Unit O: Urinary System - Mitchell High School

Urinary Tract Infection Survey
Interview ten (juniors) or seniors (no names please) and ask the following:
I would like to ask you a few questions for my Medical Sciences I class.
1. Have you already responded to this survey about urinary tract infections?
Survey
Number
If yes, thank them and ask no further questions.
If no, say “I would like to ask you three questions. This survey is anonymous, and your
identify will not be revealed.”
Gender Have you ever had
cystitis (a urinary
bladder infection)?
Did you take
antibiotics?
Summer 2005 O.20
Did you finish the
antibiotics?
1 M or F Yes No Yes No Yes No
2 M or F Yes No Yes No Yes No
3 M or F Yes No Yes No Yes No
4 M or F Yes No Yes No Yes No
5 M or F Yes No Yes No Yes No
6 M or F Yes No Yes No Yes No
7 M or F Yes No Yes No Yes No
8 M or F Yes No Yes No Yes No
9 M or F Yes No Yes No Yes No
10 M or F Yes No Yes No Yes No
# M =
# F =
Appendix MD15.03C
# M Yes =
# M No =
# F Yes =
# F No =
Teacher Information
# M Yes =
# M No =
# F Yes =
# F No =
# M Yes =
# M No =
# F Yes =
# F No =