Questionnaire Text

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Other characteristics

For those of the age indicated.

20. Permanent physical disabilities:

(For those affected, of any age.) Mark the box as appropriate.

[] 1 Blind
[] 2 Deaf
[] 3 Deaf-mute

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Item XX: Permanent physical disabilities

227 - Annotate the permanent physical impediment(s) of the affected person (of any age) by marking an (x) in the corresponding box.