10.1.	Interviewer: Is the respondent Male or Female?	___(1) Female
		___(2) Male
10.2.	In what year were you born?	___
10.3.	Which of the following best describes your marital status?
	Single	____ (1)
	Married	____ (2)
	Divorced or Separated	____ (3)
	Unmarried living with a partner	____ (4)
	Widow or Widower	____ (5)
10.4.	Do you consider yourself Hispanic or Latino?	____ (0) No
		____ (1) Yes
10.5.	Which of the following best describes you? Are you …
	Asian, Hawaiian, or Pacific Islander	____ (1)
	Black or African American	____ (2)
	Native American/Aboriginal	____ (3)
	White	____ (4)
	Some other race, specify: ___________________________	____ (9)
10.6.	What is the last grade or year that you completed in school?
	Less than high school	____ (1)
	Some high school	____ (2)
	High school graduate or GED	____ (3)
	Some college	____ (4)
	College graduate	____ (5)
	Some post-graduate	____ (6)
	Post-graduate or Professional degree	____ (7)
	Other, specify __________________________________	____ (9)
10.7.	Which of the following best describes your employment or student status?	____(1)Emplyd FullTime
	Are you employed..(Read options out loud.)	____(2)EmplydPartTime
		____(3) Retired
		____(4) Not Emplyd
		____(5) Disabled
		____(6) Student
10.8.	Which category best describes your combined family income in the last year (before taxes)? Was it	__ (1) < $5,000
		__ (2) $5,000 - $19,999
		__ (3) $20,000 - $39,999
		__ (4) $40,000 - $59,999
		__ (5) $60,000 - $79,999
		__ (6) > $80,000
		__ (8) Don't know
		__ (9) Refused
10.9.	How important to you are your religious/spiritual beliefs?	____ (0) Not applicable
	Would you say they are …	____ (1) Not important
		____ (2) Slightly important
		____ (3) Somewhat important
		____ (4) Very Important
		____ (5) Extremely important
		____ (6) Refused
10.10.	Do you currently have medical insurance coverage of any sort?	____ (0) No
		____ (1)Yes
10.11.	Interviewer: Is (family member) Male or Female (if not already known)?	___(1) Female
		___(2) Male
10.12.	In what year was (family member) born? (or age if they don't know birth year)	_____________
		_____years
10.13.	Which of the following best describes (family member)'s marital status?
	Single	____ (1)
	Married	____ (2)
	Divorced or Separated	____ (3)
	Unmarried living with a partner	____ (4)
	Widow or Widower	____ (5)
10.14.	Does (family member) consider him/herself to be the same race/ethnicity as you (SKIP to 10.14 if YES)	____ (0) No
		____ (1) Yes
10.14a	Does (family member) consider him/herself Hispanic or Latino	____ (0) No
	____ (1) Yes
10.14b.	Which of the following best describes (family member)?
	Asian, Hawaiian, or Pacific Islander	____ (1)
	Black or African American	____ (2)
	Native American/Aboriginal	____ (3)
	White	____ (4)
	Some other race, specify: ___________________________	____ (9)
10.15.	What is the last grade or year that (family member) completed in school?
	Less than high school	____ (1)
	Some high school	____ (2)
	High school graduate or GED	____ (3)
	Some college	____ (4)
	College graduate	____ (5)
	Some post-graduate	____ (6)
	Post-graduate or Professional degree	____ (7)
	Other, specify __________________________________	____ (9)
	Don't Know	______ (10)
10.16.	Which of the following best describes (family member)'s employment or student status	____(1)Emplyd Full-Time
	Are you employed..(Read options out loud.)	____(2)EmplydPart-Time
		____(3) Retired
		____(4) Not Emplyd
		____(5) Disabled
		____(6) Student
		____ (7) Don't know
10.17.	Does (family member) currently have medical insurance coverage of any sort?	____ (0) No
		____ (1)Yes
		____ (2) Don't know
10.18	What is your relationship to ___?	_____ (1) Spouse
		_____ (2) Child (of patient)
		_____ (3) Parent (of patient)
		_____ (4) Sibling
		_____(5) Other __________
		_________________________
10.19	Has (family member) ever had a seizure before the time when he/she was enrolled in the RAMPART study?	____ (0) No
		____ (1) Yes
		____ (2) Don't know
10.20.	Does (family member) take medications regularly for seizures?	____ (0) No
		____ (1) Yes
		____ (2) Don't know
10.21.	How many times in the past 2 years has (family member) had to come to the hospital or emergency room because of seizures or for other reasons?	___________