Hepatitis C Questionnaire
Respondent sequence number
Interview Status Code
Reasons for Not Done
Heard of Hepatitis C prior to letter?
First time told had Hepatitis C?
How long known infected?
Reason first tested for Hepatitis C?
Seen a doctor about test result?
Have a doctor's appointment?
Did doctor do additional tests?
What doctor told about test result?
Ever had a liver biopsy?
Doctor advised about medications?
Treated with these medicines?
Not treated: unpleasant side effects
Not treated: treatment self injected
Not treated: treatment too expensive
Not treated:waiting for better treatment
Not treated: some other reason
Did doctor limit alcohol?
T/F: infection is permanent
T/F: HepC stops liver
T/F: look and feel fine
T/F: HepC from blood transfusion
T/F: HepC from shaking hands
T/F: HepC by kissing infected person
T/F: HepC from infected sex partner
T/F: HepC from birth, infected mother
T/F: HepC from sharp instrument
T/F: HepC from coworkers
T/F: HepC from injecting drugs
Main respondent