Escolar Documentos
Profissional Documentos
Cultura Documentos
b, 30 39
c, 40 49
d, 50 59
b, Muslim
c, Christian
d, Others
b, Married
c, Widowed
d, Separated
b, Primary
c, High School
d, Higher Secondary
e, Under Graduate
f, Post Graduate
b, Private Sector
c, Business
d, Retired
b, ` 1001 ` 2000
c, ` 2001 ` 3000
d, ` 3001 ` 4000
e, ` 4001 ` 5000
b, Joint Family
c, Broken Family
9, Type of House.
a, Thatched
b, Tiled
c, Concrete
b, Telugu
c, Kannada
d, Hindi
c, Others
11, Family consultation.
No.
Name of Family
Members
Sex
Age
Marital
Status
Education
SOCIAL PROBLEM
12, Locality in which the family lives?
a, Urban
b, Sub Urban
c, Slum
d, Village
b, 3
c, 4
b, Contagious
c, Infectious
d, Hereditary
e, Normal
17, Does your family members, friends or relatives look down upon you
because of your problem.
a, Yes
b, No
________________________________________________________________________
19, What are the social factors that prevented you have this problem?
20, Are you able to adjust your family with this problem?
a, Yes
b, No
a, Yes
b, No
ECONOMICAL PROBLEMS
22, No. of earning members in your family?
a, 1
b, 2
c, 3
d, 4
b, ` 20001 ` 30000
c, ` 30001 ` 40000
d, ` 40001 above
b, ` 1001 ` 2000
c, ` 2001 ` 3000
d, ` 3001 ` 4000
e, ` 4001 above
PSYCHOLOGICAL PROBLEMS
28, What is your emotional reaction after diagnosed with the disease?
a, anxiety
b, Emotional withdraw
c, Guilt feeling
d, depressive mood
e, fear
f, no reaction
30, If you are married has you husband or wife accepted your
conditions?
a, Yes
b, No
b, Govt. Hospital
c, Aided Hospital
d, Through NGO
b, From NGO
b, Radiotherapy
c, Biological treatment
b, Vomiting