General Information Specific
Age Sex Residency Occupation Education Main History
1 70 F vajdi retired 3 HTN 10 yrs
HTN 2yrs ;
2 70 M vajdi retired - Diabetes 2yrs
Heart Dz 15-20
3 50 M devgam farmer - yrs HTN 8yrs
HTN 6-7yrs ;
4 65 F vajdi - 5 Diabetes 10yr
5 48 F kirasra farmer - Diabetes 3yrs
6 85 M Ratanpar - - HTN 20yrs
7 60 F kirasra housewife Diabetes 5yr
D.M. 1month ;
8 60 F devgam housewife 4 HTN 1yr
9 70 M vajdi - - Diabetes 2yrs
10 65 M pipaliya labourer - Diabetes 15yr
11 55 M vajdi shopkeeper - Htn 5yr
12 60 M pipaliya labourer - Diabetes 10yrs
13 40 F kirasra housewife - HTN 2yrs
14 50 M vajdi - - Diabetes 5yrs
HTN 10yrs ;
15 62 M kirasra shopkeeper - Diabetes 5yrs
16 69 M vajdi retired - Diabetes 5yrs
17 42 F pipaliya housewife - Htn 7yrs
factory
18 40 M devgam worker - Diabetes 5yrs
19 65 M kirasra retired - Htn 10yrs
20 50 F kirasra housewife - Diabetes 3yrs
Htn 3mnt; DM
21 60 M khirasra labourer - 2mnt
22 55 M pipaliya farmer - Htn 8yrs
htn 10yr; dm
23 70 F devgam - 2 10yr
24 45 F vajdi - - diabetes 7yr
25 80 M khirasra - - Htn 20yrs
26 62 F pipaliya housewife - diabetes 7yrs
DM 1yr; Htn
27 58 F khirasra housewife 4 3yr
28 85 M devgam - - Htn 20yrs
29 60 F rajkot housewife - diabetes 10yrs
htn 20yr; dm
30 70 M rajkot retires - 15yrs
htn 5yrs; dm
31 65 F kuchiyadad housewife - 5yrs
htn 12yrs; dm
32 60 M rafra farmer 2 8mnths
33 54 M bedla farmer 6 htn 10yr
34 65 F kuwadwa - 8 htn 5yrs
35 55 F maliyasan housewife 7 htn 1yr
36 75 M kuwadva - 8 htn 6yr
37 60 F kuwadwa housewife - htn 4yr
38 54 M ranpur - 7 htn 7yr; dm 6yr
diabetes 15-
39 65 M kuwadwa - - 20yr
40 40 F jamgadh labourer - diabetes 2yrs
htn 2mnt; dm
41 60 M parevda labourer - 2mnt
42 65 M magharvada farmer - diabetes 4yr
dm 1mnt; htn
43 60 F kuwadwa housewife 3 1yr
44 50 F parevara farmer - diabetes 3yrs
diabetes
45 70 M matharwada - 7 2mnths
diabetes 2-3yr;
46 60 F mewarda housewife - htn 1-2 yr
47 50 M pipaliya farmer - Htn 8yrs
48 85 M parevara - - Htn 15yrs
49 60 F kuwadwa housewife - diabetes 5yr
htn 7yr dm
50 65 F kuwadwa - 3 10yr
51 35 M pipaliya labourer 3 htn 1yr
52 60 F kuwadwa - 4 htn 2-3yr
53 45 F kuwadwa housewife 2 diabetes 4yrs
54 55 F kuwadwa housewife - htn 3-4yrs
55 60 F doshlighuna - - htn 1yr
56 47 M Sakhda farmer 7 diabetes 2yrs
57 60 M Navagam - 6 htn 1yr
diabetes 6yr;
58 45 F kuwadwa housewife 5 htn 10yrs
diabetes 5yr;
59 45 M shapar driver - htn 5yrs
dm 2-3yrs; htn
60 60 F kuwadwa housewife - 2-3yrs
61 60 F kuchiyadad labourer - diabetes 6-7yrs
62 56 F kuwadwa farmer - htn 5yrs
diabetes 7-
63 58 F Beti housewife - 8mnth
64 44 M bavanbor watchman 8 diabetes 1yr
65 60 F kuwadwa housewife - htn 4-6 mnths
diabetes 8-
66 50 M sokhda retired - 10yrs
67 60 F jamgadh - - htn 2-3mnths
68 55 M kuwadwa watchman 5 htn 5-6 yrs
69 70 F kharva - - diabetes 6-7yrs
dm 10-15yrs;
70 80 F kothariya - - htn 10-15yrs
71 58 F targadhiya - 2 htn 2-4yrs
72 37 M Ratanpar labourer 5 diabetes 2yrs
dm 5-6yrs; htn
73 75 F kuwadwa - - 8yrs
74 45 F Vakvad Farmer - diabetes 1yr
75 52 F maliyasan housewife - htn 5-6 mnths
76 55 M maliyasan retired - htn 1yr
77 60 M maliyasan farmer - diabetes 2yrs
78
79
80
81
82
Specific NCD History Tobacco
Any F/H/O? Current Medication Others Current use? Freq? When started? Past daily?
no no
T.Metformin BD
T.Glipizide BD T.Atenolol cigarette 15-20
no OD no smoking
Chewing /day 40yrs before yes
tobacco(mav
no T.Atenolol OD no o) 4-5/day since 30yrs
T.Metformin BD
T.Glipizide BD T.Atenolol
Yes OD
T.Metfo. Tid T. Glipizide
no BD
T.Atenolol OD Bidi Smoking 2-3/day since 20yrs age yes
no T.Metformin OD -
T.Metformin OD
T.Atenolol OD T.
no Amlodipine BD no
2-3
Chewing(Faki packets/d
no T. Metformin BD no ) ay 20-25 years back
Heart dz-
bypass
T. Metformin TID T. done 10
no Glipizide OD yr back Bidi smoking 5-10/day since 20 yrs age
yes T. Atenolol BD - chewing 4-5times since childhood
T. Metformin BD T. 10-
no Glipizide OD Bidi smoking 15/day At 20-25 yrs age yes
Thyroid sx
for
yes(both hyperthyr
parents) T.Atenolol BD oidism snuffing 4-5/day 10-15years back no
Heart
yes(grandfat attack 5
her) T. Metformin BD yrs back smoking bidi 4-5/day since 20yrs age yes
operation
for oral
T.Aten BD T. Met BD T. cancer 12 chewing ; 5/day ;
- Glipi BD yrs back smoking 15/day since childhood yes
an attack
of acute
T. Met OD T. pancreati
yes(mother) Atorvastatin OD tis
1st dx
T.Amlo OD during 2-3
yes(mother) T.Hydrochlothia BD last preg. snuffing time/day 15 years back -
- T. Met BD -
15- since20-25 yrs
yes(father) T.Aten BD T.Amlo OD - smoking bidi 20/day age yes
- T.Glipi BD -
15-
no T.Met BD T.Glipi BD - Bidi smokimg 20/day 20yrs back yes
Heart Dz chewing(mav
- T.Aten OD 15-20 yrs o) 1-2/day 2-3 yrs before
T. Met OD T.Gliben BD T.
yes(father) Losartan OD -
- T. Met tid T. Glipi BD -
- T. Atenolol OD - smoking bidi 4-5/day since 25 yrs age yes
- T. Met T. Glipi -
2-
T.Ate OD T. Amlo BD T. 3time/da
- Met OD T.Gliben OD - snuffing y 15 yrs ago -
yes(both T.Aten BD T. Hydrochlo 5-10/day;
parents) OD - bidi; chewing 3-5/day since childhood yes
an attack
of acute
pancreati
- T. Met BD T. Gliben BD tis
operation 4-5/day;
T.Hydrochlo T.Amlod; T. for mouth chewing; 15- since 25-30 yrs
yes(father) Met T. Gliben cancer smoking 20/day age yes
- T.Aten OD
1-
T. Met OD T.Glip OD T. chewing 2pack/da
- Ate OD - tobacco y 25yr before -
Heart
attack
before
- T. Ateno OD 10yrs
- T.Aten OD -
yes(mother) T.Aten OD -
- T. Aten BD - chewing(faki) seldom 20yrs age -
- T.Aten BD -
T.Met BD T,Enalapril OD
- T.Atorv BD T.Aspirin OD -
- T.Met TID T.Gliben TID -
- T.Met TID -
20-
- T.Met TID T.Gliben TID - bidi smoking 25/day 40yrs before yes
Heart dz-
bypass
done 3 yr
- T.Met TID T.Gliben TID back
T.Aten OD T.Amlo BD
- T.Met OD T.Gliben OD -
- T.Met TID T. Glipi BD -
- T. Met TID - chewing(faki) 2-3/day 1year before
- T. Met TID T.Aten OD -
Heart dz chewing(mav
- T.Atenolol OD 15-20yrs o) 1-2/day 2-3 year before
- T.Atenol OD -
- T.Glipi BD -
T.Met T.Glib BD
- T.Losartan OD -
yes T.Atenolol OD - chewing(faki) 2-3/day 10yrs before
- T.Atenolol OD -
- T. Met tid T. Glipi BD -
- T.Losartan OD -
- T.Atenolol OD -
T.Metformin
- T.Glibenclamide - tobacco daily 7-8yrs before
T.Amlo OD T.Enalapril
- BD - gutka 1-2/day 25-30yr age
T.Met TID T.Glipi TID
yes T.Aten OD -
T.Met TID T.Glipi TID 10-
yes T.Aten OD - bidi 15/day 20yrs ago yes
T.Met TID T.Glipi TID
- T.Aten OD -
- T.Met TID T.Glipi BD -
- T.ateno OD -
- T.Met TID T.Gliben BD -
4pack/da
yes T.Met TID T.Glipizide BD - tobacco y 15yrs ago
- T.Atenolol OD -
- T.Met TID T.Glipizide BD -
- T.Amlodipine OD -
- T.Atenolol OD -
- T.Glipizide BD -
T.Met BD T.Glipi BD
- T.Amlo OD T.Enal BD -
- T.Aten OD T.Amlo OD -
- T.Met TID T.Glipi BD - chewing(faki) 2/day 8-10yrs before -
T. Met TID T.Gliben BD
- T.Ateno OD -
- T.Met TID T.Glipi BD -
- T.Enalapril OD -
yes T.Atenolol OD -
4-
chewing 5pack/da
yes T.Met TID T.Glipi BD - tobacco y 45 yrs age -
Alcohol Diet
Any History? Fruits Vegetables Others
high intake of
no no papad
yes no -
no 2-3days
- 2-3 days
mangoes,
banana 5-6 days -
- everyday -
high intake of
no 1-2day pickles
daily two
5-6days times -
no 1-2day -
high intake of
no 2-3days pickles
2-3day 4-5days -
yes 15yrs back yes daily no -
high intake of
- 2-3 days salt in diet
high intake of
yes daily 2-3days groundnut oil
yea;
mang,ban high intake of
an - groundnut oil
banana & bread and
watermel pasta; pickles;
on 2-3days saturated oils
no 4-5days -
yes;
bananas, pickles,saturate
yes 10 yrs back grapes. 2-3days s oils
seldom seldom -
frequent seldom pickles & sugar
seldom 2-3days -
seldom 5-6days -
banana &
mangoes 2-3days pickles
frequent 2-3days pickles
high intake of
seldom seldom papad
frequent seldom -
pickles &
5-6days everyday groundnut oil
sedom everyday -
pickles,papad,oi
frequent seldom l,tea
yes(bana
nas, breads,pickles,p
yes mangoes) seldom apad,oily
medium 5-6days -
seldom 4-5days -
seldom everyday -
seldom 2-3days -
2-3days 2-3days -
seldom 5-6 days -
1-2days 1-2days -
2-3days 5-6days -
pickles,
frequent seldom groundnut oil
- 5-6days -
frequent seldom -
5-6days 2-3days -
1-2days 4-5days -
pickles,mangoe
frequent seldom s etc.
2-3 days 2-3days -
seldom seldom -
high intake of
seldom seldom papad
frequent seldom
high intake of
pickles,groundn
frequent 2-3days ut oil
pickles,sugar,pa
5-6days everyday pad
papad,groundn
- 5-6days ut oil
2-3days 5-6days -
pickles,bananas
frequent - ,etc.
salty diet,
seldom 2-3days papad
seldom 5-6days -
frequent 5-6days -
- 4-5days oily salty diet
daily daily -
no sweet iems
- 5-6days taken
daily(man
goes,ban pickles,groundn
ana) 4-5days ut oil,ladvas.
pickles,sweets,e
frequent 3-4days tc.
papads,ground
1-2days 5-6days nut oil
high
3-4days 5-6days sweets,pickles
papads,ground
- 2-3days nut oil
seldom 2-3days -
potatoes,pickle
frequent seldom s,groundnut oil
papads,ground
seldom seldom nut oil
1-2days 5-6days -
potatoes,pickle
frequent seldom s,groundnut oil
pickles,papad,oi
frequent seldom l,tea
packets,
tea,groundnut
seldom seldom oil,papad
1-2days 2-3 days -
pickles,groundn
frequent seldom ut oil,ladvas.
- 2-3days -
- 5-6days -
papads,ground
- 3-5days nut oil
pickles,honey,te
frequent seldom a,mangoes,etc.
Physical Activity Physical Measurem
Type of work no. of days? go to work by? any recreation? time sitting? Ht Wt BMI
Mild Most - - Most 165 58 21.3
mild most - no most 145 57 27.1
moderate everyday walking no 1-2 hrs 155 60 25
mild 1-2 days - - 12 hrs 158 60 24
mild everyday walking - - 160 55 21.5
mild everyday - - most 160 60 23.4
mild daily - - most 150 57 25.3
mild daily - - whole day 140 57 19.1
no activity - - - - 160 60 23.4
moderate 4-5 days - - - 155 68 28.3
mild daily walking n0 most 180 60 18.5
moderate 4-5days motorcycle - - 168 68 24
mild most - - most 150 60 26.7
mild 2-3days - - most 155 65 27
mild - - - most 150 65 29
mild - - - most 158 80 32.6
mild most - - most 145 50 23
moderate 3-4days motorcycle - - 158 58 23.2
mild most - - most 158 54 21.6
mild most - most 150 61 27
moderate daily walkinf - 1-2hrs 145 57 27.1
severe daily walking - - 160 65 25
mild 1-2days - - 12hrs 154 62 26.14
mild daily - - most 154 75 31.6
mild most - - most 160 62 24.2
mild - - - most 155 60 25
mild daily - - most 145 60 19.1
mild most days - - most 180 78 24
mild most - - - 145 55 26.1
mild most - - most 145 68 32
mild most - - - 140 60 30.5
severe daily walking - less 160 75 19.3
moderate daily walking - 8 hrs 158 70 28
mild - - - 2hrs 145 35 16.6
mild - - - 2hrs 148 60 30.6
mild - - - whole day 155 68 28.3
mild - - - most 152 85 36.8
mild most - - most 158 62 24.8
mild - - - most 150 53 23.6
severe 6days rickshaw - - 145 58 24
severe everyday walking - less 158 62 24.8
mild everyday motorcycle - - 160 62 24.2
mild - - - less 154 75 31.6
moderate everyday walking - 2-3hrs 145 57 27.1
mild daily - - most 163 60 23.7
mild daily - - most 143 63 32.7
mild daily walking - most 160 55 21.5
mild 1-2days - - most 158 60 24
mild - - - most 150 57 25.3
mild - - - most 140 56 19.1
severe everyday motorcycle - 2-3hrs 160 50 19.5
mild - - - most 140 60 30.6
mild - - - most 140 75 38.3
mild - - - most 145 83 39.5
mild - - - most 156 50 22.2
mild 2-3days motorcycle - - 162 88 33.5
mild - - most 150 67 29.8
mild - - - most 153 60 28.9
moderate daily rickshaw - 5-6hrs 162 70 26.7
mild - - - most 143 47 23
mild daily walking - 1-2hrs 141 55 27.66
mild daily walking - 4hrs 146 62 30.74
mild - - most 150 53 23.55
mild daily walking - most 169 52 18.2
mild - - - most 135 55 30.1
mild - - - most 162 75 28.6
mild - - - most 145 52 24.73
mild daily walking - most 165 75 27.5
mild - - - most 148 68 31
mild - - - most 142 70 34.7
mild - - - most 152 71 30.73
mild daily - - 8hrs 162 80 30.4
mild - - - most 150 62 27.55
moderate daily walkin - most 147 62 28.7
mild - - - most 153 53 22.64
mild - - - most 157 75 30.42
moderate daily walking - less 165 68 25
ysical Measurements
B.P. H.R. Waist
170/90 80 86
148/92 78 92
112/78 80 92
120/70 68 85
130/90 66 85
138/88 74 94
124/84 88 90
120/80 78 84
134/84 82 94
140/78 92 98
138/88 74 86
130/80 94 86
138/78 88 85
124/84 84 94
140/90 84 96
154/96 88 98
134/84 70 78
126/78 80 85
140/80 84 90
140/78 78 86
130/80 80 92
140/100 100 84
134/78 80 85
130/90 76 94
138/88 78 90
120/90 84 90
128/84 68 84
138/90 84 89
124/74 90 86
148/98 88 96
150/100 80 95
120/90 76 88
120/80 88 110
140/100 66 69
130/100 76 95
140/90 98 95
130/90 80 105
120/80 76 95
124/68 86 80
120/80 82 85
140/100 80 88
130/80 68 90
130/90 88 98
122/80 78 92
130/80 70 85
140/100 82 99
130/90 80 85
120/70 66 85
122/90 86 90
128/84 76 84
140/90 82 80
130/78 78 88
130/90 70 110
136/88 68 105
120/80 78 75
130/80 80 98
170/106 76 95
130/90 82 94
128/88 68 95
126/86 90 85
130/80 78 93
152/80 80 82
130/78 76 84
124/84 84 87
210/110 88 93
146/86 72 113
176/88 78 90
144/94 68 98
190/90 82 96
150/90 76 100
132/90 80 101
126/80 72 93
196/100 90 98
130/90 78 95
126/86 84 85
136/90 88 102
134/88 66 90
