Questionnaire Text

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F. Answer questions 15 and 16 only if this person is 5 years old or over. Otherwise, skip to the questions for Person 2 on page 10.


15. Does this person have any of the following long-lasting conditions:

a) Blindness, deafness, or a severe vision or hearing impairment?

[] Yes
[] No


b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying?

[] Yes
[] No