| 67580-1 | What do you think was the main reason for this experience:Find:RptPeriod:^Patient:Nom: | optional |
| 112299-3 | When was the last time this happened:Find:RptPeriod:^Patient:Ord: | optional |
| 112298-5 | How many times has this happened during your lifetime:Num:Lifetime:^Patient:Qn: | optional |