    5.  Cardiovascular examination:  While the examinee is sitting, & then
        when he is supine, palpate & auscult the heart.  Check especially
        for cyanosis and venous distention. Check the peripheral pulses--
        note the character of the artery as well as the quality of the
        pulsation.
    6.  Abdominal examination:  Inspect the abdomen for evidence of past
        surgery and for stigmata of malnutrition. During quiet respiration
        in the supine position, percuss the liver.  Use palpation and fist
        percussion to elicit CVA tenderness.  With the examinee's knees and
        hips flexed to relax the abdominal musculature, palpate the abdomen.
        While he is standing erect, palpate for hernia.
    7.  Musculoskeletal examination:  Examine the knees and hips for
        deformities and signs of inflammation, check for tenderness & for
        pain with active and passive motion, and perform the straight leg
        raising test.  With the examinee seated check the legs for calf
        tenderness and check the extremities for evidence of arthritis and
        epiphyseal swelling.  Also at this time check the extremities for
        pretibial edema, hyperpigmentation and pellagrous dermatitis,
        follicular hyperkeratosis, xerosis, mosaic skin, petechiae, and
        ecchymoses.  With the examinee standing check the cervical,
        thoracic,  and lumbar spine for deformities, limited range of
        motion, and pain with motion by having the examinee flex, extend,
        laterally bend, & rotate the spine.  Check for sciatic notch and
        sacro-iliac tenderness.  With the examinee bending forward (as
        in touching toes) check for exacerbation or relief of scoliosis
        (including rotary component). While the examinee is standing, again
        check the knees for deformities (and the legs for varicosities).
    8.  Neurological examination:  While the examinee is seated test for knee
        jerks, ankle jerks, and facial spasm (Chvostek sign).
    9.  Dermatological examination:  Check the skin regionally during
        the other parts of the examination as described previously--see
        "Folder I" on the trailer for illustrations of findings linked
        with malnutrition.
   10.  General appearance and behavior:  Take special note of the general
        appearance and behavior of the examinee which might reflect organic
        or functional disorders (e.g., endocrine imbalance, chromosomal
        disorders, psychosis)  which would confound evaluation of
        nutritional status or reflect malnutrition.
   11.  Blood pressure:  At the close of the physician's examination,
        the blood pressure should be taken while examinee is both in the
        supine and sitting positions.

 Recording of Findings

     The examination forms contain spaces for structured responses, open
 ended responses, & summaries of diagnostic impressions. Since the structured
 responses will be used for computer analysis, certain criteria for and/or
 definitions of these responses will be given below to ensure comparability
 of data collected by numerous physicians.  The open ended responses are
 for recording both common and rare findings (which have not been put into
 structured form because of rarity or secondary importance to the goals
 of the survey) so that a more complete medical record will be available
 if information beyond the structured responses is needed in the future.
 The summary and diagnostic impressions allows a reviewer to quickly
 synthesize the physician's findings on a given examinee and to ascertain
 the physician's subjective as well as objective evaluations.
     Unless otherwise noted in the instructions, positive responses should
 be recorded with checks in the appropriate boxes.  A correction should be
 made by circling the response to be negated and checking the correct box.
     Either the "Findings" or "No findings" box should be checked when they
 occur. If there are no findings for any section of the examination, check
 the "No findings" box; if there are findings check the "Findings" box
 as well as the individual boxes for whatever findings there are.
     The letters "R" or "Rt.," "L" or "Lt.," and "B" mean right, left,
 and both, respectively.
     At the end of the chart are forms for reporting findings to physicians.
 Record there any significant medical findings which need to be reported to
 a physician or check the box to indicate that there are no significant
 new medical findings to be reported.

 Criteria and Definitions

    1.  Pulse and blood pressure:
        Record the pulse as the number of radical pulsations per minute
        and the systolic and diastolic blood pressure in even digits to
        the nearest 2 mm. pressure.

    2.  HEENT
        a.  Dry staring hair:  Dry, wirelike, unkempt, stiff, and often
            brittle hair which sometimes may exhibit some bleaching of the
            normal color.
        b.  Dyspigmented hair:  Definite change from normal pigment of the
            hair, most usually evident & best seen by carefully combing
            hair strands upward & viewing the orderly array of hair in good
            light. Dyspigmentation includes both change of pigment (usually
            lightening of color) & depigmentation--not to be confused
            with dyed or tinted hair. Dyspigmentation is always bandlike
            in character and is usually associated with some change in
            texture of hair in the dyspigmented band. In some ethnic groups,
            particularly Negroid groups, the pigment may be slightly
            reddish in color.  In others, especially among straight
            black-haired peoples, the bandlike depigmentation ("flag sign")
            is common.  Dyspigmentation is only rarely observed in adults.
        c.  Easily pluckable hair: A condition in which the shafts of
            hair are readily removed with a minimal tug when a few strands
            are grasped between the finger and thumb and gently pulled.
            In such cases there is no reaction from the child, indicating
            a lack of pain associated with removal of the hair.
        d.  Abnormal texture or loss of curl: Changes in texture of the hair
            to a soft, silk-like hair. Loss of curl is self-explanatory.
        e.  Circumcorneal injection (bilateral): Increase in vascularity by
            new ingrowth of capillary loops, with particular concentration
            around the cornea in the absence of obvious causes other than
            nutrition.
        f.  Conjunctival injection (bilateral):  Generalized increase in the
            vascularity of the bulbar conjunctivae in the absence of obvious
            infection.
        g.  Angular blepharitis:  A fissure located in the lateral palpebral
            angle of the eyelids which presents as a crack in the epidermis
            similar to the cracks found at the angles of the mouth in
            angular stomatitis.
        h.  Pupils and Iris:  Irregularity of pupil contour.
        i.  Xerosis (conjunctivae):  The conjunctivae, upon exposure when
            holding the examinee's lids open and having the examinee
            rotate his eyes, appear dull, lusterless, and exhibit a
            striated or roughened surface.
        j.  Lesions of cornea (other):  Use oblique moving illumination
            with small flashlight to look for opacities, surface debris,
            deposits in the anterior chamber and cataract.
        k.  Bitot's spots:  Small circumscribed, grayish or yellowish-gray,
            dull, dry, foamy, superficial lesions of the conjunctivae. Seen
            most often at the lateral aspect of the bulbar conjunctivae of
            children. Usually bilateral. Not to be confused with pterygium.
        l.  Keratomalacia:  Corneal softening with deformity, either
            localized (usually central part of lower half of cornea)
            or total.
        m.  Xerophthalmia:  Xerophthalmia is recorded when the bulbar
            conjunctiva and cornea are dry and lusterless with a decrease
            in lacrimination.  It is rarely associated with evidence of
            infection but in extreme cases is associated with
            keratomalacia.
        n.  Lids and Sclera:  Lid edema, lid infection, and ptosis.
        o.  Angular lesions of lips:  Record only if definitely present
            bilaterally when the examinee's mouth is held half open.  May
            appear as pink or moist, whitish, macerated, angular lesions
            which blur the mucocutaneous junction.  Angular lesions are
            recorded only when there is definite break in continuity of
            epithelium at the angles of the mouth.
        p.  Angular scars of lips:  Scars at the angles which, if recent,
            may be pink; if old, may appear blanched.
        q.  Cheilosis:  Different from ordinary chapping.  The lips are
            swollen or puffy and appear as if the buccal mucosa extends out
            onto the lip.  There may be desquamation.  This category may be
            used to include vertical fissuring of the lips.  If associated
            with herpes labialis, note under "Other findings."
        r.  Filiform papillary atrophy of tongue:  The filiform papillae
            are exceedingly low or absent, giving the tongue a smooth
            or "slick" appearance which remains after scraping slightly
            with an applicator stick.
        s.  Fungiform papillary hypertrophy of tongue:  The fungiform
            papillae can be seen and felt when a tongue blade is drawn
            lightly over the anterior two-thirds of the tongue.
        t.  Geographic tongue:  Irregularly outlined and distributed areas
            of atrophy with irregular white patches resembling leukoplakia.
        u.  Fissures of tongue:  Linear lesions or cracks with a definite
            break in the continuity of the epithelium.
        v.  Serrations or swelling of tongue:  Tooth impressions at sides
            of tip, often noted when tongue is swollen.
        w.  Scarlet, beefy tongue:  Entire tongue is red, angry in
            appearance, with or without denudation or fissures. Not just
            a modification of the natural color due to the loss of
            papillae. Associated almost always with subjective symptoms
            of hypersensitivity, burning, and even taste changes.
        x.  Magenta tongue:  A tongue the color of alkaline phenolphthalein.
        y.  Nasolabial seborrhea:  A definite greasy, yellowish scaling or
            filiform excrescences in the nasolabial area which become more
            pronounced on slight scratching with the fingernail or a tongue
            blade.
        z.  Visible enlarged parotids:  Due to difficulties in assessing
            parotid enlargement, record as positive the presence of
            bilateral enlargement only if clearly visible.
       aa.  Bossing of skull:  Record abnormal prominence or protrusion of
            frontal or parietal areas.

    3.  Thyroid evaluation
        The World Health Organization (WHO) criteria used for grading
        goiter are:
        Grade 0:  Persons without goiter.  By definition these are persons
        whose thyroid glands are less than 4 to 5 times enlarged.
        Grade 1:  Persons with palpable goiters.  The thyroid is
        considered to be more than 4 to 5 times enlarged although not
        visible with head in normal position. Most of these will be readily
        visible with the head thrown back and the neck fully extended.
        Grade 2:  Persons with visible goiters. Persons with goiters which
        are easily visible with the head in normal position, but which
        are smaller than those in Grade 3. Palpation may be helpful in
        determining the mass of the gland, but is not needed for diagnosis.
        Grade 3:  Persons with very large goiters. The goiters of persons
        in this category can be recognized at a considerable distance.
        They are grossly disfigured and may be of such size as to cause
        mechanical difficulties with respiration and the wearing of
        clothes. (Perez, C., Scrimshaw, N.S., and Munoz, J.A., Technique of
        endemic goitre surveys. In endemic Goitre; p. 369, see esp. p. 376,
        World Health Organization Monograph Series No. 44, Geneva, 1960.)

        Other thyroid findings:  Record any tenderness, nodularity,
        enlargement of the isthmus, or other abnormal thyroid findings
        not included in grading thyroid size.

    4.  Chest evaluation:
        a.  Beading of ribs:  A definitely palpable & visible enlargement
            of the costochondral junctions.
        b.  Follicular hyperkeratosis of upper back:  This lesion has been
            likened to "gooseflesh" which is seen on chilling, but is not
            generalized and does not disappear with brisk rubbing of skin.
            Readily felt, it presents a "nutmeg grater" feel.  Follicular
            Follicular hyperkeratosis is more easily detected by the sense of
            touch than by the eye.  The skin is rough, with papillae formed
            by keratotic plugs which project from the hair follicles.  The
            surrounding skin is dry and lacks the usual amount of moisture
            or oiliness. Differentiation from adolescent folliculosis can
            usually be made by recognition of the normal skin between the
            follicles in the adolescent disorder. Follicular hypereratosis
            is distinguished from perifolliculosis by the ring of
            capillary congestion which occurs about each follicle in
            scorbutic perifolliculosis.
        c.  Wheezing on auscultation:  Record any wheezing, inspiratory or
            expiratory, as focal or diffuse.
        d.  Decreased breath sounds:  Record if there is diffusely decreased
            breath sounds.  (Focal or discrete areas of decreased breath
            sounds should be recorded under "Other findings.")
        e.  Breast Masses:  Palpate in both upright and supine positions.
            If a mass is found, characterize with regard to location,
            size, contour, consistency, tenderness and mobility.

    5.  Cardiovascular evaluation:
        a.  Cyanosis:  Record definite cyanosis which is thought to
            be related to generalized hemoglobin desaturation.  (Focal
            phenomena, e.g., one extremity cyanotic should be recorded
            under "Other findings.")
        b.  Irregular pulse:  Record any irregularities of pulse except
            physiological variations.
        c.  Cardiac murmur:  Record all murmurs.  Grade, location,
            radiation, and any other pertinent description should be
            given as well as an opinion as to the origin of the murmur.

    6.  Abdominal evaluation:
        a.  Hepatomegaly:  Record livers palpable 2 centimeters or more
            below the right costal margin.
        b.  Splenomegaly:  Record all palpable spleens.
        c.  Uterine enlargement:  Record all enlarged uteri including those
            enlarged secondary to pregnancy.
        d.  Umbilical hernia:  Record all umbilical hernias.
            If a hyrocele is present write it in under "Summary of
            Diagnostic Imressions" with its ICDA code.
        e.  Inguinal and femoral hernias:  Record all hernias and note
            next to boxes if bilateral.
        f.  Potbelly:  Record if abdomen appears abnormally distended and
            enlarged with due recognition of the usual contour of the young
            child.
        g.  Masses:  If masses are present, check box 287.  Record the
            number(s) of the location(s) (see diagram for number of
            locations) of the mass(es) to the right of 288.  Use the number
            which locates the center of the mass.  Check box 289 and write
            in a description of the masses, identify each by its number
            location, e.g., (7) 3 cm. diameter firm, fixed, nontender.
        h.  Scars: If scars are present, check box 290. Record the number(s)
            of the location(s) of the scar(s) to the right of 291.  Use the
            number which locates the center of the scar.  Check box 292 and
            write in a description of the scars, identifying each by its
            number location, e.g., (7) 3 cm well-healed appendectomy scar.

    7.  Musculoskeletal evaluation:
        a.  Bowed legs (genu varum):  Bilateral concave deformities of the
            thighs and tibiae should be recorded, even if mild.
        b.  Knock knees (genu valgum):  Bilateral convex deformities of the
            knees and tibiae should be noted only if marked.
        c.  Epiphysial enlargement of wrist:  This can be more easily
            felt than seen and should be recorded, particularly if
            present at the ulnar epiphysis.
        d.  Ortolani's maneuver:  With the infant lying supine, the
            examiner straightens and adducts the legs.  The examiner's
            thumb rests along the inside & the other fingers extend along
            the outside of the infant's thigh.  The hips and thighs are
            flexed to 90* and one leg is then abducted with the examiner's
            fingers gently pressing the trochanter of the femur upward and
            forward.  The normal hip in a relaxed infant can be abducted to
            almost 90*.  If dislocation is present, resistance may be felt
            between 45* and 60* and a click felt as the dislocated femoral
            head slips into the acetabulum.

    8.  Neurological evaluation
        a.  Absent knee jerks:  Record bilaterally absent knee
            jerks--unilateral absence should be described under "Other
            findings."
        b.  Absent ankle jerks:  Record bilaterally absent ankle
            jerks--unilateral absence should be described under "Other
            findings."
        c.  Positive Chvostek sign:  When in tapping the malar process of
            the temporal bone on both sides of the face with a percussion
            hammer, a twitching of the perioral muscles of the same side is
            elicited, this is a positive Chvostek sign.  A positive sign
            indicates hyperirritability of the neuromuscular system
            as found in spasmophilia (tetany) due to calcium deficiency.
        d.  Apathy:  This should be noted and recorded if it is marked,
            particularly in young children.  It has importance in
            relation to protein-calorie deficiency (PCD).
        e.  Marked hyperirritability:  This refers to behavior (not to
            reflexes) and should be recorded only if marked.

    9.  Skin evaluation
        a.  Follicular hyperkeratosis, arms:  See 4b.
        b.  Hyperpigmentation, hands and face:  Asymptomatic with no
            inflammatory component.  It is seen most frequently on the
            dorsum of the hands and lower forearms, particularly when skin
            hygiene is poor. The skin is rough, dry & often has a grayish,
            cyanotic base.  There is not the sharp line of demarcation
            at the border of the lesion such as one sees in pellagra.
        c.  Dry or scaling skin (xerosis): Xerosis is a clinical term used
            to describe a dry & crinkled skin which is made more obvious by
            pushing the skin parallel to the surface.  In more pronounced
            cases it is often mottled & pigmented & may appear as scaly or
            alligator-like pseudoplaques, usually not greater than 5 mm in
            diameter. The nutritional significance of it is not established.
            Differential diagnosis must be made between this condition and
            changes due to dirt, exposure, and ichthyosis.
        d.  Perifolliculosis:  Congestion around the follicles which does
            not blanch upon pressure.  (See discussion of follicular
            hyperkeratosis above.)  There is an early ring of capillary
            engorgement around some hair follicles which does not disappear
            on pressure. It is more frequently encountered on the dependent
            parts such as the legs.  Swelling and hypertrophy of the
            follicles may occur, at which time the skin becomes rough.
            Follicular hyperkeratosis and perifolliculosis may coexist.
        e.  Petechiae:  Record petechiae which you as a physician judge to
            be due to abnormalities of the examinee.  Do not record normal
            responses to minor trauma as positives.  Qualify by describing
            distribution and severity, e.g., minimal pigmented purpuric
            eruption on the legs.  If deemed contributory, a tourniquet
            test may be performed on the upper extremity with the blood
            pressure cuff adjusted between systolic & diastolic pressures
            for 5 minutes, and the results described.
        f.  Mosaic skin:  This is usually found on the lower legs and
            constitutes a dry, atrophic alteration of the skin with a
            mosaic-like pattern and a certain luster of the surface. It
            is associated with conditions where the superficial layers
            of the skin are subject to stretching (increased tension) due
            to underlying edema, e.g., in protein deficiency.
        g.  Pellagrous dermatitis:  Areas of dry dermatitis-like lesions
            on the dorsal surface of hands, cheeks, forehead, and if exposed
            on the neck (Casals necklace).
        h.  Ecchymoses:  Record ecchymoses which you as a physician judge
            to be due to abnormalities of the examinee.  Do not record
            normal minor responses to known minor trauma.

   10.  Examiner's subjective impression of nutritional status:
        This will be the examining physician's subjective appraisal of
        the state of nutrition of the examinee.  Indicate whether or not
        you judge the examinee to have "normal nutrition" or "abnormal
        nutrition."  Obesity is considered to be "abnormal nutrition."

   11.  External ear:
        Record if the ears are pierced.  Check "Operative scar" only for
        mastoid operation scars.  Check and write under "other"
        additional findings which are significant cosmetically and/or
        which might impair hearing.

   12.  Auditory canal:
        Check "Completely occluded" if there is not sufficient tympanic
        membrane visible to characterize the membrane under "Drum" (below),
        and check as "Partially occluded" all other cases in which
        there is obstruction of or protrusion into the auditory canal.
        For all positive responses check the cause of the obstruction;
        write cause under "Other" for causes other than cerumen.

   13.  Drum:
        Check "Not visible" only if "Completely occluded" is checked above.
        Check as many structured responses as apply in the description of
        the membrane, e.g., dull, bulging, and fluid may be checked under
        R ear. However, do not check two responses for one code number.
        If the membrane is perforated, check either "With discharge" or
        "Without discharge."  Check "Other" and write in a description
        if the structured responses need to be supplemented.

   14.  Nares:
        Check "Acute" or "Chronic" if the naris is obstructed (use physical
        appearance plus history to judge if obstruction is acute or
        chronic). Check as many responses under "Other significant findings"
        as are necessary to describe the nares.
        Nasal Polyps--These are soft, smooth, pale, movable tumors usually
        multiple.

   15.  Neck:
        Check "Adenopathy," "Tracheal deviation," or "Other (describe)" to
        describe significant clinical findings (except thyroid) in the neck.

   16.  Chest:
        In the structured response chart check the columns corresponding
        to the observed abnormalities at the levels of the lobes over which
        the findings are observed.  (If needed, see diagrams present
        in the MEC for normal distribution of pulmonary segments and
        lobes.)  Other auscultatory findings, and findings on inspection,
        percussion, or palpation should be checked and written in under
        "Other chest findings."

   17.  Heart:
        a.  PMI:  Check whether the PMI is "Felt" or "Not felt."  If felt,
            check the number of the closest interspace and check the
            relationship to the mid-clavicular line.
        b.  Thrills:  Check whether a thrill is "Absent" or "Present."
            If present, check systolic and/or diastolic to time
            the thrill, and check either base or apex to locate the
            maximum intensity of a given thrill.  For multiple thrills,
            record only the most intense one.
        c.  Heart sounds:  Check the structured response which best
            describes the first heart sound and the one which best
            describes the second heart sound.
        d.  Murmurs:  Check "None" if no murmurs are heard.  If a murmur or
            murmurs are heard, place checks under the appropriate
            period--systolic and/or diastolic--to indicate the timing when
            categorizing by type and location of the murmur(s) or the
            component(s) of murmur(s) within each period--systolic and
            diastolic. When typing systolic murmurs, check "Organic" if any
            systolic murmur or systolic component of a murmur is thought
            secondary to a cardiovascular lesion; and check "Functional" if
            no systolic murmur or systolic component of a murmur is thought
            secondary to a cardiovascular lesion. Check "Don't know" only if
            a reasonable clinical judgment cannot be made.  Follow the same
            guidelines for typing diastolic murmurs. Note that "Functional,"
            "Organic," and "Don't know" are to be considered mutually
            exclusive responses within each period (systole, diastole).  In
            locating and grading a murmur, record the grade of the murmur by
            checking the grade as judged at its point of maximum intensity
            in the appropriate period column to the right of the structured
            location response which best approximates the location of its
            point of maximum intensity. Unless there are both systolic and
            diastolic components to a murmur, check only one grade-location
            response for each murmur; for multiple murmurs make multiple
            responses. However, there should be only one response at a given
            location within a given period.)  To locate the origin of each
            murmur or component thought secondary to a cardiovascular lesion
            ("Organic" will have been checked), check in the appropriate
            period column (systolic, diastolic, or both) to the right
            of the location of the cardiovascular lesion thought to be the
            origin of the murmur; e.g., for pulmonic stenosis check to the
            right of 254 in the box numbered 1. Make multiple responses
            for multiple murmurs of "Organic" origin. Check "Other"
            if the location of other than 251-256 and check "Don't know"
            if the murmur is thought to be organic but a reasonable
            clinical judgment of the origin cannot be made.

        e.  Other cardiac and cardiovascular findings:  If there are
            significant cardiac or cardiovascular findings for which there
            are no other appropriate responses in either the heart or
            arterial evaluation sections, check "Yes" and then check the
            structured or open ended (under "Other") response which applies.
            Check "No" if this space is not needed to describe cardiac
            or cardiovascular findings.

   18.  Arterial evaluation:
        Check the structured response ("Normal," "Sclerotic," "Tortuous,"
        or "Sclerotic and Tortuous") which best characterizes each artery
        listed, and check the structured response ("Normal," "Bounding,"
        "Diminished," or "Absent") which best characterizes each pulse
        listed. If the dorsalis pedis pulse is absent and the posterior
        tibial pulse is present, check "Absent" for dorsalis pedis and
        write in "posterior tibial" after "Other" and check its character.
        If the dorsalis pedis and posterior tubial pulses are both absent,
        check "Absent" for dorsalis pedis and write in "popliteal"
        after "Other" and check the character of the popliteal pulse.

   19.  Joints:
        To record findings in joints, locate the box for the finding to be
        recorded (i.e., tender, swelling, deformity, limitation, Heberden's
        nodes, pain on motion, other) & the joint involved.  Within
        the box check right, left, or both to indicate the location of
        involvement for shoulder, elbow, wrist, ankle, feet, knees, & hips
        and check the total number of digits involved on each side for
        the MP and DIP joints. Check the total number of digits involved on
        the right and on the left for each finding (note this is the total
        number of digits involved and not the digit involved).
        a.  Back:  Check the described deformities if observed; check the
            location of any tenderness or limitation of motion. If there is
            pain with motion, check the location at the right of the motion
            which elicits the pain--"diffuse" should be checked if all three
            locations (cervical, thoracic, low back) are involved, but do not
            check thoracic or low back in these instances.  "Uncertain"
            should be checked if pain occurs but the site cannot be
            specified.  The severity of pain in flexion and extension of
            the neck is graded 0-none, 1-doubtful, 2-minimal, 3-moderate,
            and 4-maximum. If there is limitation of motion on flexion of
            the lumbar spine, check box M4c(368) and describe as
            limitation of flexion, lumbar spine.
        b.  Straight leg raising:  For the SLR test, check negative
            or positive for both the right and the left.  Also, for
            "Increase with dorsiflexion," check either "Yes" or "No" for
            both the right and left.

   20.  Other systems:
        Record here system findings which cannot be noted in other
        parts of the form, eg., Reticuloendothelial--marked inguinal and
        axillary adenopathy plus cervical adenopathy, pallor, and petechiae
        previously noted. But if only petechiae & cervical adenopathy were
        observed, they would have previously been recorded and need
        not be recorded here.

   21.  Blood pressure:
        Record the systolic and the diastolic blood pressures to the nearest
        even digit for both the recumbent and the sitting positions and note
        the time to the nearest minute of the determination.

   22.  Summary of diagnostic impressions
        On the last page of the physical examination recording form under the
        heading "Summary of Diagnostic Impressions" findings should be
        summarized.  Diagnostic impressions may be on the basis of physical
        exam, history, X-ray, laboratory findings, etc.  Certainly not all
        findings should be listed,but those deemed significant in relation to
        disease or certain condition states should be listed.  However, in
        order to facilitate data processing all entries under other categories
        should be listed and given ICD codes.  It is preferable to summarize
        findings by condition such as "osteoarthritis" rather than by
        listing symptoms or signs.  After completing the examination,
        indicate whether the examinee is "normal" or "abnormal."
        If abnormal, summarize findings according to the directions
        briefly outlined above. Cardiovascular (including venous disease),
        musculoskeletal, and respiratory findings should be listed in
        their appropriate sections with other findings below.
        Following each such listing, indicate the seeming severity of each,
        checking whether it appears to be either minimal, moderate,or severe.
        This will be strictly subjective and based on your own appraisal.
        Should there arise some difficulty in deciding between two of the
        possible classifications, the lesser of the two should be selected.
        Then indicate the certainty of the diagnosis using a scale
        ranging from 0 to 9 according to the following criteria:

              0-not at all certain
              2-little bit certain
              4-somewhat certain
              6-fairly certain
              8-very certain
              9-extremely certain

        The range is continuous and any number representing a degree of
        certainty between two of the listed scale numbers may be selected.
        When selected, the number should be written in the appropriate space.
        Each condition should finally be coded according to Eighth Revision
        International Classification of Diseases, Adapted for Use in the
        United States, which has been modified for use in HANES. A complete
        listing of these HANES modified codes are kept in each caravan.
        Since the vast majority of examinees with findings will have one
        or more of a small number of common conditions, the more probable
        conditions with the appropriate code numbers are listed below:

 Modified ICDA Codes for Use in HANES

          I.  Infective and Parasitic Disease (000-136)
              011.X  Pulmonary Tuberculosis
              044.X  Polio, Late Effects of
              111.0  Tinea Versicolor

         II.  Neoplasms (140-239)
              See specific Neoplasms as classified
              214.X  Lipoma
              227.0  Hemangioma of Skin

        III.  Endocrine, Nutritional and Metabolic Diseases (240-279)
              240.X  Simple Goiter
              241.X  Nontoxic Nodular Goiter
              242.X  Hyperthyroidosis (Hyperthyroidism) with or
                     without Goiter
              243.X  Cretinism
              244.X  Hypothyroidism (acquired)
              250.X  Diabetes Mellitus
              274.X  Gout
              277.X  Obesity not specified as of Endocrine Origin

         IV.  Diseases of Blood and Blood Forming Organs (280-289)
              280.X  Iron Deficiency Anemias
              282.X  Hereditary Hemolytic Anemias including Sickle
                     Cell Disease
              287.X  Purpura and other Hemorrhagic Conditions

          V.  Mental Disorders (290-315)
              295.X  Schizophrenia
              296.X  Affective Psychoses
              300.X  Neuroses
              303.X  Alcoholism
              309.X  Mental Disorders not specified as Psychotic; associated
                     with Physical Conditions; includes Brain Syndrome
              309.2  Due to Brain Trauma
              309.3  Due to Circulatory Disturbance
              309.6  Due to Senile or Presenile Brain Disease

         VI.  Diseases of the Nervous System and Sense Organs (320-389)
              324.X  Meningitis or Encephaslitis, late effects of
              342.X  Paralysis Agitans (Parkinson's Syndrome)
              343.X  Cerebral Spastic Infantile Paralysis
              344.X  Other Cerebral Paralysis
              344.1  Hemiplegia
              345.X  Epilepsy
              346.X  Migraine
              350.X  Facial Paralysis
              353.X  Neuralgia or Neuritis of Sciatic Nerve
              360.X  Conjunctivitis and Conjunctival Infection
              367.X  Retinitis
              373.X  Strabismus
              374.X  Cataract
              375.X  Glaucoma
              377.0  Vascular Lesions of Retina
              377.1  Degeneration of Retina
              379.X  Blindness
              380.X  Otitis External
              381.X  Otitis Media without Mastoiditis
              382.X  Otitis Media with Mastoiditis

        VII.  Diseases of Circulatory System (390-458)
              394.X  Disease of Mitral Valve
              395.X  Disease of Aortic Valve
              401.X  Essential Benign Hypertension
              402.X  Hypertensive Heart Disease
              403.X  Hypertensive Renal Disease
              412.X  Chronic Ischemic Heart Disease
              413.X Angina Pectoris
              427.0  Congestive Heart Failure
              427.3  Heart Block
              427.4  Atrial Fibrillation or Flutter
              427.9  Other and Unspecified Disorders of Heart Rhythm
                     (Other than PAT, AT, VF, Heart Block)
              429.0  Cardiac Enlargement and Hypertrophy
              436.X  Stroke
              440.X  Arteriosclerosis
              443.0  Raynaud's Syndrome
              443.9  Intermittent Claudication, PVD, not otherwise
                     specified
              451.X  Phlebitis and Thrombophlebitis
              454.0  Varicose Veins, with Ulcer
              454.1  Varicose Veins, with Stasis Dermatitis without Ulcer
              454.9  Varicose Veins other, without Ulcer

        VIII.  Disease of Respiratory System (460-519)
               460.X  Cold
               461.X  Acute Sinusitis
               462.X  Acute Pharyngitis
               463.X  Acute Tonsillitis
               464.X  Acute Laryngitis and Tracheitis
               465.X  URI of unspecified or multiple site
               466.X  Acute Bronchitis
               491.X  Chronic Bronchitis
               492.X  Emphysema
               493.X  Asthma
               500.X  Hypertrophy of Tonsils and Adenoids
               504.X  Deviated Nasal Septum
               505.X  Nasal Polyp
               507.X  Hay Fever
               507.1b Allergic Rhinitis

          IX.  Disease of Digestive System (520-577)
               529.1  Geographic Tongue
               533.X  Peptic Ulcer, site unspecified
               550.X  Inguinal Hernia not obstructed
               551.0  Femoral Hernia not obstructed
               551.1  Umbilical Hernia not obstructed
               551.3  Diaphragmatic Hernia, not obstructed
               564.1  Irritable Colon
               571.X  Cirrhosis of Liver
               573.0  Hepatitis, not otherwise specified
               574.1  Cholelithiasis with Cholecystitis or Cholangitis
                      (chronic)
               574.9  Cholelithiasis without Cholecystitis or Cholangitis
               575.X  Cholecystitis, without mention of Calculus

           X.  Diseases of the Genitourinary System (580-629)
               590.0  Chronic Pyelonephritis

          XI.  Complications of Pregnancy, Childbirth and the Puerperium
               (630-678)
         XII.  Diseases of the Skin and Subcutaneous Tissue (680-709)
               680.X  Boil and Carbuncle
               684.X  Impetigo
               690.X  Seborrheic Dermatitis
               691.X  Atopic Dermatitis, Infantile Eczema, Neurodermatitis
               692.X  Contact Dermatitis
               695.2  Erythema Nodusum
               696.X  Psoriasis
               706.1  Acne Vulgaris
               708.9  Hives
               709.9  Intertrigo, Vitiligo

        XIII.  Diseases of the Musculoskeletal System and Connective Tissue
               (710-738)
               712.X  Rheumatoid Arthritis
               713.0  Osteoarthritis
               714.0  Traumatic Arthritis
               715.X  Arthritis, unspecified
               717.9  Fibrositis, Myalgia, Myositis
               718.X  Rheumatism, unspecified
               725.0  Displaced Cervical Intervertebral Disc
               725.1  Displaced Lumbar & Lumbosacral Intervertebral Disc
               728.0  Pain in Neck
               728.7  Low Back Pain
               730.X  Bunion
               731.X  Synovitis or Bursitis
               735.0  Scoliosis
               735.1  Kephosis
               736.X  Flat Foot

         XIV.  Congenital Anomalies (740-759)
               752.1  Undescended Testicle
               756.4  Pectus Excavatum
               757.4  Congenital Clubnail

               Miscellaneous
               780.3  Abnormal Involuntary Movements (Atheosis, Tremor)
               780.4  Disturbance of Coordination (Ataxia, Muscular
                      Incoordination)
               989.X  Insect Bites

  b This is an artificial code not included in the ICDA codes.




This page last reviewed: Thursday, January 28, 2016
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