Table 3.

Sample Item From the QuICCC

1a.  Do any of the children [in the household] take medicine or drugs prescribed by a doctor other than regular vitamins?
  1  ( ) Yes
  2  ( ) No (Skip to next question)
  3  ( ) Don't know (Skip to next question)
 b.  Is this because of a medical, behavioral, or other health condition that the child still has?
  1  ( ) Yes
  2  ( ) No (Skip to next question)
  3  ( ) Don't know (Skip to next question)
 c.  Has this condition been going on or is it expected to go on for at least one year?
  1  ( ) Yes
  2  ( ) No
  3  ( ) Don't know
 d.  Which child is this?