SL. No | Question | Option | Skip | |
1 | How old are you? | 0 - 5 years = 1 6 - 10 years = 2 11 - 16 years = 3 | □ |
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2 | Sex | Male = 1 Female = 2 | □ |
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3 | What is your father occupation? | Businessman = 1 Service = 2 Others = 3 | □ |
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4 | Average monthly income? | <10,000 = 1 10,000 - 20,000 = 2 20,000 - 30,000 = 3 >30,000 = 4 | □ |
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5 | How old were you when the disease started? | Years □ Month □ |
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6 | How long are you suffering from the disease? | <1 years = 1 1 - 2 years = 2 >2 years = 3 | □ |
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7 | Type of JIA? | Refractory sJIA |
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