Questionnaire Text

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4.14 Do you have any of the following handicaps? (Choose only one alternative, prioritizing them in the order given)
[] 1 total permanent paralysis
[] 2 permanent paralysis of the legs
[] 3 permanent paralysis of one side of the body
[] 4 loss of leg, arm, hand, foot or thumb
[] 5 none of the above

Questionnaire instructions view entire document:  text  image

Question 4.14 - Do you have any of the following handicaps? (Mark only one alternative, giving special priority to the order presented)

1 - Permanent total paralysis - for persons who say they are paralyzed from the neck down that is, they are quadriplegic;
2 - Permanent paralysis of the legs - for persons who say they are paralyzed from the waist down, that is, they are paraplegic;
3 - Permanent paralysis of one side of the body - for persons who say they are hemiplegic;
4 - Missing a leg, arm, hand, foot or thumb - for persons who say they lack one or both upper or one or both lower limbs or both upper and lower since birth or due to later amputation due to disease or accident. Consider the loss of an arm, forearm, hand, thumb, leg, part of the leg, or foot; and
5 - None of those specified above - for persons who do not have any of the handicaps listed above.