study_engine 0.0.2
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- checksums.yaml +7 -0
- data/Rakefile +42 -0
- data/app/assets/images/study_engine/spinner.gif +0 -0
- data/app/assets/images/study_engine/sprite/delete.png +0 -0
- data/app/assets/images/study_engine/sprite/download.png +0 -0
- data/app/assets/images/study_engine/sprite/edit.png +0 -0
- data/app/assets/images/study_engine/sprite/incomplete.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc-sm.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc.png +0 -0
- data/app/assets/images/study_engine/sprite/new.png +0 -0
- data/app/assets/javascripts/study_engine/admin_notes.js.coffee +12 -0
- data/app/assets/javascripts/study_engine/assessment_notifications.js.coffee +36 -0
- data/app/assets/javascripts/study_engine/assessment_timeout.js.coffee +24 -0
- data/app/assets/javascripts/study_engine/disable_buttons_after_click.js.coffee +6 -0
- data/app/assets/javascripts/study_engine/fire_click_event_immediately_on_mobile.js.coffee.erb +10 -0
- data/app/assets/javascripts/study_engine/response_validation.js.coffee +8 -0
- data/app/assets/javascripts/study_engine/restart_assessment_button.js.coffee +3 -0
- data/app/assets/javascripts/study_engine/study_engine.js.coffee +9 -0
- data/app/assets/javascripts/study_engine/study_id_picker.js.coffee +28 -0
- data/app/assets/stylesheets/study_engine.sass +1 -0
- data/app/assets/stylesheets/study_engine/_constant.sass +52 -0
- data/app/assets/stylesheets/study_engine/_mobile.sass +8 -0
- data/app/assets/stylesheets/study_engine/_tablet.sass +36 -0
- data/app/assets/stylesheets/study_engine/application.sass +101 -0
- data/app/assets/stylesheets/study_engine/base/_form.sass +131 -0
- data/app/assets/stylesheets/study_engine/base/_list.sass +38 -0
- data/app/assets/stylesheets/study_engine/base/_tables.sass +33 -0
- data/app/assets/stylesheets/study_engine/base/_text.sass +78 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_login-fields.sass +14 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_start-fields.sass +101 -0
- data/app/assets/stylesheets/study_engine/components/-nav/_global-nav.sass +19 -0
- data/app/assets/stylesheets/study_engine/components/-table/_results-table.sass +75 -0
- data/app/assets/stylesheets/study_engine/components/-table/_users-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/components/_assessment-questions.sass +30 -0
- data/app/assets/stylesheets/study_engine/components/_form-buttons.sass +102 -0
- data/app/assets/stylesheets/study_engine/components/_helpt-text.sass +2 -0
- data/app/assets/stylesheets/study_engine/components/_method-icons.sass +15 -0
- data/app/assets/stylesheets/study_engine/components/_notes-modal.sass +65 -0
- data/app/assets/stylesheets/study_engine/components/_progress-bar.sass +25 -0
- data/app/assets/stylesheets/study_engine/components/_sortable-columns.sass +26 -0
- data/app/assets/stylesheets/study_engine/components/_table-actions.sass +8 -0
- data/app/assets/stylesheets/study_engine/components/_table-buttons.sass +17 -0
- data/app/assets/stylesheets/study_engine/components/_user-privileges.sass +3 -0
- data/app/assets/stylesheets/study_engine/mixins/_actions-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/mixins/_buttons.sass +55 -0
- data/app/assets/stylesheets/study_engine/mixins/_checkbox-columns.sass +50 -0
- data/app/assets/stylesheets/study_engine/mixins/_custom-radios.sass +47 -0
- data/app/assets/stylesheets/study_engine/mixins/_icons.sass +38 -0
- data/app/assets/stylesheets/study_engine/mixins/_notification-text.sass +23 -0
- data/app/controllers/study_engine/admin/application_controller.rb +6 -0
- data/app/controllers/study_engine/admin/assessments_controller.rb +79 -0
- data/app/controllers/study_engine/admin/notes_controller.rb +17 -0
- data/app/controllers/study_engine/application_controller.rb +12 -0
- data/app/controllers/study_engine/assessments_controller.rb +94 -0
- data/app/helpers/study_engine/helpers.rb +15 -0
- data/app/helpers/study_engine/mailer_helpers.rb +11 -0
- data/app/mailers/study_engine/mailer.rb +25 -0
- data/app/models/study_engine/answer.rb +36 -0
- data/app/models/study_engine/assessment.rb +118 -0
- data/app/models/study_engine/begin_assessment_form.rb +110 -0
- data/app/models/study_engine/existing_assessments_form.rb +99 -0
- data/app/models/study_engine/form.rb +59 -0
- data/app/models/study_engine/report.rb +69 -0
- data/app/models/study_engine/result.rb +46 -0
- data/app/models/study_engine/screen_results.rb +54 -0
- data/app/models/study_engine/study_id.rb +47 -0
- data/app/models/study_engine/study_id/bank.rb +38 -0
- data/app/models/study_engine/study_id/sync.rb +52 -0
- data/app/models/study_engine/update_assessments_form.rb +53 -0
- data/app/views/study_engine/_progress_bar.html.slim +4 -0
- data/app/views/study_engine/admin/assessments/_assessment.html.slim +36 -0
- data/app/views/study_engine/admin/assessments/domain_results.csv.csvbuilder +17 -0
- data/app/views/study_engine/admin/assessments/edit.html.slim +68 -0
- data/app/views/study_engine/admin/assessments/index.html.slim +26 -0
- data/app/views/study_engine/admin/assessments/item_results.csv.csvbuilder +24 -0
- data/app/views/study_engine/admin/assessments/new.html.slim +46 -0
- data/app/views/study_engine/admin/assessments/screen_results.csv.csvbuilder +2 -0
- data/app/views/study_engine/assessments/complete.html.slim +25 -0
- data/app/views/study_engine/assessments/create.html.slim +46 -0
- data/app/views/study_engine/assessments/index.html.slim +43 -0
- data/app/views/study_engine/assessments/restart.html.slim +28 -0
- data/app/views/study_engine/assessments/show.html.slim +60 -0
- data/app/views/study_engine/mailer/assessment_recorded_notification.erb +8 -0
- data/app/views/study_engine/mailer/assessment_url_notification.erb +6 -0
- data/config/routes.rb +15 -0
- data/db/migrate/20160422185859_create_tables.rb +52 -0
- data/lib/study_engine.rb +5 -0
- data/lib/study_engine/config.rb +37 -0
- data/lib/study_engine/cucumber.rb +96 -0
- data/lib/study_engine/engine.rb +7 -0
- data/lib/study_engine/version.rb +3 -0
- data/lib/tasks/study_engine_tasks.rake +10 -0
- data/spec/ar_helper.rb +30 -0
- data/spec/models/study_engine/answer_spec.rb +28 -0
- data/spec/models/study_engine/assessment_spec.rb +250 -0
- data/spec/models/study_engine/begin_assessment_form_spec.rb +87 -0
- data/spec/models/study_engine/existing_assessments_form_spec.rb +171 -0
- data/spec/models/study_engine/report_spec.rb +48 -0
- data/spec/models/study_engine/result_spec.rb +102 -0
- data/spec/models/study_engine/screen_results_spec.rb +69 -0
- data/spec/models/study_engine/study_id/bank_spec.rb +72 -0
- data/spec/models/study_engine/study_id/sync_spec.rb +61 -0
- data/spec/models/study_engine/study_id_spec.rb +7 -0
- data/spec/models/study_engine/update_assessments_form_spec.rb +38 -0
- data/spec/rails_helper.rb +50 -0
- data/spec/schema.rb +65 -0
- data/spec/spec_helper.rb +72 -0
- data/spec/support/CATEngine3.exe +0 -0
- data/spec/support/forms/01. Physical Function Bank.xml +1213 -0
- data/spec/support/forms/02. Pain Interference Bank.xml +443 -0
- data/spec/support/forms/03. Anxiety Bank.xml +322 -0
- data/spec/support/forms/04. Depression Bank.xml +311 -0
- data/spec/support/forms/05. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/06. Psychosocial Illness Impact Pos Bank.xml +900 -0
- data/spec/support/forms/07. Applied Cognition Gen Concerns Bank.xml +377 -0
- data/spec/support/forms/08. Satisfaction with Roles and Activities Bank Version 2.xml +443 -0
- data/spec/support/forms/09. Sleep Disturbance Bank.xml +300 -0
- data/spec/support/forms/10. Emotional Support Bank.xml +163 -0
- data/spec/support/forms/A - 07. Psychosocial Illness Impact Pos Bank.xml +471 -0
- data/spec/support/forms/A - 08. Pain interference Bank.xml +443 -0
- data/spec/support/forms/A - 09. Depression Bank.xml +311 -0
- data/spec/support/forms/B - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/B - 08. Physical Function Remainder A.xml +543 -0
- data/spec/support/forms/B - 09. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/C - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/C - 08. Physical Function Remainder B.xml +553 -0
- data/spec/support/forms/C - 09. Anxiety Bank.xml +322 -0
- data/spec/support/parameters/01. Physical Function Bank.xml +682 -0
- data/spec/support/parameters/02. Pain Interference Bank.xml +256 -0
- data/spec/support/parameters/03. Anxiety Bank.xml +190 -0
- data/spec/support/parameters/04. Depression Bank.xml +184 -0
- data/spec/support/parameters/05. Ability to Participate Social bank Version 2.xml +226 -0
- data/spec/support/parameters/06. Psychosocial Illness Impact Pos Bank.xml +211 -0
- data/spec/support/parameters/07. Applied Cognition Gen Concerns Bank.xml +1 -0
- data/spec/support/parameters/08. Satisfaction with Roles and Activities Bank Version 2.xml +1 -0
- data/spec/support/parameters/09. Sleep Disturbance Bank.xml +1 -0
- data/spec/support/parameters/10. Emotional Support Bank.xml +1 -0
- metadata +394 -0
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59
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60
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61
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62
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63
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64
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65
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66
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67
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68
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70
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71
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72
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73
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74
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<Element ElementOID="3BF20BB8-57F9-467E-8C34-057517C75D68" Description="Does your health now limit you in doing eight hours of physical labor?" ElementOrder="2"/>
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75
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76
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77
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78
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79
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80
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81
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+
</Element>
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82
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+
</Item>
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83
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84
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+
<Element ElementOID="BED78803-8B2C-48B7-AC81-7BF9635A0059" Description="Are you able to bend down and pick up clothing from the floor?" ElementOrder="2"/>
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85
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86
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87
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88
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89
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90
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+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="654B05BA-4B6C-4AAC-A8D2-32110DA1AB1A" Value="5" Position="5"/>
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91
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+
</Element>
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|
92
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+
</Item>
|
|
93
|
+
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|
|
94
|
+
<Element ElementOID="3C7A78DD-4FEA-46D8-BD52-FEC9AE0A4203" Description="Are you able to push open a heavy door?" ElementOrder="2"/>
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95
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+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
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96
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97
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+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="0422BCF4-62B8-4DC4-BCB9-51F522043493" Value="2" Position="2"/>
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98
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99
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<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="B1FA4C21-DEFE-4F5B-BBB9-91A1531B2DF6" Value="4" Position="4"/>
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100
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+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="52FA1FCD-9818-4792-95DC-EAD8A49EEC06" Value="5" Position="5"/>
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101
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+
</Element>
|
|
102
|
+
</Item>
|
|
103
|
+
<Item FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ID="PFA25" Order="22">
|
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104
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+
<Element ElementOID="89568D9C-483E-4E98-B3CC-6EFA1701D997" Description="Are you able to do yard work like raking leaves, weeding, or pushing a lawn mower?" ElementOrder="2"/>
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105
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
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106
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107
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108
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109
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<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="A5996F6D-747C-425F-8E33-20E25BDA3EA5" Value="4" Position="4"/>
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110
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<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="28A0373E-A983-4A4E-BB50-9B1DD4A0F56B" Value="5" Position="5"/>
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111
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</Element>
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112
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+
</Item>
|
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113
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+
<Item FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ID="PFB5r1" Order="53">
|
|
114
|
+
<Element ElementOID="1E12D36E-0CBB-4C1E-BD83-0039ACE0E152" Description="Does your health now limit you in hiking a couple of miles (3 km) on uneven surfaces, including hills?" ElementOrder="1"/>
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115
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116
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<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="6AA7C4AA-6FC8-4E0E-857E-04CE82B17F51" Value="1" Position="1"/>
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117
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118
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<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="9C593F38-B15D-4545-9F32-6C9166EC9058" Value="3" Position="3"/>
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119
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<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="7ACDEE19-B935-4FA3-9A6B-A4FA818EFD2E" Value="4" Position="4"/>
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120
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<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="5C7D8AE4-5C9D-4C2F-9D90-DF0F160F6FB4" Value="5" Position="5"/>
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121
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</Element>
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</Item>
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</Form>
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@@ -0,0 +1,543 @@
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1
|
+
<?xml version="1.0"?>
|
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2
|
+
<Form DateFinished="" Name="Creation of a new version of Physical Function that accommodates 19 revisions, in preparation of Spanish translations.">
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|
3
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<Item FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ID="PFA50" Order="44">
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4
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<Element ElementOID="25F10D4A-D29B-4ED7-A33A-2DBBEF6B96D7" Description="Are you able to brush your teeth?" ElementOrder="2"/>
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<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="801ADB4D-07EA-40D6-86AF-821BCC19670F" Value="2" Position="2"/>
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<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="5747F875-7051-4658-8B2C-01CD2358E261" Value="3" Position="3"/>
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<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="B46CB324-268C-4026-9D79-904215AC5A49" Value="4" Position="4"/>
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<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="F8321894-6D3A-461C-9C6A-A3151023E2C1" Value="5" Position="5"/>
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11
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</Element>
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12
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</Item>
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13
|
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<Item FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ID="PFB3" Order="52">
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14
|
+
<Element ElementOID="E749AAD0-44CA-4EC0-A36C-36B4F2072074" Description="Does your health now limit you in putting a trash bag outside?" ElementOrder="2"/>
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15
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<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
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22
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</Item>
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23
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24
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<Element ElementOID="843E803D-FF2D-4E95-8AE1-9C48794C822E" Description="Are you able to get in and out of a car?" ElementOrder="2"/>
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25
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29
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30
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="51D5D3E3-2C3A-498D-82E0-D7EB70E939A5" Value="5" Position="5"/>
|
|
31
|
+
</Element>
|
|
32
|
+
</Item>
|
|
33
|
+
<Item FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ID="PFA6" Order="5">
|
|
34
|
+
<Element ElementOID="6552A8EB-E9B5-4601-8EA5-5C08488EC6D2" Description="Does your health now limit you in bathing or dressing yourself?" ElementOrder="2"/>
|
|
35
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
36
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="74F93748-E91F-4120-A625-DAEB48BAE550" Value="1" Position="1"/>
|
|
37
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="F3D24B93-6048-4B06-BCA2-56AA6260CFD5" Value="2" Position="2"/>
|
|
38
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="5155BA5E-3EBB-4403-8DB6-2753CF897100" Value="3" Position="3"/>
|
|
39
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="79BC832D-4880-4702-BF23-B7BA51F04F32" Value="4" Position="4"/>
|
|
40
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="9D021D6F-8D90-444B-AF4B-0812461F128C" Value="5" Position="5"/>
|
|
41
|
+
</Element>
|
|
42
|
+
</Item>
|
|
43
|
+
<Item FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ID="PFB8r1" Order="55">
|
|
44
|
+
<Element ElementOID="F9A9E329-4D25-47EA-AD34-27292D8B30E0" Description="Are you able to carry two bags filled with groceries 100 yards (100 m)?" ElementOrder="1"/>
|
|
45
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
46
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="A78C0DD4-54B5-4022-841E-1334A2A94713" Value="1" Position="1"/>
|
|
47
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="24C36055-AB49-45BB-97D0-2085CE69DB42" Value="2" Position="2"/>
|
|
48
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="F908BB77-6B9C-44FD-BB5C-DBC003F0E270" Value="3" Position="3"/>
|
|
49
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="1E1E9742-F23C-4BF4-93E4-E1A1469EA7F8" Value="4" Position="4"/>
|
|
50
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="503AA403-C6B3-4D7F-BA5B-5F14E9B1A84C" Value="5" Position="5"/>
|
|
51
|
+
</Element>
|
|
52
|
+
</Item>
|
|
53
|
+
<Item FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ID="PFA32" Order="27">
|
|
54
|
+
<Element ElementOID="1A1D7432-D219-4148-AD5C-3C0E36D9A977" Description="Are you able to stand with your knees straight?" ElementOrder="2"/>
|
|
55
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
56
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="75400B76-D3F5-46FE-87D7-28D3F3013900" Value="1" Position="1"/>
|
|
57
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="4AC17E78-6F6C-49F1-9475-7365F92D6878" Value="2" Position="2"/>
|
|
58
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="CB040E76-0BA9-46DF-BCBC-445A878D75B6" Value="3" Position="3"/>
|
|
59
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="9831E9B1-EAE3-4126-8A32-AAEE7AAA7E98" Value="4" Position="4"/>
|
|
60
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="A11FBB1D-0D61-4AFC-9051-219F0BC5CC43" Value="5" Position="5"/>
|
|
61
|
+
</Element>
|
|
62
|
+
</Item>
|
|
63
|
+
<Item FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ID="PFB13" Order="60">
|
|
64
|
+
<Element ElementOID="F7E0557A-79BB-4670-9F70-7D8C7F70E080" Description="Are you able to carry a shopping bag or briefcase?" ElementOrder="2"/>
|
|
65
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
66
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="C63925FF-6AFF-4D9D-8F07-5DA59EC77561" Value="1" Position="1"/>
|
|
67
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="693B950C-D539-4321-82BF-0A5825FAC3D8" Value="2" Position="2"/>
|
|
68
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="DF642025-5535-400E-8841-8D5E96661A19" Value="3" Position="3"/>
|
|
69
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="C7E85741-3B98-4890-9418-E48892DD3B02" Value="4" Position="4"/>
|
|
70
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="CF45409D-93C8-4507-8EEE-2880464525DA" Value="5" Position="5"/>
|
|
71
|
+
</Element>
|
|
72
|
+
</Item>
|
|
73
|
+
<Item FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ID="PFA10" Order="8">
|
|
74
|
+
<Element ElementOID="0D7AC282-7101-4528-86FE-9F7089480012" Description="Are you able to stand for one hour?" ElementOrder="2"/>
|
|
75
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
76
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="E9444DD7-AEC9-41E9-9E25-CCC2E5F87E42" Value="1" Position="1"/>
|
|
77
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="7CF284DC-CE3D-48DD-8312-475AF9FF1F7A" Value="2" Position="2"/>
|
|
78
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="F4B2CB64-A4B0-43AE-ABAE-A35F9E47D729" Value="3" Position="3"/>
|
|
79
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="A06A4812-5730-433C-BA0A-13907885021C" Value="4" Position="4"/>
|
|
80
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="E533DC33-3511-4399-9AC6-0A34E0A90A8A" Value="5" Position="5"/>
|
|
81
|
+
</Element>
|
|
82
|
+
</Item>
|
|
83
|
+
<Item FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ID="PFA16r1" Order="14">
|
|
84
|
+
<Element ElementOID="5D0955F3-B229-46C5-B6D3-15A0F2DC5295" Description="Are you able to dress yourself, including tying shoelaces and buttoning your clothes?" ElementOrder="1"/>
|
|
85
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
86
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="6231597E-26B0-4E32-AF03-C6564BA2DB2A" Value="1" Position="1"/>
|
|
87
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="AEE6DC2F-83A8-4F89-9E4D-C9E65EECDEB9" Value="2" Position="2"/>
|
|
88
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="31F53FF0-733D-461B-B549-004D55A2DE22" Value="3" Position="3"/>
|
|
89
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="326DA98D-DA6B-4B16-9EF2-5B0EB03CB219" Value="4" Position="4"/>
|
|
90
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="BE5DC566-E5D4-42CB-BB92-587B48353D01" Value="5" Position="5"/>
|
|
91
|
+
</Element>
|
|
92
|
+
</Item>
|
|
93
|
+
<Item FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ID="PFB1" Order="51">
|
|
94
|
+
<Element ElementOID="E72C0E84-ACDD-43B4-8804-FDF00E724073" Description="Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries?" ElementOrder="2"/>
|
|
95
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
96
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="B026E94E-50B7-4019-AD7F-6466B3C15EF3" Value="1" Position="1"/>
|
|
97
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="EFA3123D-F75B-409E-83B4-8A8C1C604854" Value="2" Position="2"/>
|
|
98
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="84A29153-E2D5-493F-B210-8458C5C40830" Value="3" Position="3"/>
|
|
99
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="1634FE91-34FE-4C9B-BE0A-A5D2204CC4A3" Value="4" Position="4"/>
|
|
100
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="334FD050-373F-42F4-AEC8-E8CC1AB09827" Value="5" Position="5"/>
|
|
101
|
+
</Element>
|
|
102
|
+
</Item>
|
|
103
|
+
<Item FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ID="PFA36" Order="31">
|
|
104
|
+
<Element ElementOID="06E46D12-D8CA-497A-A721-CAD491FD879D" Description="Are you able to put on and take off a coat or jacket?" ElementOrder="2"/>
|
|
105
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
106
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="A64AE07B-8386-4332-B0FE-B1460131798B" Value="1" Position="1"/>
|
|
107
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="C7191C70-E643-444A-BE19-81C758416003" Value="2" Position="2"/>
|
|
108
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="1448218F-5322-47DD-B8BF-9F72212CBDCB" Value="3" Position="3"/>
|
|
109
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="4F860E42-8518-4C76-9383-96D566735A87" Value="4" Position="4"/>
|
|
110
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="55916686-5897-4542-A4C3-E3C22EAE049D" Value="5" Position="5"/>
|
|
111
|
+
</Element>
|
|
112
|
+
</Item>
|
|
113
|
+
<Item FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ID="PFA49" Order="43">
|
|
114
|
+
<Element ElementOID="58B89040-62F3-4E77-A07B-B88F4A47C982" Description="Are you able to bend or twist your back?" ElementOrder="2"/>
|
|
115
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
116
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="A6BC67EA-7ECE-4E2E-83D1-64C802C8B89C" Value="1" Position="1"/>
|
|
117
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="7C24D299-651C-4592-8ED4-5B6C054B5AB0" Value="2" Position="2"/>
|
|
118
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="874838E9-21F4-4CEF-B20C-526A3081873B" Value="3" Position="3"/>
|
|
119
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="0B0FA2AF-375D-4652-9675-043B9D7DA4BD" Value="4" Position="4"/>
|
|
120
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="2CEE04CB-0163-459F-9B8A-FED635D039B1" Value="5" Position="5"/>
|
|
121
|
+
</Element>
|
|
122
|
+
</Item>
|
|
123
|
+
<Item FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ID="PFB14" Order="61">
|
|
124
|
+
<Element ElementOID="33B9740F-D91A-4C00-8939-11A71DB613B5" Description="Are you able to take a tub bath?" ElementOrder="2"/>
|
|
125
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
126
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="2E51A68A-1A9C-4796-A8D8-00FBB023A666" Value="1" Position="1"/>
|
|
127
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="84EF456F-C910-4191-BE02-3F4DC95014A8" Value="2" Position="2"/>
|
|
128
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="8C8FE821-767F-4900-B835-7036B6A8D846" Value="3" Position="3"/>
|
|
129
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="9A56F268-6980-4A77-BC86-BB8A6EF8554E" Value="4" Position="4"/>
|
|
130
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="57C1A0A6-E38B-452F-8517-172B061745C1" Value="5" Position="5"/>
|
|
131
|
+
</Element>
|
|
132
|
+
</Item>
|
|
133
|
+
<Item FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ID="PFA3" Order="2">
|
|
134
|
+
<Element ElementOID="E16B583B-636A-4BC3-A324-2BC8C7722A0D" Description="Does your health now limit you in bending, kneeling, or stooping?" ElementOrder="2"/>
|
|
135
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
136
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="FFB59F0E-9534-41FF-AE46-43CF6A4A7DE4" Value="1" Position="1"/>
|
|
137
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="4A5D72D0-DDAE-41E1-8FA6-B709CC64F69E" Value="2" Position="2"/>
|
|
138
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="A444AB69-9D6E-431E-990B-075B686D7FEF" Value="3" Position="3"/>
|
|
139
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="DEAE5A56-38DF-4010-AEE6-8BD3755773FB" Value="4" Position="4"/>
|
|
140
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="0E7D78FB-5853-4BC2-92E0-3850BD024EB1" Value="5" Position="5"/>
|
|
141
|
+
</Element>
|
|
142
|
+
</Item>
|
|
143
|
+
<Item FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ID="PFA34" Order="29">
|
|
144
|
+
<Element ElementOID="0ADEBD37-FC8F-4ED0-B118-FCF1D7D22FC9" Description="Are you able to wash your back?" ElementOrder="2"/>
|
|
145
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
146
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="7D6F9E9E-0508-4D76-A398-8A3A34777970" Value="1" Position="1"/>
|
|
147
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="6E1955D6-867C-4CFB-943C-605C287893A3" Value="2" Position="2"/>
|
|
148
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="439A243E-DCAD-4A4F-99C2-03FFCCDE8F12" Value="3" Position="3"/>
|
|
149
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="70E499DF-1881-4911-AAAB-B85B2206D7DC" Value="4" Position="4"/>
|
|
150
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="3631ABA6-A9AB-4D9F-9D5A-1C7C293BF8CC" Value="5" Position="5"/>
|
|
151
|
+
</Element>
|
|
152
|
+
</Item>
|
|
153
|
+
<Item FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ID="PFA5" Order="4">
|
|
154
|
+
<Element ElementOID="2A2E24C4-25E9-499F-937E-C2CFC7900D38" Description="Does your health now limit you in lifting or carrying groceries?" ElementOrder="2"/>
|
|
155
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
156
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="5FB846C2-0B84-47A1-995E-7532D6C867D2" Value="1" Position="1"/>
|
|
157
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="7A9BB904-C230-44BB-8692-C3F3FE3DE2BE" Value="2" Position="2"/>
|
|
158
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="D4532E89-A5AD-4F99-8591-E8BFC826DE25" Value="3" Position="3"/>
|
|
159
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="2B99E9D6-11AF-4D57-A409-5EB4979EF4EE" Value="4" Position="4"/>
|
|
160
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="2B7860F9-31C8-4C64-864A-BB085FA016A2" Value="5" Position="5"/>
|
|
161
|
+
</Element>
|
|
162
|
+
</Item>
|
|
163
|
+
<Item FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ID="PFA54" Order="48">
|
|
164
|
+
<Element ElementOID="6C134388-565C-4AEB-B2E4-F4D690A7EA61" Description="Are you able to button your shirt?" ElementOrder="2"/>
|
|
165
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
166
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="15075CA3-3139-4286-97C6-9B237F67AD18" Value="1" Position="1"/>
|
|
167
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="9B9E2E78-D8E5-4F58-BB79-3A192AF46551" Value="2" Position="2"/>
|
|
168
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="3B9D46E3-2633-4F2B-8859-501E8150E52D" Value="3" Position="3"/>
|
|
169
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="08D331D3-EE34-4845-8415-B68085CB2C34" Value="4" Position="4"/>
|
|
170
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="5D29995F-1379-4685-A24C-7A3B14A13A57" Value="5" Position="5"/>
|
|
171
|
+
</Element>
|
|
172
|
+
</Item>
|
|
173
|
+
<Item FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ID="PFB9" Order="56">
|
|
174
|
+
<Element ElementOID="0A3B39C3-A742-4E63-94E8-6A2B334E4F41" Description="Are you able to jump up and down?" ElementOrder="2"/>
|
|
175
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
176
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="A2AE8796-1DA8-4216-876E-410288E48754" Value="1" Position="1"/>
|
|
177
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="596170BA-D09A-4D10-8306-0C5FDF50B7E7" Value="2" Position="2"/>
|
|
178
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="D13C4A0B-8358-485B-AB95-DE23B5BCBBCE" Value="3" Position="3"/>
|
|
179
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="890DAB13-01D3-4FB6-BC33-F102F6CF7B3D" Value="4" Position="4"/>
|
|
180
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="A6683A82-2B4C-4012-B300-DC2A2F86389F" Value="5" Position="5"/>
|
|
181
|
+
</Element>
|
|
182
|
+
</Item>
|
|
183
|
+
<Item FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ID="PFA47" Order="41">
|
|
184
|
+
<Element ElementOID="892BC880-A169-4CB2-8AEC-44882EEE1A36" Description="Are you able to pull on trousers?" ElementOrder="2"/>
|
|
185
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
186
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="65E16B78-06B1-41B6-ABA0-9F2BEA57E968" Value="1" Position="1"/>
|
|
187
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="CC0C752C-7157-4DB7-9AB8-6236426B2AE5" Value="2" Position="2"/>
|
|
188
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="668A164F-3D7B-4C8F-A189-D5DBD7A225DC" Value="3" Position="3"/>
|
|
189
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="558BDC67-38DA-43AE-BADF-556FBDD8170C" Value="4" Position="4"/>
|
|
190
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="F2708681-97B3-45B3-9D4C-38E1ECB95CEC" Value="5" Position="5"/>
|
|
191
|
+
</Element>
|
|
192
|
+
</Item>
|
|
193
|
+
<Item FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ID="PFA30" Order="25">
|
|
194
|
+
<Element ElementOID="0D08EEC7-F65C-4BB1-A173-542F6702E09A" Description="Are you able to step up and down curbs?" ElementOrder="2"/>
|
|
195
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
196
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="9492DCEC-C47E-4A21-9163-9B8EAAD25720" Value="1" Position="1"/>
|
|
197
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="F1A39B23-3B10-439B-97CF-08FDC330E751" Value="2" Position="2"/>
|
|
198
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="5DE01DA2-2EE2-45EE-AD5C-88AB7FF70629" Value="3" Position="3"/>
|
|
199
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="7EE314A7-18E6-4CA4-A309-9AD3E4C463D8" Value="4" Position="4"/>
|
|
200
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="136BF0F7-FC43-43D8-BFC8-4F527B0F7829" Value="5" Position="5"/>
|
|
201
|
+
</Element>
|
|
202
|
+
</Item>
|
|
203
|
+
<Item FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ID="PFA42" Order="37">
|
|
204
|
+
<Element ElementOID="24153E80-9CE9-406A-AEB6-508E625C2819" Description="Are you able to carry a laundry basket up a flight of stairs?" ElementOrder="2"/>
|
|
205
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
206
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="D009EB87-3631-4C80-9458-ABC8501A601E" Value="1" Position="1"/>
|
|
207
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="7219E03C-1BC6-4C93-98BE-40BF9E74B2BE" Value="2" Position="2"/>
|
|
208
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="A7CBE389-6BAF-422F-B37A-23C814B3A98D" Value="3" Position="3"/>
|
|
209
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="817394F7-F88A-4C72-AB88-DE17EC2E7B8B" Value="4" Position="4"/>
|
|
210
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="21B288EF-E914-477B-A337-E32FFF222A8E" Value="5" Position="5"/>
|
|
211
|
+
</Element>
|
|
212
|
+
</Item>
|
|
213
|
+
<Item FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ID="PFA40" Order="35">
|
|
214
|
+
<Element ElementOID="505A0EF6-5DCC-4B20-9AD3-419167C5D8DE" Description="Are you able to turn a key in a lock?" ElementOrder="2"/>
|
|
215
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
216
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="4C8D0ED5-8966-48F9-85C9-768136BC2762" Value="1" Position="1"/>
|
|
217
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="B9A5D309-A1F9-49D3-8CEC-6F2010CD02F2" Value="2" Position="2"/>
|
|
218
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="453B9C1A-0FFB-4D9E-A3E4-E4AEEDDD6FE1" Value="3" Position="3"/>
|
|
219
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="252673D2-DE4D-483B-824E-525CBB6F5C86" Value="4" Position="4"/>
|
|
220
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="5B3B53F1-DFE0-457D-B031-B586F09B7BBF" Value="5" Position="5"/>
|
|
221
|
+
</Element>
|
|
222
|
+
</Item>
|
|
223
|
+
<Item FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ID="PFA20" Order="18">
|
|
224
|
+
<Element ElementOID="63AD93BE-140B-4E03-A077-6817DF52E9AF" Description="Are you able to cut your food using eating utensils?" ElementOrder="2"/>
|
|
225
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
226
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="AE6CCD3C-8B22-4890-AC38-6F3AF804E85E" Value="1" Position="1"/>
|
|
227
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="CF05D01F-3BDF-476A-9BE3-4BAAAD739C8C" Value="2" Position="2"/>
|
|
228
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="3A04CC40-6610-48F0-8F82-9BE93CFA93FF" Value="3" Position="3"/>
|
|
229
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="05A88FC7-4A26-4010-A8CB-E74C4C75ECC2" Value="4" Position="4"/>
|
|
230
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="FE993528-2E9C-4B56-995F-DD239C17B416" Value="5" Position="5"/>
|
|
231
|
+
</Element>
|
|
232
|
+
</Item>
|
|
233
|
+
<Item FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ID="PFA17" Order="15">
|
|
234
|
+
<Element ElementOID="7D214313-7629-4D6F-AEC9-44335CF98241" Description="Are you able to reach into a high cupboard?" ElementOrder="2"/>
|
|
235
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
236
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="5EF0EC1D-EE9D-48FA-ABE3-B6095DC070F0" Value="1" Position="1"/>
|
|
237
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="79D0EF6D-F919-42A8-BA68-484235692EFE" Value="2" Position="2"/>
|
|
238
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="2E941732-9660-485C-86B5-0425CFC78EBC" Value="3" Position="3"/>
|
|
239
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="CAF8ED82-398E-4875-B7D1-6E55F0A6A87D" Value="4" Position="4"/>
|
|
240
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="92FDF0F4-E9FD-492E-B879-D5C2809FCE13" Value="5" Position="5"/>
|
|
241
|
+
</Element>
|
|
242
|
+
</Item>
|
|
243
|
+
<Item FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ID="PFA45" Order="40">
|
|
244
|
+
<Element ElementOID="DBFCC80E-2D05-44F9-958C-0AC24A7D5631" Description="Are you able to get out of bed into a chair?" ElementOrder="2"/>
|
|
245
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
246
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="0618C458-F487-4BCD-B969-A15304F19B5D" Value="1" Position="1"/>
|
|
247
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="4A263000-8D23-44DE-BDB5-73C61A814555" Value="2" Position="2"/>
|
|
248
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="86FB001F-0339-4CBE-9DAF-9E16A37B2F29" Value="3" Position="3"/>
|
|
249
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="D8C76DBB-4069-4CBF-9012-3AA4DA841A4D" Value="4" Position="4"/>
|
|
250
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="629989AC-8AD2-40EC-810C-155344B0129F" Value="5" Position="5"/>
|
|
251
|
+
</Element>
|
|
252
|
+
</Item>
|
|
253
|
+
<Item FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ID="PFA29r1" Order="24">
|
|
254
|
+
<Element ElementOID="9158C498-D38D-4866-9F0A-BB36AEFE21BE" Description="Are you able to pull heavy objects (10 pounds/ 5 kg) towards yourself?" ElementOrder="1"/>
|
|
255
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
256
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="AA9AD8EB-CC3C-4C8B-BB8A-6FAEE0925FBC" Value="1" Position="1"/>
|
|
257
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="AD99B30A-474E-499D-86AD-3641EB05061B" Value="2" Position="2"/>
|
|
258
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="9DB3094C-D704-4009-9421-C3C2138D3400" Value="3" Position="3"/>
|
|
259
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="07EA1C3F-7491-4BB1-B654-13100DDD538E" Value="4" Position="4"/>
|
|
260
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="69F596C1-7C3A-44F4-AA0A-3297B654F9FE" Value="5" Position="5"/>
|
|
261
|
+
</Element>
|
|
262
|
+
</Item>
|
|
263
|
+
<Item FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ID="PFA14r1" Order="12">
|
|
264
|
+
<Element ElementOID="BB6BA0B0-5D29-47FE-9961-D370AA44C3E1" Description="Are you able to carry a heavy object (over 10 pounds /5 kg)?" ElementOrder="1"/>
|
|
265
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
266
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="5CD4E6FC-B377-428D-B19D-09ADBDA9AD1F" Value="1" Position="1"/>
|
|
267
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="0D18B8B2-3615-4444-9876-CF6796D5C198" Value="2" Position="2"/>
|
|
268
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="29BC6F55-0256-4373-A313-2907B8579399" Value="3" Position="3"/>
|
|
269
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="00382AF9-EC3C-43F1-AD6C-910326EFD09D" Value="4" Position="4"/>
|
|
270
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="673E331B-1B9F-4565-89DF-099E3B2E4AB8" Value="5" Position="5"/>
|
|
271
|
+
</Element>
|
|
272
|
+
</Item>
|
|
273
|
+
<Item FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ID="PFA28" Order="23">
|
|
274
|
+
<Element ElementOID="8081059F-27FD-43CB-BAC6-1625DF00266E" Description="Are you able to open a can with a hand can opener?" ElementOrder="2"/>
|
|
275
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
276
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="9C0A4CEC-33DB-4019-8AC4-BDECBF154086" Value="1" Position="1"/>
|
|
277
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="80E777FF-11DB-493F-AAA4-FE1CDFCD459C" Value="2" Position="2"/>
|
|
278
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="F4D9A819-B74C-4031-B9D3-F9202617A7A1" Value="3" Position="3"/>
|
|
279
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="1E82C485-1430-43BE-9CF3-4AA6E9508E02" Value="4" Position="4"/>
|
|
280
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="751266BF-B1BE-4C3E-951C-A5FC2C430732" Value="5" Position="5"/>
|
|
281
|
+
</Element>
|
|
282
|
+
</Item>
|
|
283
|
+
<Item FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ID="PFA23" Order="21">
|
|
284
|
+
<Element ElementOID="99FFC37C-AA68-4ED4-B8BC-CF96610CC3CE" Description="Are you able to go for a walk of at least 15 minutes?" ElementOrder="2"/>
|
|
285
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
286
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="FD2B69CE-A7CD-40EC-8CC8-259A8CF3011B" Value="1" Position="1"/>
|
|
287
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="420D3F7F-69ED-4845-AED6-E39D657F661C" Value="2" Position="2"/>
|
|
288
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="71C7606A-7B9C-4030-BB7A-263347DBFF7E" Value="3" Position="3"/>
|
|
289
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="7276D336-10A9-4FBF-8C35-8F294541F583" Value="4" Position="4"/>
|
|
290
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="C0F62A05-B98F-45A8-81D7-E6E5B177F4DD" Value="5" Position="5"/>
|
|
291
|
+
</Element>
|
|
292
|
+
</Item>
|
|
293
|
+
<Item FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ID="PFA53" Order="47">
|
|
294
|
+
<Element ElementOID="645F21B5-F0C0-4665-AC60-5EC7101C18A5" Description="Are you able to run errands and shop?" ElementOrder="2"/>
|
|
295
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
296
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="E0F29A0B-2D24-4C03-B739-5906045A7370" Value="1" Position="1"/>
|
|
297
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="30268CD3-7651-4714-BCF5-84EB6EFD205D" Value="2" Position="2"/>
|
|
298
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="714983D6-C592-45CC-BB8D-25113917F817" Value="3" Position="3"/>
|
|
299
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="1225C318-7D2D-4DE3-BE9A-379A13C37287" Value="4" Position="4"/>
|
|
300
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="2591E67D-0BE0-48C0-A761-7A96F44B9703" Value="5" Position="5"/>
|
|
301
|
+
</Element>
|
|
302
|
+
</Item>
|
|
303
|
+
<Item FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ID="PFA11" Order="9">
|
|
304
|
+
<Element ElementOID="8139E821-386D-4CF7-868E-4238B9D571AB" Description="Are you able to do chores such as vacuuming or yard work?" ElementOrder="2"/>
|
|
305
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
306
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="9DA8E613-62AD-478A-9A9D-A769459AD100" Value="1" Position="1"/>
|
|
307
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="9C4A6E4B-785A-4C4D-AD01-9BD9CD0715A8" Value="2" Position="2"/>
|
|
308
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="28F0DAC6-31C4-441A-9549-1C6456685557" Value="3" Position="3"/>
|
|
309
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="A4D553FD-2CF1-46AE-943B-7B3922F70C19" Value="4" Position="4"/>
|
|
310
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="38E5FB56-9CC4-405C-AD08-F1402A7D0F21" Value="5" Position="5"/>
|
|
311
|
+
</Element>
|
|
312
|
+
</Item>
|
|
313
|
+
<Item FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ID="PFA4" Order="3">
|
|
314
|
+
<Element ElementOID="2B613D19-8D42-4CE7-ACF5-52DC8F90E63E" Description="Does your health now limit you in doing heavy work around the house like scrubbing floors, or lifting or moving heavy furniture?" ElementOrder="2"/>
|
|
315
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
316
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="8A548999-BD77-45F1-A3CE-BEE5A04BDB71" Value="1" Position="1"/>
|
|
317
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="E5F5CF62-5EFF-405B-B121-0D0F5B009BAB" Value="2" Position="2"/>
|
|
318
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="2CAE0D23-60D8-49D0-9783-85F275D5E940" Value="3" Position="3"/>
|
|
319
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="8E0BE6BE-BDCE-4FD7-A118-B6FE16693C44" Value="4" Position="4"/>
|
|
320
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="AA51D7E6-13EF-437C-BC0B-354D11744865" Value="5" Position="5"/>
|
|
321
|
+
</Element>
|
|
322
|
+
</Item>
|
|
323
|
+
<Item FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ID="PFA41" Order="36">
|
|
324
|
+
<Element ElementOID="00B4926D-8162-4360-AD5D-066C302605AD" Description="Are you able to squat and get up?" ElementOrder="2"/>
|
|
325
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
326
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="78B3789E-CC4D-444D-AEDE-8F64361129EE" Value="1" Position="1"/>
|
|
327
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="6642C1F3-6C61-49D5-BE9E-2CA985D4B4FC" Value="2" Position="2"/>
|
|
328
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="91281D76-F109-4B65-8890-A38C3DCB7F18" Value="3" Position="3"/>
|
|
329
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="D74CAA24-9D0A-4370-86E7-E19BA1762290" Value="4" Position="4"/>
|
|
330
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="F7B33C7F-5EA8-4596-A544-9C9BF4891E62" Value="5" Position="5"/>
|
|
331
|
+
</Element>
|
|
332
|
+
</Item>
|
|
333
|
+
<Item FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ID="PFA37" Order="32">
|
|
334
|
+
<Element ElementOID="C9DD5DFB-DC70-4B37-85D5-09E47C0F535E" Description="Are you able to stand for short periods of time?" ElementOrder="2"/>
|
|
335
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
336
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="91BE4B56-C287-45A1-A524-BC6966223CCD" Value="1" Position="1"/>
|
|
337
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="96A024D4-2B09-406F-A7C5-39BEADF48AC1" Value="2" Position="2"/>
|
|
338
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="67A6144F-CBF4-45E3-9E38-F2BB1CAEBFBD" Value="3" Position="3"/>
|
|
339
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="33FCAF17-3BF3-49BF-82A0-3739025F2D46" Value="4" Position="4"/>
|
|
340
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="58B8B2E1-26C9-42D7-914C-CE7049AAA471" Value="5" Position="5"/>
|
|
341
|
+
</Element>
|
|
342
|
+
</Item>
|
|
343
|
+
<Item FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ID="PFA1" Order="1">
|
|
344
|
+
<Element ElementOID="97A71B3C-ACE3-4A49-9CEF-16DBB6B7F669" Description="Does your health now limit you in doing vigorous activities, such as running, lifting heavy objects, participating in strenuous sports?" ElementOrder="2"/>
|
|
345
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
346
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ItemResponseOID="B6D4FFC2-0735-48AF-B272-B441A7C2FDD0" Value="1" Position="1"/>
|
|
347
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ItemResponseOID="60BC2C72-B205-43E6-B056-7389F6A42884" Value="2" Position="2"/>
|
|
348
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ItemResponseOID="178F10C4-0BB2-4D88-8835-A07F9BF89649" Value="3" Position="3"/>
|
|
349
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ItemResponseOID="CAACF80B-F79D-44C3-9A6B-614145875B40" Value="4" Position="4"/>
|
|
350
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="421541DF-BACA-4A7D-9B82-0A69B87F4991" ItemResponseOID="DD38ADFA-23F0-4480-9218-355FF92CF167" Value="5" Position="5"/>
|
|
351
|
+
</Element>
|
|
352
|
+
</Item>
|
|
353
|
+
<Item FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ID="PFA8" Order="6">
|
|
354
|
+
<Element ElementOID="3496CB3B-441E-4113-BC8F-37E2DA0E7B34" Description="Are you able to move a chair from one room to another?" ElementOrder="2"/>
|
|
355
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
356
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="100A78ED-3949-496E-AE2D-0F647AE4632D" Value="1" Position="1"/>
|
|
357
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="C83B6A69-4373-4E8B-8C62-C1858C4EB121" Value="2" Position="2"/>
|
|
358
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="1A0B52B3-EB80-4695-8985-0A8FE5554EFC" Value="3" Position="3"/>
|
|
359
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="F05E059D-F938-4D74-96E0-31B88BF5D827" Value="4" Position="4"/>
|
|
360
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="8C521DD3-DBA1-41BA-B36E-73F36B41B31E" Value="5" Position="5"/>
|
|
361
|
+
</Element>
|
|
362
|
+
</Item>
|
|
363
|
+
<Item FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ID="PFB11" Order="58">
|
|
364
|
+
<Element ElementOID="F0580F23-7D2F-451C-8B01-56FF49167F82" Description="Are you able to wash dishes, pots, and utensils by hand while standing at a sink?" ElementOrder="2"/>
|
|
365
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
366
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="4B6717BC-2FAF-4BAD-96FF-30391197E959" Value="1" Position="1"/>
|
|
367
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="EB08C924-CB43-4E44-916C-ED669C4C23F4" Value="2" Position="2"/>
|
|
368
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="418C932D-2DEE-4353-8226-A9ACFB91F18E" Value="3" Position="3"/>
|
|
369
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="C3E1A8D2-5E07-45FE-BE4D-2D4886B988FD" Value="4" Position="4"/>
|
|
370
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="C036BDE8-0140-4E70-9381-7257285FA741" Value="5" Position="5"/>
|
|
371
|
+
</Element>
|
|
372
|
+
</Item>
|
|
373
|
+
<Item FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ID="PFA33" Order="28">
|
|
374
|
+
<Element ElementOID="9F12A1E5-B57C-4900-BBE4-1C6FEA8DBA57" Description="Are you able to exercise hard for half an hour?" ElementOrder="2"/>
|
|
375
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
376
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="F4C9209F-E632-4D42-AFF0-1F35ABA8FFA6" Value="1" Position="1"/>
|
|
377
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="B05064D0-4EF7-4CA6-9370-32852700F713" Value="2" Position="2"/>
|
|
378
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="F7119A19-4B5D-4BD1-B68F-B5A7ABED2DD2" Value="3" Position="3"/>
|
|
379
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="8FF63410-B945-4EF3-9D19-739DC6C1B2D9" Value="4" Position="4"/>
|
|
380
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="6A485EA2-C2C3-4022-8A17-D77F11996829" Value="5" Position="5"/>
|
|
381
|
+
</Element>
|
|
382
|
+
</Item>
|
|
383
|
+
<Item FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ID="PFB10" Order="57">
|
|
384
|
+
<Element ElementOID="E9AEDF64-D5F9-4077-ABBA-F1D0EB3C4F86" Description="Are you able to climb up five steps?" ElementOrder="2"/>
|
|
385
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
386
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="FD0D42BC-6333-4BC1-A71F-16E93952C278" Value="1" Position="1"/>
|
|
387
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="2F5C8799-245F-48F4-84EE-C87E889FA28C" Value="2" Position="2"/>
|
|
388
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="F3B1EF4E-E88A-4AEF-B718-E240B60DABA4" Value="3" Position="3"/>
|
|
389
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="E9362F71-0E07-4670-B527-597B74FEF891" Value="4" Position="4"/>
|
|
390
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="8C87C81E-06F2-4729-A46F-AD623CE723CF" Value="5" Position="5"/>
|
|
391
|
+
</Element>
|
|
392
|
+
</Item>
|
|
393
|
+
<Item FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ID="PFB12" Order="59">
|
|
394
|
+
<Element ElementOID="FF337CCA-E64E-427D-BA4E-F2C3B674271C" Description="Are you able to make a bed, including spreading and tucking in bed sheets?" ElementOrder="2"/>
|
|
395
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
396
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="CF180264-8E96-48D5-8202-F930E9FB4832" Value="1" Position="1"/>
|
|
397
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="E56CCA26-6DFB-4BE7-A76D-05A25028D7C8" Value="2" Position="2"/>
|
|
398
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="D7A8A402-D24A-46E1-9EC3-D8DD6E512FDF" Value="3" Position="3"/>
|
|
399
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="B367736C-7F9E-4E46-A232-15D23F36A25B" Value="4" Position="4"/>
|
|
400
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="4280567D-4DFA-4BD2-B73F-1103445C3C6F" Value="5" Position="5"/>
|
|
401
|
+
</Element>
|
|
402
|
+
</Item>
|
|
403
|
+
<Item FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ID="PFA22" Order="20">
|
|
404
|
+
<Element ElementOID="13E93D3D-A04B-4A6D-89E3-C9F6B5BB17AF" Description="Are you able to open previously opened jars?" ElementOrder="2"/>
|
|
405
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
406
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="BCEE1E17-A4A0-4907-970D-31A110BEF07B" Value="1" Position="1"/>
|
|
407
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="3D371C03-862C-4A3B-B71E-83EC50E3937B" Value="2" Position="2"/>
|
|
408
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="1A5FF944-966E-4046-9A7D-89532138E05C" Value="3" Position="3"/>
|
|
409
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="8FABB657-4241-407C-8085-A3FD3CB71579" Value="4" Position="4"/>
|
|
410
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="5FB23EBC-FE12-4A6A-A382-C3EDE29F610A" Value="5" Position="5"/>
|
|
411
|
+
</Element>
|
|
412
|
+
</Item>
|
|
413
|
+
<Item FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ID="PFA38" Order="33">
|
|
414
|
+
<Element ElementOID="946C93FF-8FE4-4177-A7A0-E748F75E7392" Description="Are you able to dry your back with a towel?" ElementOrder="2"/>
|
|
415
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
416
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="983F2C40-BB05-4F81-AA27-776D34A3215B" Value="1" Position="1"/>
|
|
417
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="FED3DE72-0874-471F-B07D-829E7762F542" Value="2" Position="2"/>
|
|
418
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="7BBC799D-2BEA-40A7-A09F-79AB258CF22C" Value="3" Position="3"/>
|
|
419
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="B6DBF63C-877D-4FBA-B27B-0B1946D56E1F" Value="4" Position="4"/>
|
|
420
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="825E4D90-1814-4403-AB02-FD70DD4FA359" Value="5" Position="5"/>
|
|
421
|
+
</Element>
|
|
422
|
+
</Item>
|
|
423
|
+
<Item FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ID="PFA43" Order="38">
|
|
424
|
+
<Element ElementOID="E2F73F1C-1C29-402E-832F-F5619E7DC733" Description="Are you able to write with a pen or pencil?" ElementOrder="2"/>
|
|
425
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
426
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="776B756A-966C-41B0-B378-3D0F5274F53A" Value="1" Position="1"/>
|
|
427
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="E8C81E44-1B38-49F7-AD21-E204786FE348" Value="2" Position="2"/>
|
|
428
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="C5F3BEF0-ADE8-40EE-9E9E-8AA025CA66D1" Value="3" Position="3"/>
|
|
429
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="05452552-7EEE-4423-9784-F5D19B569A40" Value="4" Position="4"/>
|
|
430
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="26D6C8EB-62E4-4423-8A47-E21179ADF1AE" Value="5" Position="5"/>
|
|
431
|
+
</Element>
|
|
432
|
+
</Item>
|
|
433
|
+
<Item FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ID="PFA35" Order="30">
|
|
434
|
+
<Element ElementOID="35C59AF6-80A8-4DEA-A146-5E065CBD7998" Description="Are you able to open and close a zipper?" ElementOrder="2"/>
|
|
435
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
436
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="AE9AAC8D-24FB-4AC2-B40C-B73762F51845" Value="1" Position="1"/>
|
|
437
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="9BD1C3B6-EA84-4271-9576-3F6163E2CEA6" Value="2" Position="2"/>
|
|
438
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="EEFC3F56-8859-44CD-AF5F-F1DFD5748302" Value="3" Position="3"/>
|
|
439
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="AD805055-9D5D-409B-8107-577DF7AE9A3C" Value="4" Position="4"/>
|
|
440
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="4194086C-92D8-4A6F-B1AA-3DB8F3A7E17C" Value="5" Position="5"/>
|
|
441
|
+
</Element>
|
|
442
|
+
</Item>
|
|
443
|
+
<Item FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ID="PFA31r1" Order="26">
|
|
444
|
+
<Element ElementOID="BA5D18D1-8697-46F8-8DB4-8CD32E1F61A3" Description="Are you able to get up from the floor from lying on your back without help?" ElementOrder="1"/>
|
|
445
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
446
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="A213E77D-4845-4BE1-AD2D-63F2889D0B7B" Value="1" Position="1"/>
|
|
447
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="B6B3964F-687D-4738-B7E6-001E08655A67" Value="2" Position="2"/>
|
|
448
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="2CD15B58-B4DF-4A9B-A81F-CAD5E93C6830" Value="3" Position="3"/>
|
|
449
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="27059662-B5DF-41A3-AAF5-C18B20C03432" Value="4" Position="4"/>
|
|
450
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="0FDAFC83-88E7-426D-B1FD-ECD99400C3C5" Value="5" Position="5"/>
|
|
451
|
+
</Element>
|
|
452
|
+
</Item>
|
|
453
|
+
<Item FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ID="PFA18" Order="16">
|
|
454
|
+
<Element ElementOID="6030769E-74C3-4121-8F98-FCE92D7AED29" Description="Are you able to use a hammer to pound a nail?" ElementOrder="2"/>
|
|
455
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
456
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="FF9FE56C-6F28-4BB0-80F4-337E44811280" Value="1" Position="1"/>
|
|
457
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="532F35A5-6B2C-4227-A484-FFECC284941C" Value="2" Position="2"/>
|
|
458
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="8BCACD89-CDB5-453E-B450-2FE96B7596FB" Value="3" Position="3"/>
|
|
459
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="ED472611-9E4D-4578-83CC-FA1A79B9C763" Value="4" Position="4"/>
|
|
460
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="B46FCF14-E0A5-4055-AFF1-92E82EA3AB86" Value="5" Position="5"/>
|
|
461
|
+
</Element>
|
|
462
|
+
</Item>
|
|
463
|
+
<Item FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ID="PFA15" Order="13">
|
|
464
|
+
<Element ElementOID="5AA75A60-8A08-465E-AE4D-F9AD60E52045" Description="Are you able to stand up from an armless straight chair?" ElementOrder="2"/>
|
|
465
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
466
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="9C613E53-13CD-4B4A-B674-F3D3F7AB2120" Value="1" Position="1"/>
|
|
467
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="2AA95BEC-DECA-464F-A8F4-E93F80F2B87E" Value="2" Position="2"/>
|
|
468
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="45FE4007-3582-4CDE-BEAE-39E8C0AB6476" Value="3" Position="3"/>
|
|
469
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="94711FA9-E59B-497B-A52C-2BD26C1E261F" Value="4" Position="4"/>
|
|
470
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="B4B09630-9BA0-44DC-AC5D-77C7908AF1CD" Value="5" Position="5"/>
|
|
471
|
+
</Element>
|
|
472
|
+
</Item>
|
|
473
|
+
<Item FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ID="PFA48" Order="42">
|
|
474
|
+
<Element ElementOID="0A1BC41B-E241-41C4-813F-250D2F4A3E9D" Description="Are you able to peel fruit?" ElementOrder="2"/>
|
|
475
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
476
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="71F3A352-94AB-4E2A-89D6-C6ED5F3B7578" Value="1" Position="1"/>
|
|
477
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="2CF66FE9-0949-4775-B948-CF7A8375DD8B" Value="2" Position="2"/>
|
|
478
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="1E44C509-C614-46C1-A1AC-2B1AC00EBCD4" Value="3" Position="3"/>
|
|
479
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="0006814F-58A9-434A-A604-A4DF5F7FB279" Value="4" Position="4"/>
|
|
480
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="98D75F96-70E3-44D9-B6E2-788304AEEE60" Value="5" Position="5"/>
|
|
481
|
+
</Element>
|
|
482
|
+
</Item>
|
|
483
|
+
<Item FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ID="PFA51" Order="45">
|
|
484
|
+
<Element ElementOID="A2F3E839-1C85-4AE4-8388-4315751589C5" Description="Are you able to sit on the edge of a bed?" ElementOrder="2"/>
|
|
485
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
486
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="B3B4CA1D-0AC0-4532-9740-B2FD60C2FBCB" Value="1" Position="1"/>
|
|
487
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="BA1A75F7-0E38-43E5-9D59-B40931EC91E0" Value="2" Position="2"/>
|
|
488
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="BC7DB9FD-8222-4AFA-B732-646AA1756379" Value="3" Position="3"/>
|
|
489
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="EAEE6FC0-9F05-4DD0-A621-496811544A46" Value="4" Position="4"/>
|
|
490
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="4E1184FC-2A2F-4F0F-BCEA-77CB8DBF4F5D" Value="5" Position="5"/>
|
|
491
|
+
</Element>
|
|
492
|
+
</Item>
|
|
493
|
+
<Item FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ID="PFA44" Order="39">
|
|
494
|
+
<Element ElementOID="DF863891-8A25-40E5-9F7D-4A71DD8674EA" Description="Are you able to put on a shirt or blouse?" ElementOrder="2"/>
|
|
495
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
496
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="6A16DDDF-8813-4AA4-A5FD-850FFC898ADF" Value="1" Position="1"/>
|
|
497
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="411D83A8-B89B-4BE1-B774-55C0E1844F27" Value="2" Position="2"/>
|
|
498
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="754AAAF5-D22B-460F-A3DD-D87ABB2350E2" Value="3" Position="3"/>
|
|
499
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="24F2729E-E86E-426D-BD66-C17B02DDF35B" Value="4" Position="4"/>
|
|
500
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="DF5AFC1C-D203-411F-8F7F-BBE881138B95" Value="5" Position="5"/>
|
|
501
|
+
</Element>
|
|
502
|
+
</Item>
|
|
503
|
+
<Item FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ID="PFA52" Order="46">
|
|
504
|
+
<Element ElementOID="42158F6C-C66D-49D9-A15C-B67208A6421D" Description="Are you able to tie your shoelaces?" ElementOrder="2"/>
|
|
505
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
506
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="94006C9D-CA58-46D0-B6EA-9B0DD80830FC" Value="1" Position="1"/>
|
|
507
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="CB212C09-2DD6-408D-B20A-ED8881DCC7CA" Value="2" Position="2"/>
|
|
508
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="0C8DAB05-ED25-4629-8C00-9E39E37D081C" Value="3" Position="3"/>
|
|
509
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="F9BED045-D24E-4E74-A15E-C6224F732F53" Value="4" Position="4"/>
|
|
510
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="EBD8DAAD-963E-43DF-88A4-DF72EAF1CC48" Value="5" Position="5"/>
|
|
511
|
+
</Element>
|
|
512
|
+
</Item>
|
|
513
|
+
<Item FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ID="PFA13" Order="11">
|
|
514
|
+
<Element ElementOID="F2D23576-DAF6-4A79-AE1C-775935816F41" Description="Are you able to exercise for an hour?" ElementOrder="2"/>
|
|
515
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
516
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="007B869B-27BB-4A79-BB49-EF30A30B5212" Value="1" Position="1"/>
|
|
517
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="0F28C205-BE4A-477A-AF98-7D868A8AE417" Value="2" Position="2"/>
|
|
518
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="5A6CBF6D-427F-49C8-8A96-A48B750D7328" Value="3" Position="3"/>
|
|
519
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="BFCFC9DF-1CCF-4E69-AD92-8B4387EBB438" Value="4" Position="4"/>
|
|
520
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="9584778E-34D5-4ACA-B149-175E3EA13DEB" Value="5" Position="5"/>
|
|
521
|
+
</Element>
|
|
522
|
+
</Item>
|
|
523
|
+
<Item FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ID="PFA19r1" Order="17">
|
|
524
|
+
<Element ElementOID="727D9C38-C5D5-48F7-A5B5-CD2279B24CD4" Description="Are you able to run or jog for two miles (3 km)?" ElementOrder="1"/>
|
|
525
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
526
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="60232F89-A5FD-464B-BD55-8BA07761D20B" Value="1" Position="1"/>
|
|
527
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="383004EE-32DF-4EF4-BD83-44E47D64A594" Value="2" Position="2"/>
|
|
528
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="326BB15F-5FE2-4938-8345-7CF15516EEDE" Value="3" Position="3"/>
|
|
529
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="5DD828B9-DA3F-43BE-932B-F66ECC287DBE" Value="4" Position="4"/>
|
|
530
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="B99D23ED-BCD2-4D2F-9E92-97F20FEDD8B7" Value="5" Position="5"/>
|
|
531
|
+
</Element>
|
|
532
|
+
</Item>
|
|
533
|
+
<Item FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ID="PFA21" Order="19">
|
|
534
|
+
<Element ElementOID="1E839D6D-4E88-4BCA-BF28-4355AB7EAC31" Description="Are you able to go up and down stairs at a normal pace?" ElementOrder="2"/>
|
|
535
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
536
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="FE3D1266-95D5-4260-94C0-5DA84F378188" Value="1" Position="1"/>
|
|
537
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="81CB22A2-0277-4FEB-9555-EFFD610B6F00" Value="2" Position="2"/>
|
|
538
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="6A0F1C9C-0FB0-41EC-88E3-6AC6EEAD62A8" Value="3" Position="3"/>
|
|
539
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="180C0EF9-8675-4E2A-A052-56179C145FCC" Value="4" Position="4"/>
|
|
540
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="80872952-2FAE-4596-B44D-3FC89EC91C46" Value="5" Position="5"/>
|
|
541
|
+
</Element>
|
|
542
|
+
</Item>
|
|
543
|
+
</Form>
|