Questionnaire Text

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The fields (71, 72) are filled for all handicapped persons without recognition to the sex or age.


71. Type of disability

[] 1 No hearing
[] 2 Dumb
[] 3 No hearing and dumb
[] 4 Lost one eye
[] 5 Lost both eyes
[] 6 Lost one leg
[] 7 Lost both legs
[] 8 Lost one hand
[] 9 Lost both hands
[] 10 Insane
[] 11 Paralysis
[] 12 Others ____

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71. The type of Handicapped:
Indicated by the sign (x) in the square opposite to the type of handicapped the person had. If the person is blind the sign is put in the square opposite to the phrase (lost 2 eyes) if one of his legs is cut the sign is put in the square opposite to the phrase (lost 1 leg), if the person has lost one leg and one eye at the same time the state is recorded in the special space for that and so on.