Prince Hall Grand Lodge Health Survey (1)

Prince Hall Grand Lodge Health Survey
To better understand healthcare issues most relevant to Prince Hall Grand Lodge and Prince Hall Grand Chapter, The Most Worshipful Grand Master has created a Member Health Services Committee and appointed Brother Martin F. Hill, Ph.D., LMHC as the Director. The Member Health Service Committee has developed a health care inventory questionnaire.

This questionnaire is being distributed to brothers and sisters inquiring about various aspects of individual and family health and concerns.

The data collected will be anonymous. No personally identifying information will be connected to the member or utilized for dissemination of the results.

Results will be utilized to:

Ø Educate members on the current health status of the jurisdiction.

Ø Refine presentations and healthcare initiatives that are most germane to the membership.

Ø Create and monitor health initiatives.
Dr. Martin F. Hill
1) Have you been diagnosed with COVID-19?*

YesNo
2) I have individuals in my family (can be inclusive of self) who seem nervous to the point it affects being social, public speaking, or willingness to leave the house. The person may complain of sweating or having heart palpitations/chest pain, muscle tension.*

YesNo
3) I have people in my family (can be inclusive of self) who have difficulty initiating and completing tasks, paying attention, being too forgetful, or being impulsive, which impacts family cohesion, household, or work-related tasks.*

YesNo
4) Do you have a firearm in your home?*

YesNo
5) Is the firearm secure (defined as a container that is locked by key or code) in your home?*

YesNo
6) I have people in the family (can be inclusive of self) who are having difficulty remembering names, places, and how to do things. Sometimes this has caused safety issues.*

YesNo
7) I have people in my family (can be inclusive of self) who have difficulty taking their medications regularly.*

YesNo
8) On average would you do 2.5 hours of physical activity per week (for example, 30minutes a day for 5 days a week)?*

YesNo
9) How would you rate your health?*

ExcellentGoodFairPoor
10) I have individuals in my family (can be inclusive of self) who are eating too much or too little which is impacting his or her health and body image.*

YesNo
11) Doyou eat 5 or more servings of fruit or vegetables per day?*

YesNo
12) Do you have a regular health care provider/professional you usually see when you are sick or want health care advice?*

YesNo
13) Which of the following best describes how you react when you feel sick or are in pain or concerned about your health?*

I wait as long as possible to see if I get better.I wait at least a week to see if I get better.I will wait a few days to see if I get better.I seek medical advice as soon as possible.
14) Have you had a blood cholesterol test within the last 2 years?*

YesNo
15) I have individuals in my family (can be inclusive of self) that have or are dealing with depression, thoughts of death or suicidal ideations, poor energy, frequent crying spells, difficulty experiencing pleasure, or processing the death of someone.*

YesNo
16) Have you had a physical exam within the last year (In person or via Telemedicine or Telephone)?*

YesNo
16a) Why Not?
17) I have individuals in my family (can be inclusive of self) who hear or see things other people do not seem to see or hear or act in such an unconventional way that it causes others to be standoffish to him or her.*

YesNo
18) Are you still experiencing complications from COVID-19?*

YesNo
19) I have individuals in my family (can be inclusive of self) that have overutilized legal or illicit substances (e.g., nicotine, vaping, alcohol, marijuana, methamphetamine, cocaine, prescription medications, etc.), which has caused communication issues, family issues, or work issues.*

YesNo
20) Have you ever been diagnosed with either of the following chronic health conditions(select all that apply)?

HypertensionCancerArthritisHeart DiseaseKidney DiseaseDiabetesStrokeLung CancerI have not been diagnosed with any of the above
21) I am open to learning about different ways to increase my coping skills to deal with my significant other, parent- child or work-related interpersonal issues.*

YesNo
22) I am open to learning how my mind and body are interactive.*

YesNo
23) I have Health Insurance*

YesNo
Should be Empty: