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Agency
example.org
Identifier
4b8e ... 166
Version
1
Last Updated
Thursday, July 21, 2022
Updated by
AD\sydneylw
Rationale
replacing the Parent (1995) change from 7/20/2022
History
Full History
Revision 1
5/17/2023 2:55:10 PM
AD\sydneylw
replacing the Parent (1995) change from 7/20/2022
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Physical/Functional Limitations
Add Health
Add Health
Add Health Questions/Variables
Add Health Questions/Variables
Add Health Questions/Variables
Add Health Questions/Variables
Conceptual Variable Group
Label
Physical/Functional Limitations
Conceptual Variables
Name
Label
506
Does the condition involve asthma?
507
Does the condition involve breathing difficulties?
508
Has a doctor, nurse or other health care provider ever told you that you have or had: asthma, chronic bronchitis or emphysema?
519
Do you have a condition involving a heart problem?
802
Do you use a brace, cane, crutches, walker, medically prescribed shoes, wheelchair, or scooter because of a physical condition?
803
Do you use a brace for your hand, arm, leg, or foot because of a permanent physical condition?
804
Do you use an artificial hand, arm, leg, or foot?
805
By yourself and not using aids, do you have difficulty walking up 10 steps without resting?
806
How much difficulty do you have?
807
By yourself and not using aids, do you have difficulty walking one-quarter of a mile, or about three city blocks?
808
How much difficulty do you have walking one-quarter of a mile, or about three city blocks?
809
By yourself and not using aids, do you have difficulty standing for about 20 minutes?
810
How much difficulty do you have standing for about 20 minutes?
811
By yourself and not using aids, do you have difficulty reaching up over your head, or reaching out as if to shake someone's hand?
812
How much difficulty do you have reaching up over your head, or reaching out as if to shake someone's hand?
813
By yourself and not using aids, do you have difficulty using your fingers to grasp or handle something, for example, picking up a glass?
814
How much difficulty do you have using your fingers to grasp or handle something, for example, picking up a glass?
815
By yourself and not using aids, do you have difficulty holding a pen or pencil?
816
How much difficulty do you have holding a pen or pencil?
817
Do you need help from another person when eating?
818
Do you need help from another person when bathing?
819
Do you need help from another person when dressing?
820
Do you need help from another person when getting on or off the toilet?
821
Do you need help from another person when shopping?
822
Do you use special equipment in eating, dressing, or getting on or off the toilet?
823
Do you use special equipment in bathing?
824
Do you use special equipment in shopping?
825
Do you use a cane?
826
Do you use crutches or a walker?
827
Do you use medically prescribed shoes?
828
Do you use a manual wheelchair, a powered wheelchair, or a scooter?
829
Do you consider yourself to have a disability?
830
Do you think other people consider you to have a disability?
6191
Do you have difficulty using your hands, arms, legs, or feet because of a physical condition?
6192
Do you have difficulty using your hands, arms, legs, or feet because of a physical condition that has lasted for the past twelve months or more? Does that condition involve: a heart problem?
6193
Do you have difficulty using your hands, arms, legs, or feet because of a physical condition that has lasted for the past twelve months or more? Does that condition involve: asthma?
6194
Do you have difficulty using your hands, arms, legs, or feet because of a physical condition that has lasted for the past twelve months or more? Does that condition involve: other breathing difficulties?
6195
Do you have difficulty using your hands, arms, legs, or feet because of a physical condition that has lasted for the past twelve months or more? Does that condition involve: some other problem?
6196
Have you used a brace on your arms, hands, legs, or feet for the past twelve months or more?
6201
In the last month, how often did a health or emotional problem cause you to have trouble walking?
6202
In the last month, how often did a health or emotional problem cause you to have trouble running?
6203
In the last month, how often did a health or emotional problem cause you to have trouble bending or lifting?
6204
In the last month, how often did a health or emotional problem cause you to have trouble using your hands or fingers?
6525
Does {NAME} have difficulty using (his/her) hands or arms?
6526
Does (he/she) have difficulty using (his/her) feet or legs?
6529
Are (his/her) difficulties caused by a physical condition?
6530
Did the condition result from an accident, or from a disease, or was it present at birth?
6531
How old was {NAME} when this condition first occurred?
6532
What parts of the body are affected by this condition? entire right hand
6533
What parts of the body are affected by this condition? fingers of right hand
6534
What parts of the body are affected by this condition? entire left hand
6535
What parts of the body are affected by this condition? fingers of left hand
6536
What parts of the body are affected by this condition? upper right arm
6537
What parts of the body are affected by this condition? lower right arm
6538
What parts of the body are affected by this condition? upper left arm
6539
What parts of the body are affected by this condition? lower left arm
6540
What parts of the body are affected by this condition? entire right foot
6541
What parts of the body are affected by this condition? toes of right foot
6542
What parts of the body are affected by this condition? entire left foot
6543
What parts of the body are affected by this condition? toes of left foot
6544
What parts of the body are affected by this condition? upper right leg
6545
What parts of the body are affected by this condition? lower right leg
6546
What parts of the body are affected by this condition? upper left leg
6547
What parts of the body are affected by this condition? lower left leg
6548
What parts of the body are affected by this condition? Back
6549
What parts of the body are affected by this condition? Other
6550
Because of this condition, does {NAME} get help from another person in eating?
6551
Because of this condition, does {NAME} get help from another person in bathing?
6552
Because of this condition, does {NAME} get help from another person in dressing?
6553
Because of this condition, does {NAME} get help from another person in getting on or off the toilet?
6554
What special equipment must {NAME} use as a result of this condition? cane
6555
What special equipment must {NAME} use as a result of this condition? crutches/walker
6556
What special equipment must {NAME} use as a result of this condition? medically prescribed shoes
6557
What special equipment must {NAME} use as a result of this condition? manual wheelchair/powered wheelchair/scooter
6558
What special equipment must {NAME} use as a result of this condition? brace (arm, hand, foot, or leg)
6559
What special equipment must {NAME} use as a result of this condition? other
6560
What special equipment must {NAME} use as a result of this condition? none
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