Hospital Number: Surname: Date of Birth: Question Text: Have you had any cardiac problems? Question ID: 275 Question Summary: Cardiac Problems Table Name: Patient Field Name: CardiacProblem Answer ID:1970 [ ] No Answer ID:7874 [ ] Arrhythmia Answer ID:18028 [ ] Cardiac disease (under cardiac care)_________________ Answer ID:18029 [ ] Cardiac murmur (under cardiac care) Answer ID:1972 [ ] Cardiac murmur Answer ID:11202 [ ] Cardiac surgery_________________ Answer ID:11203 [ ] Cardiac transplant Answer ID:12966 [ ] Congenital cardiac anomaly_________________ Answer ID:17587 [ ] Ischaemic heart disease_________________ Answer ID:1971 [ ] Rheumatic fever Answer ID:1973 [ ] Valve lesion Answer ID:1980 [ ] Other_________________ Question Text: Have you ever had hypertension? Question ID: 2622 Question Summary: Hypertension Table Name: Patient Field Name: Hypertension Answer ID:17350 [ ] No Answer ID:18058 [ ] Currently - medicated_________________ Answer ID:18059 [ ] Currently - no medication Answer ID:17351 [ ] During pregnancy medicated_________________ Answer ID:17352 [ ] During pregnancy not medicated Answer ID:17353 [ ] Non pregnant medicated Answer ID:17354 [ ] Non pregnant no medication Question Text: Have you had anaemia or other haematological problems? Question ID: 277 Question Summary: Haematological Problems Table Name: Patient Field Name: HaematologicalProblem Answer ID:8784 [ ] No Answer ID:6934 [ ] Anaemia Answer ID:17318 [ ] Antibody sensitivity_________________ Answer ID:6939 [ ] Alpha Thalassaemia Answer ID:6938 [ ] Beta Thalassaemia Answer ID:17588 [ ] Beta Thalassaemia Trait Answer ID:18045 [ ] Bone marrow transplant Answer ID:17320 [ ] Rhesus isoimmunisation Answer ID:6937 [ ] Sickle cell disease Answer ID:6936 [ ] Sickle cell trait Answer ID:1998 [ ] Other_________________ Question Text: Is there any history of thromboembolic or clotting disorders? Question ID: 2623 Question Summary: Thromboembolic Disorder Table Name: Patient Field Name: ThromboembolicDisorder Answer ID:17356 [ ] No Answer ID:17357 [ ] Antiphospholipid syndrome Answer ID:18031 [ ] Antithrombin deficiency Answer ID:18183 [ ] Compound heterozygotes Answer ID:17358 [ ] DVT - anticoagulated Answer ID:17359 [ ] DVT - not anticoagulated Answer ID:18030 [ ] Factor V Leiden (homozygous) Answer ID:18074 [ ] Haemophilia Answer ID:18037 [ ] Idiopathic Thrombocytopenic Purpura (ITP) Answer ID:18038 [ ] Previous arterial thrombosis Answer ID:17361 [ ] Previous DIC Answer ID:17362 [ ] Protein C deficiency Answer ID:17363 [ ] Protein S deficiency Answer ID:18033 [ ] Prothrombin mutation (factor II homozygous) Answer ID:17364 [ ] Pulmonary embolus Answer ID:17365 [ ] Thrombocytopenia Answer ID:17366 [ ] Thrombophilia Answer ID:17367 [ ] Varicose veins with phlebitis Answer ID:17368 [ ] Varicose veins no phlebitis Answer ID:17369 [ ] Von Willebrand disease Answer ID:17370 [ ] Other_________________ Question Text: Have you had any respiratory problems? Question ID: 282 Question Summary: Respiratory Problems Table Name: Patient Field Name: RespiratoryProblem Answer ID:2044 [ ] No Answer ID:9080 [ ] Asthma Answer ID:18060 [ ] Asthma - previous admission in last 12 months Answer ID:18061 [ ] Asthma - Specialist Consultant Care Answer ID:2050 [ ] Chronic bronchitis Answer ID:18064 [ ] Chronic obstructive airway disease Answer ID:16744 [ ] Cystic fibrosis Answer ID:6917 [ ] Hay fever Answer ID:18063 [ ] Pulmonary fibrosis Answer ID:18062 [ ] Sarcoidosis Answer ID:2048 [ ] Tuberculosis CURRENT treatment_________________ Answer ID:2047 [ ] Tuberculosis past treatment Answer ID:2051 [ ] Other_________________ Question Text: Have you had jaundice or liver problems? Question ID: 281 Question Summary: Hepatic Problems Table Name: Patient Field Name: HepaticProblems Answer ID:2038 [ ] No Answer ID:17589 [ ] Acute Fatty Liver_________________ Answer ID:18076 [ ] Autoimmune hepatitis Answer ID:17590 [ ] HELLP syndrome Answer ID:2042 [ ] Hepatitis A_________________ Answer ID:6921 [ ] Hepatitis B_________________ Answer ID:6922 [ ] Hepatitis C_________________ Answer ID:6923 [ ] Hepatitis type unknown Answer ID:2040 [ ] Jaundice not hepatitis specific_________________ Answer ID:6984 [ ] Liver transplant Answer ID:6924 [ ] Obstetric cholestasis Answer ID:2043 [ ] Other hepatic problem_________________ Question Text: Have you had urinary or kidney problems? Question ID: 1640 Question Summary: Renal Problems Table Name: Patient Field Name: RenalProblems Answer ID:11224 [ ] No Answer ID:18015 [ ] Chronic renal failure Answer ID:11229 [ ] Congenital renal anomaly_________________ Answer ID:18016 [ ] Dysplasia Answer ID:18017 [ ] Glomerulonephritis Answer ID:18018 [ ] Glomerulosclorosis Answer ID:18019 [ ] Haemolytic uremic syndrome Answer ID:18020 [ ] Henoch-Schonlein Purpura Answer ID:18021 [ ] IgA Nephropathy Answer ID:18022 [ ] Lupus Nephritis Answer ID:11233 [ ] Nephrectomy Answer ID:18023 [ ] Nephrotic Syndrome Answer ID:17591 [ ] Polycystic kidney disease Answer ID:11226 [ ] Pyelonephritis Answer ID:11225 [ ] Recurrent infection Answer ID:11228 [ ] Renal stones or colic Answer ID:11236 [ ] Renal surgery_________________ Answer ID:11234 [ ] Renal transplant Answer ID:11227 [ ] Urinary incontinence Answer ID:11237 [ ] Other renal_________________ Question Text: Have you had any gastrointestinal problems? Question ID: 283 Question Summary: Gastrointestinal Problems Table Name: Patient Field Name: GastroIntestinalProblem Answer ID:2052 [ ] No Answer ID:18067 [ ] Achalasia Answer ID:2061 [ ] Coeliac disease Answer ID:2059 [ ] Crohns disease Answer ID:6920 [ ] Faecal incontinence Answer ID:2053 [ ] Haemorrhoids treated Answer ID:2054 [ ] Haemorrhoids not treated Answer ID:6919 [ ] Hiatus hernia Answer ID:2063 [ ] Irritable bowel syndrome Answer ID:18066 [ ] Gastric ulcer Answer ID:18065 [ ] Malabsorption syndrome Answer ID:2062 [ ] Pancreatitis Answer ID:2060 [ ] Ulcerative colitis Answer ID:2066 [ ] Other_________________ Question Text: Have you had any endocrine problems? Question ID: 279 Question Summary: Endocrine Problems Table Name: Patient Field Name: EndocrineProblem Answer ID:2013 [ ] No Answer ID:18024 [ ] Addisons disease Answer ID:18025 [ ] Autoimmune hypothyroidism Answer ID:18026 [ ] Cushings syndrome Answer ID:11139 [ ] Diabetes type 1 Answer ID:2016 [ ] Diabetes type 2 Answer ID:18027 [ ] Endocrine disease_________________ Answer ID:2017 [ ] Gestational diabetes Answer ID:2019 [ ] Hyperthyroidism Answer ID:17592 [ ] Hyperthyroidism - current_________________ Answer ID:17593 [ ] Hyperthyroidism in past Answer ID:2022 [ ] Hypothyroidism Answer ID:16745 [ ] Pituitary disorder_________________ Answer ID:11354 [ ] Polycystic ovarian syndrome (PCOS) Answer ID:2025 [ ] Other_________________ Question Text: Are there any diabetic concerns? Question ID: 2494 Question Summary: Diabetic Concerns Table Name: Pregnancy Field Name: DiabeticCoMorbidities Answer ID:16625 [ ] None Answer ID:16626 [ ] Diabetic retinopathy_________________ Answer ID:16627 [ ] Diabetic nephropathy_________________ Answer ID:16628 [ ] Autonomic neuropathy_________________ Answer ID:16629 [ ] Fluctuating glycaemic control_________________ Answer ID:16630 [ ] Other_________________ Question Text: How is the diabetes controlled? Question ID: 1011 Question Summary: Diabetes Control Table Name: Patient Field Name: DiabeticControl Answer ID:7431 [ ] Diet & exercise Answer ID:7433 [ ] Insulin Answer ID:7432 [ ] Oral hypoglycaemics Question Text: What is the latest HbA1c result? (%) Question ID: 2485 Question Summary: Latest HbA1c Table Name: Pregnancy Field Name: ResultHbA1c ___________________________________ Answer ID:16607 [ ] Not known Question Text: Has retinal assessment been performed in the last 12 months? Question ID: 2488 Question Summary: Retinal Assessment Table Name: Pregnancy Field Name: RetinopathyScreening Answer ID:16631 [ ] Yes Answer ID:16632 [ ] No Question Text: Has a renal assessment been undertaken in the last 12 months? Question ID: 2493 Question Summary: Renal Assessment Table Name: Pregnancy Field Name: RenalAssessment Answer ID:16622 [ ] Yes Answer ID:16623 [ ] No Question Text: Did you have any preconceptual counselling? Question ID: 1220 Question Summary: Preconceptual Counselling Table Name: Pregnancy Field Name: PreconceptualCounselling Answer ID:8312 [ ] No Answer ID:8311 [ ] Yes Question Text: Have you had fits, epilepsy or neurological problems? Question ID: 280 Question Summary: Neurological Problems Table Name: Patient Field Name: NeurologicalProblem Answer ID:2026 [ ] No Answer ID:18039 [ ] Cerebral palsy Answer ID:2035 [ ] Chronic fatigue syndrome Answer ID:2036 [ ] Epilepsy no medication Answer ID:2028 [ ] Epilepsy requires medication_________________ Answer ID:16765 [ ] Fits Not epilepsy_________________ Answer ID:2030 [ ] Migraine Answer ID:18040 [ ] Migraine - severe Answer ID:18041 [ ] Myotonic dystrophy Answer ID:18042 [ ] Neuropathy Answer ID:18043 [ ] Previous subarachnoid haemorrhage Answer ID:6925 [ ] Spina bifida Answer ID:18044 [ ] Stroke Answer ID:2037 [ ] Other_________________ Question Text: Do you have any of the following inherited disorders? Question ID: 2621 Question Summary: Genetic/Inherited Disorder Table Name: Patient Field Name: GeneticDisorder Answer ID:17336 [ ] No Answer ID:17337 [ ] Aperts Syndrome Answer ID:17338 [ ] Congenital adrenal hyperplasia Answer ID:17339 [ ] Congenital hip dysplasia Answer ID:17340 [ ] Cystic fibrosis Answer ID:17341 [ ] Down's Syndrome Answer ID:17342 [ ] Haemochromatosis Answer ID:17343 [ ] Klinefelters Syndrome Answer ID:17344 [ ] Marfans Syndrome Answer ID:17345 [ ] MCADD Answer ID:17346 [ ] Muscular dystrophy Answer ID:17347 [ ] Neurofibromatosis Answer ID:17348 [ ] Phenylketonuria Answer ID:17349 [ ] Other_________________ Question Text: Are you receiving specialist secondary care because of this genetic condition? Question ID: 2723 Question Summary: Specialist Care Table Name: Pregnancy Field Name: GeneticDisorderSpecialistInput Answer ID:18048 [ ] No Answer ID:18049 [ ] Yes Question Text: Is there any history of autoimmune disease? Question ID: 2619 Question Summary: Autoimmune Disease Table Name: Patient Field Name: AutoImmuneDisease Answer ID:17321 [ ] No Answer ID:17323 [ ] Gestational pemphigoid Answer ID:17324 [ ] Multiple sclerosis Answer ID:17325 [ ] Myasthenia Gravis_________________ Answer ID:17326 [ ] Pernicious anaemia_________________ Answer ID:17327 [ ] Psoriasis Answer ID:18034 [ ] Psoriatic arthropathy Answer ID:17328 [ ] Rheumatoid arthritis Answer ID:17329 [ ] Systemic lupus erythematosus Answer ID:18035 [ ] Systemic sclerosis Answer ID:17330 [ ] Vitiligo Answer ID:17331 [ ] Other_________________ Question Text: Have you had any skin problems? Question ID: 285 Question Summary: Dermatological Problems Table Name: Patient Field Name: DermatalogicalProblem Answer ID:2075 [ ] No Answer ID:2079 [ ] Acne Answer ID:6928 [ ] Contact dermatitis Answer ID:2077 [ ] Eczema Answer ID:11357 [ ] Melanoma Answer ID:2076 [ ] Psoriasis Answer ID:2078 [ ] Other_________________ Question Text: Is there any possibility that you have taken roaccutane (Isotretinoin) in early pregnancy? Question ID: 1639 Question Summary: Roaccutane Table Name: Pregnancy Field Name: Roaccutane Answer ID:11238 [ ] No Answer ID:11223 [ ] Yes_________________ Question Text: Have you had any musculoskeletal problems? Question ID: 1221 Question Summary: Musculoskeletal Problems Table Name: Patient Field Name: MusculoskeletalProblem Answer ID:8454 [ ] No Answer ID:17371 [ ] Achondroplasia Answer ID:18077 [ ] Achondroplasia - Specialist consultant care Answer ID:8316 [ ] Connective tissue disorder Answer ID:8313 [ ] Fractured pelvis Answer ID:8377 [ ] Scoliosis Answer ID:16526 [ ] Spinal injury_________________ Answer ID:16525 [ ] Syphysis pubis dysfunction Answer ID:8317 [ ] Other_________________ Question Text: Is there any history of malignancy within the last 3 years? Question ID: 1904 Question Summary: Malignancy Table Name: Patient Field Name: Malignancy Answer ID:13101 [ ] No Answer ID:13102 [ ] Treatment in past 3 yrs_________________ Answer ID:13103 [ ] Current treatment_________________ Question Text: Have you had any gynaecological problems or surgery? Question ID: 288 Question Summary: Gynaecological Problems or Surgery Table Name: Patient Field Name: GynaecologicalProb Answer ID:2103 [ ] No Answer ID:2113 [ ] Abnormal cervical smears Answer ID:6930 [ ] Cervical cautery Answer ID:10182 [ ] Colposcopy Answer ID:2112 [ ] Cone biopsy Answer ID:2118 [ ] D and C NOT after miscarriage Answer ID:18056 [ ] Endometrial ablation Answer ID:2117 [ ] Endometriosis Answer ID:2108 [ ] Fibroids Answer ID:2122 [ ] Infertility investigations_________________ Answer ID:2105 [ ] Laparotomy Answer ID:2104 [ ] Laparoscopy Answer ID:2111 [ ] Laser treatment Answer ID:2106 [ ] Myomectomy Answer ID:2126 [ ] Ovarian cystectomy_________________ Answer ID:2115 [ ] Pelvic floor repair Answer ID:2124 [ ] Pelvic inflammatory disease Answer ID:18132 [ ] Previous OASIS repair Answer ID:10181 [ ] Reversal of sterilisation Answer ID:18057 [ ] Septectomy Answer ID:2119 [ ] Tubal surgery_________________ Answer ID:17594 [ ] Uterine surgery_________________ Answer ID:2123 [ ] Uterine anomaly_________________ Answer ID:6953 [ ] Vulvo-vaginal warts Answer ID:17595 [ ] 3 or more consecutive miscarriages Answer ID:2125 [ ] Other_________________ Question Text: Has the woman ever undergone female genital mutilation? Question ID: 2649 Question Summary: Genital Mutilation Table Name: Patient Field Name: FGM Answer ID:17596 [ ] No Answer ID:17597 [ ] Yes Question Text: What classification is the female genital mutilation? Question ID: 2650 Question Summary: FGM Classification Table Name: Pregnancy Field Name: FGMClassification Answer ID:17598 [ ] Type 1 Answer ID:17599 [ ] Type 2 Answer ID:17600 [ ] Type 3 Answer ID:17601 [ ] Type 4 Answer ID:17602 [ ] Reversal already performed Answer ID:17603 [ ] Type not known Question Text: Has a reversal been discussed? Question ID: 2651 Question Summary: FGM Plan Table Name: Pregnancy Field Name: FGMReversal Answer ID:17604 [ ] No Answer ID:17605 [ ] Yes - obstetric referral required Question Text: Has the woman ever been admitted to hospital? Question ID: 2521 Question Summary: Previous Admissions Table Name: Pregnancy Field Name: AdmittedInPast Answer ID:16759 [ ] No Answer ID:16760 [ ] ICU_________________ Answer ID:16761 [ ] HDU_________________ Answer ID:16762 [ ] Accident and Emergency_________________ Answer ID:16763 [ ] Other_________________ Question Text: When was your last smear? Question ID: 289 Question Summary: Last Smear Table Name: Pregnancy Field Name: LastSmear Answer ID:2127 [ ] Smear never performed Answer ID:10023 [ ] Within last year Answer ID:10024 [ ] Within last two years Answer ID:2130 [ ] Within last three years Answer ID:2131 [ ] Over three years ago Answer ID:2132 [ ] Don't know Question Text: What was the result of this smear? Question ID: 290 Question Summary: Result of Last Smear Table Name: Pregnancy Field Name: ResultLastSmear Answer ID:2133 [ ] Normal Answer ID:2136 [ ] Awaiting result please check Answer ID:2135 [ ] Human papilloma virus Answer ID:2134 [ ] Inflammatory changes Answer ID:2137 [ ] Mild dyskaryosis or dysplasia Answer ID:2138 [ ] Moderate dyskaryosis or dysplasia Answer ID:2139 [ ] Severe dyskaryosis or dysplasia Answer ID:2140 [ ] Other_________________ Question Text: Is a postnatal smear required? Question ID: 1222 Question Summary: Postnatal Smear Required Table Name: Pregnancy Field Name: PNSmearRequired Answer ID:8461 [ ] No Answer ID:8462 [ ] Yes Question Text: Have you had any other operations or surgery? Question ID: 287 Question Summary: Operations Table Name: Patient Field Name: Operations Answer ID:2091 [ ] No Answer ID:13668 [ ] Appendicectomy Answer ID:7875 [ ] Breast augmentation Answer ID:2095 [ ] Breast biopsy Answer ID:7876 [ ] Breast reduction Answer ID:15656 [ ] Cholecstectomy Answer ID:11358 [ ] Hip surgery_________________ Answer ID:15657 [ ] Laparotomy_________________ Answer ID:2096 [ ] Mastectomy_________________ Answer ID:8308 [ ] Spinal surgery_________________ Answer ID:2102 [ ] Other_________________ Question Text: Have you had any infections? Question ID: 284 Question Summary: Infections Table Name: Patient Field Name: Infections Answer ID:2067 [ ] No Answer ID:6945 [ ] Candida Answer ID:13094 [ ] C Difficile Answer ID:6942 [ ] Chicken pox Answer ID:6946 [ ] Chlamydia Answer ID:2072 [ ] Cytomegalovirus Answer ID:6949 [ ] Genital warts Answer ID:2068 [ ] Glandular fever Answer ID:6940 [ ] Group B strep colonisation Answer ID:17606 [ ] Gonorrhoea Answer ID:6947 [ ] Herpes genitalis Answer ID:6952 [ ] Human immunodifiency virus Answer ID:2073 [ ] Malaria Answer ID:6943 [ ] Meningitis Answer ID:6948 [ ] MRSA Answer ID:7877 [ ] Parvovirus Answer ID:6951 [ ] Polio Answer ID:6941 [ ] Rubella Answer ID:6950 [ ] Syphilis Answer ID:2071 [ ] Toxoplasmosis Answer ID:2074 [ ] Tropical disease_________________ Answer ID:2070 [ ] Other_________________ Question Text: Have you had any mental health problems? Question ID: 304 Question Summary: Mental Health Problems Table Name: Patient Field Name: MentalHealthProblem Answer ID:2242 [ ] No Answer ID:7884 [ ] Anxiety disorder Answer ID:7878 [ ] Bipolar disorder Answer ID:2249 [ ] Depression current treatment_________________ Answer ID:2243 [ ] Depression past treatment_________________ Answer ID:7883 [ ] Generalised anxiety disorder Answer ID:17607 [ ] Eating disorder_________________ Answer ID:10025 [ ] Nervous breakdown_________________ Answer ID:6954 [ ] Obsessive-compulsive disorder_________________ Answer ID:6956 [ ] Overdose taken_________________ Answer ID:7882 [ ] Post traumatic stress disorder Answer ID:2254 [ ] Previous postnatal depression_________________ Answer ID:2247 [ ] Puerperal psychosis_________________ Answer ID:2245 [ ] Schizophrenia Answer ID:6955 [ ] Self harm_________________ Answer ID:2244 [ ] Suicide attempt_________________ Answer ID:2248 [ ] Other_________________ Question Text: Are you currently receiving specialist secondary care because of this mental health issue? Question ID: 2724 Question Summary: Secondary Care Table Name: Pregnancy Field Name: MentalHealthIssueSpecialistInput Answer ID:18050 [ ] No Answer ID:18051 [ ] Yes Question Text: Have you had any mental health referrals or admissions? Question ID: 1501 Question Summary: Mental Health Referrals or Admissions Table Name: Pregnancy Field Name: MedicalHelpPsych Answer ID:10183 [ ] No Answer ID:10184 [ ] Admission_________________ Answer ID:18052 [ ] Detention under the Mental Health Act Answer ID:10185 [ ] Referral_________________ Answer ID:10186 [ ] Other_________________ Question Text: Have you any physical disabilities? Question ID: 274 Question Summary: Physical Disabilities Table Name: Patient Field Name: Impairments Answer ID:1962 [ ] No Answer ID:1966 [ ] Blind Answer ID:17608 [ ] Amputee_________________ Answer ID:1967 [ ] Deaf with speech Answer ID:1968 [ ] Deaf without speech Answer ID:18184 [ ] Difficulty using arms Answer ID:18055 [ ] Impaired mobility (using crutches/frame) Answer ID:17609 [ ] Paralysis_________________ Answer ID:18054 [ ] Partial hearing loss (severe) Answer ID:18053 [ ] Partially sighted (uncorrected by glasses) Answer ID:1965 [ ] Wheelchair user_________________ Answer ID:1969 [ ] Other_________________ Question Text: Do you have any allergies? Question ID: 306 Question Summary: Allergies Table Name: Patient Field Name: Allergies Answer ID:2262 [ ] No Answer ID:2269 [ ] Animals_________________ Answer ID:6959 [ ] Aspirin_________________ Answer ID:10026 [ ] Cosmetic or detergents_________________ Answer ID:6962 [ ] Elastoplast_________________ Answer ID:2266 [ ] Food/drinks_________________ Answer ID:2267 [ ] Grass/pollen_________________ Answer ID:2270 [ ] Latex_________________ Answer ID:6960 [ ] Local anaesthetics_________________ Answer ID:11360 [ ] Morphine_________________ Answer ID:2263 [ ] Nuts_________________ Answer ID:6957 [ ] Penicillin_________________ Answer ID:6958 [ ] Septrin_________________ Answer ID:6961 [ ] Scoline_________________ Answer ID:2264 [ ] Other antibiotic_________________ Answer ID:2265 [ ] Other_________________ Question Text: Have you had problems with previous anaesthetic? Question ID: 1013 Question Summary: Past Anaesthetic Problems Table Name: Patient Field Name: PastAnaestheticProb Answer ID:7436 [ ] No Answer ID:7438 [ ] Problem with previous GA_________________ Answer ID:7437 [ ] Problem with previous epidural_________________ Answer ID:13669 [ ] Problem with previous spinal_________________ Question Text: Have you had a blood transfusion? Question ID: 293 Question Summary: Blood Transfusions Table Name: Patient Field Name: BloodTransfusion Answer ID:2161 [ ] No Answer ID:6963 [ ] Yes Answer ID:9087 [ ] Declined blood products_________________ Answer ID:2166 [ ] Not Known Question Text: Did you have a transfusion reaction? Question ID: 1012 Question Summary: Transfusion Reaction Table Name: Patient Field Name: TransfusionReaction Answer ID:7435 [ ] No Answer ID:11222 [ ] Yes_________________ Question Text: Have you any notable family history (state relationship and details)? Question ID: 307 Question Summary: Family History of Note Table Name: Pregnancy Field Name: FHOfNote Answer ID:2271 [ ] No Answer ID:6971 [ ] Cardiac problem_________________ Answer ID:6972 [ ] Clotting disorder_________________ Answer ID:17610 [ ] Childhood eye disorder_________________ Answer ID:6976 [ ] Congenital anomaly_________________ Answer ID:17611 [ ] Congenital adrenal hypoplasia_________________ Answer ID:11361 [ ] Congenital dislocation of hips_________________ Answer ID:11362 [ ] Cystic fibrosis_________________ Answer ID:6966 [ ] Diabetes - type 1_________________ Answer ID:6967 [ ] Diabetes - type 2_________________ Answer ID:17612 [ ] Congenital hypothyroidism_________________ Answer ID:8309 [ ] Genetic problems_________________ Answer ID:6968 [ ] Haemaglobinopathy_________________ Answer ID:16438 [ ] Haematological disorder_________________ Answer ID:17613 [ ] Female genital mutilation_________________ Answer ID:6974 [ ] Hearing disability_________________ Answer ID:6970 [ ] Hypertensive disorder_________________ Answer ID:7880 [ ] Mental health_________________ Answer ID:6975 [ ] Multiple pregnancy (not IVF etc)_________________ Answer ID:6969 [ ] Pre eclampsia_________________ Answer ID:15728 [ ] Pregnancy induced hypertension_________________ Answer ID:17614 [ ] MCADD_________________ Answer ID:13749 [ ] Thrombosis_________________ Answer ID:6973 [ ] Tuberculosis_________________ Answer ID:15660 [ ] Venous Thromboembolism_________________ Answer ID:2275 [ ] Family history not known Answer ID:17615 [ ] PKU_________________ Answer ID:2274 [ ] Other major condition_________________ Question Text: Have any of your family had mental illness problems that required hospital admission or referral to a psychiatrist? Question ID: 1226 Question Summary: Family Mental Illness Table Name: Pregnancy Field Name: FHMentalHealth Answer ID:8324 [ ] No Answer ID:17616 [ ] Bipolar disorder_________________ Answer ID:17617 [ ] Depression_________________ Answer ID:16766 [ ] Mother had puerperal psychosis Answer ID:17618 [ ] Obsessive compulsive disorder_________________ Answer ID:17619 [ ] Schizophrenia_________________ Answer ID:17620 [ ] Other_________________