General Instruction

The questionnare asked about difficulties due to health/mental conditions. Health conditions include diseases or illness, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs. Think back over the past 30 days and answer these questions thinking how much difficulty you had the following activities. For each question, please click only one response.

In the past 30 days, how much difficulty did you have in:

Understanding & Communicating

Getting Around

Self Care

Getting Along With People

Life Activities - Household

Life Activities - School/Work

Participation In Society