Medical LA Question Title * 1. Murray Hill Center a National Market Research Company specializing in health care has several research opportunities. We will only contact you if you meet the specific criteria we are currently interviewing. All of our opportunties are strictly for research purposes only. You will receive a cash honoraria for participating. Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Question Title * 2. What is your phone number? Question Title * 3. What is your secondary phone number? Question Title * 4. Please tell us what age you are? Question Title * 5. Are you a Male ot Female? Male Female Question Title * 6. Which, if any, of the following conditions has a physician diagnosed you Allergies Asthma Diabetes High blood pressure High cholesterol HIV Migraine headaches Incontinence Cancer Non of the above Question Title * 7. If you answered yes to HIV, Cancer or incontinence please continue. This question pertains to HIV treatment only. What month and year were you diagnosed? Question Title * 8. Question pertains to HIV treatment. Would you please go get the prescription medicines you are currently taking for HIV and mark accordingly? Agenerase (amprenavir)………………………………….. Aptivus (tipranavir)………………………………………… Atripla (emtricitabine+tenofovir+efavirenz)........………... AZT/Retrovir (zidovudine)………………………………… Crixivan (indinavir)………………………………………… Combivir (zidovudine+lamivudine)………………………. Complera (emtricitabine+tenofovir+rilpiverine)………… Edurant (rilpiverine)……………………………………….. Emtriva/FTC (emtricitabine)……………………………… Epivir (lamivudine)………………………………………… Epzicom (lamifucine+abacavir)........…………………….. Fuzeon (enfurvitide)……………………………………….. Intelence (etravirine)………………………………………. Invirase (saquinavir)…………………………………….…. Isentress (raltegravir)……………………………………… Kaletra (lopinavir+ritonavir)…………………………….…. Lexiva (fosamprenavir)………………………………….… Prezista (darunavir)………………………………………... Reyataz (atazanavir sulfate)……………………………… Selzentry (maraviroc)……………………………………… Sustiva (efavirenz)…………………………………………. Trizivir (abacavir+lamivudine+zalcitabine Truvada (emtricitabine_tenofovir)………………………… Videx (didanosine)…………………………………………. Viramune (nevirapine)…………………………………….. Viramune XR (nevirapine)………………………………… Viracept (nelfinavir)………………………………………… Viread (tenofovir)………………………………………….. Zerit (stavudine)…………………………………………… Ziagen (abacavir)…………………………………………. Question Title * 9. Question pertains to HIV patient. How many drug combinations have you taken? 0 1 2+ Question Title * 10. Question pertains to HIV treatment. I am going to mention some ways in which a person can become infected with the HIV virus. Please stop me when I read the category that applies to you Male to male sexual contact Heterosexual contact Injection drug use Other: specify Don’t know Question Title * 11. Question pertains to Incontinence patient: Do you experience urine leakage only, urine leakage with bowel leakage, or bowel leakage only Urine Leakage Only Urine and Bowel Leakage Bowel Leakage only Question Title * 12. Question pertains to Incontience patients: How often do you use an absorbent product for urine leakage protection in an average week Daily Two or more times a week Once a week Less than once a week Do not wear absorbent products Do not read) DK/ Refused Question Title * 13. Question pertains to Incontience patient only: What ONE type of product have you used most often in the past month for daytime urine leakage protection Feminine hygiene pantiliners Thin or UltraThin pad Maxi Thick pad Bladder control pantiliner Thin or UltraThin pad Moderate absorbency Bladder control pad Maximum absorbency Bladdeer Control Pad Ultimate absorbency control pad Belted shields Step-in/Pull-on pants or underwear - Moderate absorbency Step-in/Pull-on pants or underwear - Maximum absorbency Briefs Male Guards (males only) Refastenable/adjustable underwear Cloth or paper toweling Other Nothing/Don’t know Question Title * 14. Question pertains to Cancer patient only: What type of cancer have you been diagnosed with? Brain cancer Breast cancer Bone cancer Colon and/or rectum cancer Gynecologic cancer Head & neck cancer Leukemia (acute or chronic) Lymphoma (Hodgkin’s or non-Hodgkin’s) Lung cancer Metastatic Renal Cell Carcinoma Myeloma Prostate cancer Skin cancer Other type of cancer (specify) Done