Questionnaire Text

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39. Does [the respondent] have permanent limitations for: (basic)

39.1 Mobility or walk?
[] 1 Yes
[] 2 No
39.2 Move his/her arms or hands?
[] 1 Yes
[] 2 No
39.3 See, despite using contact lenses or glasses?
[] 1 Yes
[] 2 No
39.4 Hear, even with hearing aids?
[] 1 Yes
[] 2 No
39.5 Speech
[] 1 Yes
[] 2 No
39.6 Understand or learn?
[] 1 Yes
[] 2 No
39.7 Maintain relationships with others due to mental or emotional problems?
[] 1 Yes
[] 2 No
39.8 Bathe, dress, feed himself/herself?
[] 1 Yes
[] 2 No
39.9 Other permanent limitation?
[] 1 Yes
[] 2 No

(If in all of the questions you marked "No," continue with question 41)


40. Of the above listed limitations for [the respondent], which is the one that most affects your daily activities? (expanded) _____

[This question was asked of person's who had at least one permanent limitation, per question 39.]

(In the DMC, select the corresponding answer from the previous list)


40.1 This limitation was caused by: (expanded)

[] 1 Because he/she was born this way?
[] 2 Because of an illness?
[] 3 Because of an accident?
[] 4 Because of violence of armed groups?
[] 5 Because of domestic violence?
[] 6 Because of common criminal violence?
[] 7 Due to old age, aging?
[] 8 Due to another cause?
[] 9 Does not know?