Questionnaire Text

Questionnaire form view entire document:  text  image

4. Does the person have any permanent physical, sensorial, or mental disability? (Incapacity)
[ ] 1 Yes

[ ] 1 To see (blindness, only shadows)
[ ] 2 To move or use his/her body (paralysis, amputations)
[ ] 3 Is deaf or uses hearing aids? (deaf, deaf/mute)
[ ] 4 Mental retardation
[ ] 5 Psychiatric Illness (craziness)
[ ] 6 Multiple (two or more of the above)
[ ] 7 Other (disfigurations, internal organs)

[ ] 2 No
[ ] 9 Don't know
Questionnaire instructions view entire document:  text  image

Question 4.- Do you have any physical, sensory, or mental disability? (Handicap)

[There is a picture of question 4 from this section of the enumeration form.]

Mr. Enumerator, this question deals with identifying a handicap in the person being enumerated. As an orientation, it's important to consider the following:

Permanent disability: physical, sensory, or mental

This is a permanent difficulty in doing an activity that is considered normal, due to irreversible effects from an incurable congenital or acquired disease.

In seeing (blindness, only shadows).- Mark box 1 when the person being enumerated cannot see or can only see shadows, with one or both eyes, and therefore needs help to get by. People that use lenses because of myopia or similar diseases are excluded from this category.

In moving or using their body (paralysis, amputations).- Mark box 2 if the person in question has a physical disability manifested by an absence of or decrease in the ability to move any part of their body: legs, arms, hands, etc. For example: paralytics who can't walk or only do so with some apparatus; people who can't use their upper body due to the aftereffects of a brain hemorrhage, bone marrow injury, polio, etc.; people who can't move parts of their body because they don't have them due to amputations; people who suffer from involuntary movements of their body.

Is deaf or uses a hearing device (deafness, mute and deaf).- Mark box 3. People who can't hear or who use devices (hearing aids or sound amplifiers) to hear should be considered in this category; in general these are deaf people or those known as deaf-mutes.

Mentally retarded.- Mark box 4 when the person being enumerated has a decreased degree of intelligence due to mental retardation. In some populations these people are called "innocents," "silly ones", or "mutes" (not because of deafness). People affected by Down syndrome, microcephaly, cretinism, autism, etc. are in this group.

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Psychiatric illness (insanity).- Mark box 5 if the person suffers from mental disorders and, despite having a good level of intelligence, demonstrates strange behaviors that impede them from getting along with others. These people are usually referred to as being insane.

Multiple (two or more of the previous).- Mark box 6 if the person being enumerated suffers from various disabilities simultaneously, for example: deaf-blind, blind-paralytic, etc.

Other (disfigurement, internal organs).- Mark box 7 when the person being enumerated has disfiguring problems that primarily affect their esthetic appearance and which don't impede their ability to move, such as: dwarfism, noticeable scars from wounds or burns, leprosy, etc. Include people who have severe problems with their internal organs, like those whose life depends on the use or an artificial kidney (weekly dialysis).

Mark no, box (2), if the informant indicates that they don't have any permanent physical, sensory, or mental disability (handicap) and continue with question 5.

Mark unknown, box (9), in those cases where the information is being provided by a third party who doesn't know if the person being referred to has any physical, sensory, or mental disability (handicap) or not, and continue with question 5.