---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 41 OR MORE/WEEK 25-40/WEEK 7-24/WEEK 3-6/WEEK 1-2/WEEK STOPPED NON-DRINKER SAW OR IN 4-/YEAR SAW OR IN 2-3/YEAR SAW OR IN 0-1/YEAR-------------------------------------------------------------------------------- ABOVE AVERAGE RISK AVERAGE RISK BELOW AVERAGE RISK RISK REDUCTION PGM RISK REDUCTION PGM RISK REDUCTION PGM-------------------- ABOVE AVERAGE RISK AVERAGE RISK BELOW AVERAGE RISK RISK REDUCTION PGM AVERAGE RISK BELOW AVERAGE RISK---------------------------------------------------------------------------------------------------------------------------------------------------------------- LESS THAN 10% 10-24% 25-74% 75-100%------------------------------------------------------------ HAS HAD HAS NOT HAD-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 280+ 220-279 BELOW 220-------------------------------------------------------------------------------- UNCONTR. DIAB. CONTROLLED DIAB. NOT DIABETIC------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ SMALL MEDIUM LARGE-------------------------------------------------------------------------------- ALMOST DAILY SOMETIMES RARELY OR NEVER-------------------------------------------------------------------------------- UNDESIRABLE MINIMUM RECOMMENDED VIGOROU SEDENTARY EXER. PGM EXERCISE PROGRAM------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ YES YES NO NO------------------------------------------------------------ YES NO---------------------------------------------------------------------------------------------------- YES NO---------------------------------------------------------------------------------------------------- HAS DOES NOT HAVE---------------------------------------------------------------------------------------------------- HAS HAD HAS HAD + X-RAY HAS NOT HAD-------------------------------------------------------------------------------- HAS HAD HAS NOT HAD---------------------------------------------------------------------------------------------------- ANNUAL NO ANNUAL EXAMANNUAL EXAM AFTER 40-------------------------------------------------------------------------------- HAS MURMUR HAS WITH MEDICATION HAS NOT HAD-------------------------------------------------------------------------------- BLOOD IN STOOL NO BLOOD IN STOOL---------------------------------------------------------------------------------------------------- R.H.MURMUR/NO MED. R.H. MURMUR + MED.R.F./NO MURM NO MED.R.F./NO MURM. + MED. NO R.F. + NO MURMUR---------------------------------------- NO SYMPTOMS HAS SYMPTOMS---------------------------------------------------------------------------------------------------- HAS HAD >10 YRS HAS HAD <10 YRS HAS NO SYMPTOMS-------------------------------------------------------------------------------- HAS HAD HAS NOT HAD------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ NOT HAD/NOT SURE MORE THAN 3 YRS ONCE IN 2-3 YEARS ANNUALLY AS RECOMMENDED AS RECOMMENDED HAD HYSTERECTOMY LOW AVERAGE HIGH-------------------------------------------------------------------------------- NO YES---------------------------------------------------------------------------------------------------- FAMILY HISTORY FH + SELF-EXAM NO FAMILY HIST. NO FH + SELF-EXAM------------------------------------------------------------
