Questionnaire Text

Questionnaire form view entire document: text image

[Questions from 23 to 28 is applicable for persons aged 5 years and above]

26. Can write a letter?

[] 1 Yes
[] 2 No

Questionnaire instructions view entire document: text image

Question 26: Able to Write letter
Fill out "Yes" oval box if able to write letter and No oval box for not able.

Question 26: Able to write Letter? Ask whether the person is able to write letter. Fill out 1 oval box for "Yes" and 2 oval box for no.