Questionnaire Text

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18.

c. Does this person have difficulty dressing or bathing?
[] Yes
[] No
Questionnaire instructions view entire document:  text  image
Answer person questions 18a through 18c if this person is 5 years old or over.

18a-18c. Mark the "yes" or "no" box to indicate if the person has serious difficulty with any of the activities listed in parts a, b, and c because of a physical, mental, or emotional condition.