Sunday, January 20, 2013

Teen questionnaire

This morning I was reading an article on WND entitled Homeschooler's Neighbor Sparks Social Services Case. The topic of the article aside, I found this fascinating attachment in the comments following the article. It's called Teen Questionnaire, 13 to 18 Years Old:

Apparently this is a Kaiser Permanente insurance form. Because the screenshot is so small, I transcribed the questions as follows:

1. Do you always wear a seatbelt when riding in a car?
2. Do you ever use a bike, scooter, skateboard, skis/snowboard, or rollerblades WITHOUT a helmet?
3. Have you ever had a sunburn?
4. Do you play sports or get at least 60 minutes of active physical play each day?
5. Do you eat five or more servings of vegetables or fruits every day?
6. Do you usually drink more than one soda, juice, or sports drink each day?
7. Do you usually spend more than two hours a day watching TV or movies, playing video games, or using the computer?
8. Are you using supplements (such as creatine, andro, or steroids)?
9. In the past year, have you used laxatives, diet pills, or made yourself vomit to try to lose weight?
10. Have your grades been dropping at school?
11. Are you having any problems at school?
12. Do you, your parents, or any of your friends have a gun?
13. Have you ever been physically abused by an adult?
14. Have you ever been forced or pressured to have sex?
15. Have you ever been in trouble with the law?
16. Are your close friends gang members?
17. Does anyone smoke in your home?
18. Have you smoked cigarettes or chewed tobacco during the past year?
19. Do your close friends drink alcohol or get high?
20. Have you ever been in a car with a driver who had too much to drink or was high?
21. During the past year did you drink any alcohol?
22. Have you ever tried drugs (such as marijuana, cocaine, ecstasy, glue, or meth)?
23. During the past few weeks, have you OFTEN felt sad, down, or hopeless?
24. Have you seriously thought about killing yourself, made a plan, or tried to kill yourself?
25. Who do you live with?
26. Do you feel safe at home?
27. Have you had sex (including oral, vaginal, or anal sex)?
28. Do you sometimes have sexual feelings for someone of your own sex (gay or lesbian feeling)?
29. If you have any other concerns, please write them here.

Here are a couple of comments left after this attachment:

One person writes: This is the form that is given out at the doctor's office. They want the child and the parent to fill out separate forms in order to compare answers. We have refused these questionnaires each time they have been given to us. The receptionist admitted to me when I questioned the form that this for does not affect our insurance or the care my children receive. She said that the doctor wanted the information, but my doctor said that the clinic wanted it. Too much information!

Another person writes: Questions #1, 2, 12, 17 are looking for obedience. Question #20 calls for speculation by an unqualified individual. Questions# 22, 24, 28 can be construed as enticement. Question# 27a is simply asinine

I've never seen such a form from our doctors, but then we don't have Kaiser. Has anyone else seen something like this?


  1. Yes. I've seen this and worse.

    This form also could be construed as a form of entrapment.

    And they're just getting warmed up.

    It's impossible not to see the troubling comparisons between this nation in its current state to that of Germany in the 1930s.

    A. McSp

    1. Yes it is worse. About 6 months ago I took my older brother to ER for back pain and they asked him one question on the pain and then proceeded to do a suicide risk assessment.On there paper it said a score of 12 will get you a nice involuntary visit. For being a single male over 50 they gave him a score of 5. If you have ever had any trauma add 3, if you live alone add 2,if anyone in your family has tried to commit suicide add 1,if you drink moderately add 2, divorced add 2, widowed add 3 etc. Needless to say when I seen where it was going I grabbed the paper so they couldn't put it in his medical records and stormed out.We went elsewhere for help. Now add this to Obama's recent gun control charge and a database for the mentally ill and you can see its about disarmament. The other hospital diagnosed brother with kidney stones.Let me know if you would like a copy of the suicide risk assessment Patrice and I'll mail you a copy.

    2. Thank you for sharing this.

      I suspect such inappropriate and hazardous treatment will soon be a very common risk for anyone over fifty.

      It's vital folks learn ways to protect themselves the way you protected your brother.

      A Mc

  2. Yes, I have seen such a form at a doctor's office. It was about ten years ago. I refused to answer all questions, was seen by the doctor anyway and received good care. Since then, I have not been insured and have not been to any doctor's office, so have seen no further forms.

  3. As I read through the survey, I kept thinking back to the book 1984...
    I haven't seen a survey like that from Kaiser but it's been 10 years since I've gone there.
    When I was in highschool (a rural public school) 7 years ago they had a speaker come and talk to us about teen pregnancy and the difficulties of growing up into adulthood.We were also told by the speaker that they (I don't remember the company) would give everyone $5 if we took their survey. My parents taught my brother and I well when it came to our families privacy so him and I refused the survey and the money.Our friends who took it said that it was mostly about guns and if there were any in their household and if so how many... I guess our friends came to their senses and decided to lie about the family guns. No parental permission slips were ever sent out to the parents and many parents went to the school board and the paper and gave everyone a good ass-chewing, rightly so.

  4. Something similar, yes, but with more space for comments, not just ticking off yes or no. And I can't say I understand the problem.

  5. I've been noticing the gun question popping up more on questionnaires. I always put no even though I do have one and want a few more.

  6. Maybe I am not bothered because I work in health care and I know why they are asking the questions.

    1. perhaps you can expound on the reasons they ask these questions and share your answers here for the rest of us who become annoyed.

    2. So enlighten us. Why are they asking the questions?

      Should be noted that you have dumped significant personal information in your name link.

      Why would you announce to the world at large the details of where you live, your family structure and livelihood/employers? I suspect you have no issues with the concept of govt invasion of privacy. Let it all hang out. You've got nuthin' to hide, after all.....

    3. You are correct, I don't do anonymous posts. My choice. :)

      Okay, my opinion on these surveys:
      1. They are older than Obamacare. So we can't blame Obamacare.
      2. These can be seen as safety questions, and I believe the pediatricians with whom I work see them as such. It's a genuine desire to make sure their little patients live in safety.
      3. Comparing the answers of child with those of parent is revealing, if everybody tells the truth.

      I agree entirely with the comment just below this, from Xa Lynn. How sad it is that families face these issues.

    4. I should stop re-reading the second Anonymous' comment, it just irritates me more every time I read it. :) I have nothing to hide, it is true. And our dear government has plenty more on me just from my concealed carry licenses and weapons permits than anyone would ever glean from my email address. Heh.

  7. The entire set of questions is a terrible commentary on the state of our society.

  8. i have never seen this form or any like it, however, the last six years or so, we are questioned orally by a nurse before seeing the dr in exam room with questions similar...wanting to know if we were afraid to stay by ourself, do we/how much do we smoke, do we have panic attacks, do we cut ourselves get the drift....and the patients answers to these questions are noted in their charts as well. it is extremely annoying and mostly none of their business and has nothing to do with our health insurance.

  9. Yes, I think it's the same form both our teens were given at Kaiser in Sacramento. I don't know if they filled it out and turned it in.

  10. Maria Stahl, since you say you work in health care and know why they are asking the questions, perhaps you can share that information with the rest of us.

  11. The entire survey is outrageous, but I'm curious why a doctor would be asking #12...

  12. We once were asked a series of questions at an educational evaluation for our child in the local public school system. Several of the questions had to do with the conditions under which our child was conceived, if we were married, if she was planned, was her gender acceptable.. Etc etc. we refused to answer, paid for the evaluations in a private setting and are very happy with her Christian private school and teachers. I am so happy for the red flag on that visit.

  13. We all need to take more control. I went to see a dr for a bad knee issue. They asked to take my weight. I was on crutches. I said NO i can not stand without the crutches and GAVE them my weight. I went back a wk later .. they went to do the weight thing. I am NOT over weight. I told her to get real, i was jus there a week ago and my weight had nothing to do with my knee. When they ask who is responsible for the bill i put SELF, then the question ARE YOU MARRIED ( i am) but i write DOES NOT APPLY to my bill and is not really any of your business. They ask Race and i put HUMAN. Come ON folks, we need to let them know just how stupid some of the questions are. I am 65 yrs old and they ask WHAT Rx i take. I tell them NONE and they are SHOCKED and look like they don't believe me. My question is what do YOU take.. they say NONE .. so i say WELL THERE YA GO.. if they say that they take xyz i just oh that is to bad, perhaps you will get well soon. SICK SICK SICK of stupid people asking questions and then not believing the now i give them the answer.. NONE OF YOUR BUSINESS. Funny, they seem to take that. But i am pretty sure they write DIFFICULT PATIENT on my chart. (For all your Sienfield fans.. yeah, me and Elaine. LOL)

  14. I haven't seen this questionnaire, it's annoying sometimes but i don't really know the purpose of it.

  15. I was asked a lot of questions like these on my son's last well child visit. When they started becoming irrelevant to my child's actual health and just plain nosy, I said I would not answer any more questions.

  16. When taking our kids in to see our family Dr. I get asked often by the M.A. if anybody smokes in the home. I have twice been asked (by the M.A.) to fill out a form for my children with seatbelt, smoking and firearms questions on it. I answer seatbelt & smoking questions... I am always in the room with my kids when they have to see the Dr., but as they are getting older, I guess I need to address how to answer if anybody ever asks them those questions directly. We homeschool, so I don't worry about them getting questioned at school. :-)

  17. This isn't new-I filled out something similar in high school-late 1970s. I don't think it had anything to do with insurance, though.

  18. Unreal...
    I suppose they think it "takes a village" for everyone to be taken care of--none of us is capable of watching out for ourselves!

  19. As the world turns .. and in Russia .. they are supposedly cracking down on the gay agenda for teens.

  20. My son was being seen by a pediatric geneticist for possible Marfan's syndrome and he looked down and mumbled some question to my twelve year old son about any guns in the home. SO I MUMBLED BACK that the twelve year old would not be answering any questions other than in regard to his physical health.

    Doc was agreeable and said something to the effect he had to ask, but we didn't have to answer. I didn't care who required him asking, I just stated that we drove 150 miles and we had to drive the same distance home and I only wanted the evaluation, nothing else.


  21. I have a little different perspective, and I do see how some of these "intrusive" or "inappropriate" questions make sense from a medical point of view. Of course, few of these questions are relevant for nice, normal well-adjusted families with no problems. When when you find an abusive or chaotic family that doesn't lie about it, please let everybody know.

    Teenager with sucidal thoughts or other answers that indicate depression + gun in the home = You do the math.

    Young teenager presenting with symptoms of a UTI, constipation, or unexplained "sore throat" + sexual activity that they don't want their parents to know about = it's gross but it happens.

    Kid who does not feel safe at home, wants to disclose abuse or sexual abuse without parent punishing them.

    Kid with asthma or persistent ear infections whose symptoms can't be controlled by normal treatment - knowing they were secretly smoking can make a big difference. Or, if one parent is trying to hide their smoking from the other but the kid is still being exposed - yeah, it matters.

    And for folks above who complain about being asked routine questions like their weight, if you want quality medical care having your doctor track your weight and vital signs makes sense. You might not "complain" of a large, fast weight loss, or might not notice creeping weight gain, but it can reveal a serious health condition. For example, in my early 30's I put on about 40 lbs in 6 months. I thought it was just poor habits but turned out to be my thyroid died.

    You know that old song, "the foot bone is connected to the knee bone?" Well, lots of things are connected that might not be obvious.