study_engine 0.0.2
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- 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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61
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62
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63
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64
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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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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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82
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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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91
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92
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93
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94
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<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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96
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97
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98
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99
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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>
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102
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+
</Item>
|
|
103
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<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
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106
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107
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108
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109
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110
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111
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112
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</Item>
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113
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114
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<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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117
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118
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119
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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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</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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<Element ElementOID="25F10D4A-D29B-4ED7-A33A-2DBBEF6B96D7" Description="Are you able to brush your teeth?" ElementOrder="2"/>
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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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</Element>
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12
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</Item>
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13
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14
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<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="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
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="6B053C5D-CF48-428E-9EBA-F51B6C2A94CE" Value="4" Position="4"/>
|
|
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>
|