Appendix A. Online Risk Assessment Tool - AHRQ National ...

Nutrition and activity# Question Prereq1How many servings doyou eat per day of:1 How many servings do you eat per day of:Vegetables2Sub-Question Options Script(s) Programming NotesFruitsopen-endednumber valueHealthy Eatingopen-endednumber value Healthy EatingDo you eat fish morethan twice a week? Yes Mercury2 Do you eat fish more than twice a week?No3Do you eat any of thefollowing? Check allthat apply:3 Do you eat any of the following? Check all that apply:3 Do you eat any of the following? Check all that apply:3 Do you eat any of the following? Check all that apply:3 Do you eat any of the following? Check all that apply:4at risk if fruits and veggies addup to less than 5. Plug in "donot eat enough fruits andvegetables" to Healthy Eatingscript.at risk if fruits and veggies addup to less than 5. Plug in "donot eat enough fruits andvegetables" to Healthy EatingscriptRaw or veryundercookedmeats or fish Toxoplasmosis If selected, provide scriptUnpasteurizeddairy products orcheese Listerosis If selected, provide scriptSoft cheeses likefeta, bluecheese, brie,goat cheese orqueso fresco Listerosis If selected, provide scriptHot dogs or delimeat Listerosis If selected, provide scriptWalnuts, olive oilor fatty fish(salmon,mackerel, laketrout, sardines,albacore tuna)Omega-3 FattyAcidsDo you tend to snackon junk food (chips,soda, candy, desserts)most days? Yes Healthy Eating4 Do you tend to snack on junk food (chips, soda, candy, desserts) most days?No5Do you think youmight have an eatingdisorder, like anorexiaor bulimia? Yes Eating Disorder5 Do you think you might have an eating disorder, like anorexia or bulimia?No6Select the way(s) youget folic acid:6 Select the way(s) you get folic acid:Folic6 Select the way(s) you get folic acid:None6 Select the way(s) you get folic acid:Don'tMultivitamin with400 mcg folicacidacid pillknowMultivitaminwith folic acid(doesn’t takeone)Multivitaminwith folic acid(doesn’t takeone)Provide script if NOT selectedPlug in "eat a lot of junk food"to Healthy Eating script19