Questionnaire Text

Questionnaire form view entire document:  text  image
I. Answer question 20 if this person is 15 years old or over. Otherwise, skip to the questions for Person 2 on page 12.

20. Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone such as visiting a doctor's office or shopping?

[] Yes
[] No
Questionnaire instructions view entire document:  text  image
Person questions 20-24

Answer question 20 if this person is 15 years old or over. Otherwise, skip to the questions for Person 2 on page 19.

P20. (no special instructions)