Questionnaire Text

Questionnaire form view entire document:  text  image

6. Resident characteristics


Disability - for all residents


6.14 Do you have any permanent difficulty in seeing?
(If you wear glasses or contact lenses, make your evaluation while wearing them)

[] 1 Yes, cannot do it at all
[] 2 Yes, major trouble
[] 3 Yes, some difficulty
[] 4 No, no difficulty

Questionnaire instructions view entire document:  text  image

6.14 - Do you have a vision impairment?
(If using glasses or contact lenses, used them to determine sight)


Depending on the situation, record:
1 - Yes, not able to see: A person who declares himself/herself unable to see.

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2 - Yes, has difficulty seeing: A person who has a permanent and/or great difficulty to see even with glasses or contact lenses.
3 - Yes, some difficulty in seeing: A person who has some difficulty seeing, even with glasses or contact lenses.
4 - No, can see very well: A person who sees very well, even if he/she needs to wear glasses or contact lenses.