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Screening for type II diabetes
Please enter your age(18-80)
Please enter your gender 1:Male 2:Female
Please select your gender
1-Male
2-Female
Please enter your Waistline(cm)
Please enter your Sagittal Abdominal Diameter(cm)
(What is Sagital Abdominal Diameter?)
Do you smoke at least 100 cigarettes in life? 1:Yes 2:No
Please select your type
1-Yes
2-No
Alcohol:In any one year, have you had at least 12 drinks of any type of alcoholic beverage? By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or a one and a half ounces of liquor. 1:Yes 2:No
Please select your type
1-Yes
2-No
Do you have Hypertension? 1:Yes 0:No
Please select your type
0-No
1-Yes
Close relative (father, mother, sister or brother) had diabetes? 1:Yes 2:No
Please select your type
1-Yes
2-No
Would you say your health in general is . . .? 1:Excellent 2:Very good 3:Good 4:Fair 5:Poor
Please select your type
1-Excellent
2-Very good
3-Good
4-Fair
5-Poor
Please enter your relative leg length(Upper leg length/height 0-1)
(What is relative leg length?)
Please ener your 60 sec.pulse
Are you now controlling or losing weight? 1:Yes 2:No
Please select your type
1-Yes
2-No
submit
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