Hydrocodone Online Questionnaire

June 20, 2011

Hydrocodone is a drug derived from opium and provided to an individual against a valid prescription. Hydrocodone online questionnaire is prepared for online purchase of this drug, as the customer has to answer to a questionnaire that would enable him to buy the drug. Such a questionnaire has to be easy to understand and the language should be very fluid.  Through this questionnaire purchasing or selling becomes easy as this is a kind of drug which is not given to people without a valid prescription.

Sample Hydrocodone Online Questionnaire

Name: ____________________________________

Age: __________

Sex: ____________

Date: ____________

Please answer the questions given below, in brief:

1)   What is the disorder or disease that you are suffering from?

_________________________________________________

2)   When you were first diagnosed with this disease?

___________________________________________

3)   Who is your supervising physician at present?

_______________________________________

4)   Did you consult any other physicians before this?

________________________________________

5)   What other medications has the physician prescribed you?

________________________________________

6)   Have you taken hydrocodone before this?

___________________________________________

7)   If yes, for how long have you been undergoing this medication?

_________________________________________________

8)   Have you experienced any side effects like blood disorders, acute emesis, euphoria, nausea, sweating after taking this drug?

________________________________________________

9)   Do you consume more than three helpings of alcoholic beverage?

_________________________________________________

10)               Do you take acetaminophen or Tylenol?

____________________________________________________

11)               Did you ever suffer from cirrhosis of liver?

___________________________________________________

12)               Do you suffer from emphysema, asthma or any other respiratory diseases?

Please mention the onset date of any medical complication along with its complications.

___________________________________

Download  Hydrocodone  Online Questionnaire in Word Format

 

 

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