Questionnaire Text

Questionnaire form view entire document:  text  image
P-13 Assistive devices and medication
Does [the person] use any of the following?
Write the appropriate code [number from 1 to 3] in the box.

_ A. Eye glasses
_ B. Hearing aid
_ C. Walking stick or frame
_ D. A wheelchair
_ E. Chronic medication
1. Yes
2. No
3. Do not know
Questionnaire instructions view entire document:  text  image
5. Section C: General health and functioning (remember to follow instructions)
Purpose: Helps to determine the number of people with disabilities in the country for planning and provision of services.

This section must be completed for every person listed on the questionnaire.