| QNo. | Question and Instructions | Response | Codes |
| 1 | Acute chest syndrome | None Once more than once | 1 2 3 |
| 2 | Hand and foot syndrome | None Once more than once | 1 2 3 |
| 3 | Splenic sequestration | None Once more than once | 1 2 3 |
| 4 | Stroke | None Once More than once | 1 2 3 |
| 5 | VOC (specify)–Acute abdomen -Bone and Joint pain | None Once more than once | 1 2 3 |
| 6 | Hyperhemolysis | None Once more than once | 1 2 3 |
| 7 | Aplastic Anemia | None Once more than once | 1 2 3 |