Welcome to your MMM Data Capture GENERAL INFORMATION 1. Region Hong Kong Macau Others 2. How old are you in years? (Estimate if unknown) 3. What is your sex? Male Female Others 4. Weight in kg (estimate if not measured) SOCIAL HABITS 1. Do you use tobacco? (including chewing tobacco, cigars and pipes) Yes No – but I did in the past Never 2. Do you consume alcohol? Never/rarely 1-3 times per month 1-6 times per week Daily 3. Do you take part in at least 150 mins of moderate exercise (brisk walking) or 75 mins of more vigorous exercise per week? Yes No 4. How many years of education do you have? Nil Primary school Secondary school Tertiary/University MEDICATION BACKGROUND 1. Have you ever been diagnosed with high BP by a health professional (except in pregnancy)? Yes No 1a. If yes, at what age were you diagnosed? 1b. How many drug classes are you currently taking for your BP? 0 1 2 3 4 5+ Don't know 1c. Are you currently taking the medication - "Statin"? Yes No Don't know 1d. Are you currently taking the medication - "Aspirin"? Yes No Don't know 1e. Are you currently taking the medication - "Warfarin/oral anticoagulant (blood thinners)"? Yes No Don't know 2. Have you been diagnosed as having diabetes by a health professional (except in pregnancy)? Yes No 3. Have you ever experienced or been diagnosed as the following? Heart Attack Stroke Heart failure Irregular heartbeat COVID-19 RELATED 1. Have you had a positive test for COVID-19? If so, when? No Yes: 0-3 months ago Yes: 3-6 months ago Yes: 6-9 months ago Yes: 9-12 months ago Yes: >12 months ago 2. Have you received the COVID-19 vaccination? No Yes: 1 dose Yes: 2 doses Yes: 3 doses BLOOD PRESSURE RECORDSBy filling in the blood pressure records, you can help us to realise your health status more.You can fill in the blood pressure records in the following section, or using HealthCap app to record. Please record 3 times per day.iPhone users：https://apps.apple.com/hk/app/healthcap-%E6%8B%8D%E5%81%A5/id1456738545?l=en Android users： https://play.google.com/store/apps/details?id=healthcap.DH08082018What is HealthCap? 1. Have you ever used HealthCap app to record blood pressure? Yes No Date of measurement (Please take 3 times on same day) First Blood Pressure Measurement A1. Systolic Blood Pressure (SBP) A2. Diastolic Blood Pressure (DBP) A3. Pulse A4. Was the pulse regular? Yes No Second Blood Pressure Measurement B1. Systolic Blood Pressure (SBP) B2. Diastolic Blood Pressure (DBP) B3. Pulse B4. Was the pulse regular? Yes No Third Blood Pressure Measurement C1. Systolic Blood Pressure (SBP) C2. Diastolic Blood Pressure (DBP) C3. Pulse C4. Was the pulse regular? Yes No Phone Number Previous Next Time is Up! Time's up
