study_engine 0.0.2
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- checksums.yaml +7 -0
- data/Rakefile +42 -0
- data/app/assets/images/study_engine/spinner.gif +0 -0
- data/app/assets/images/study_engine/sprite/delete.png +0 -0
- data/app/assets/images/study_engine/sprite/download.png +0 -0
- data/app/assets/images/study_engine/sprite/edit.png +0 -0
- data/app/assets/images/study_engine/sprite/incomplete.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc-sm.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc.png +0 -0
- data/app/assets/images/study_engine/sprite/new.png +0 -0
- data/app/assets/javascripts/study_engine/admin_notes.js.coffee +12 -0
- data/app/assets/javascripts/study_engine/assessment_notifications.js.coffee +36 -0
- data/app/assets/javascripts/study_engine/assessment_timeout.js.coffee +24 -0
- data/app/assets/javascripts/study_engine/disable_buttons_after_click.js.coffee +6 -0
- data/app/assets/javascripts/study_engine/fire_click_event_immediately_on_mobile.js.coffee.erb +10 -0
- data/app/assets/javascripts/study_engine/response_validation.js.coffee +8 -0
- data/app/assets/javascripts/study_engine/restart_assessment_button.js.coffee +3 -0
- data/app/assets/javascripts/study_engine/study_engine.js.coffee +9 -0
- data/app/assets/javascripts/study_engine/study_id_picker.js.coffee +28 -0
- data/app/assets/stylesheets/study_engine.sass +1 -0
- data/app/assets/stylesheets/study_engine/_constant.sass +52 -0
- data/app/assets/stylesheets/study_engine/_mobile.sass +8 -0
- data/app/assets/stylesheets/study_engine/_tablet.sass +36 -0
- data/app/assets/stylesheets/study_engine/application.sass +101 -0
- data/app/assets/stylesheets/study_engine/base/_form.sass +131 -0
- data/app/assets/stylesheets/study_engine/base/_list.sass +38 -0
- data/app/assets/stylesheets/study_engine/base/_tables.sass +33 -0
- data/app/assets/stylesheets/study_engine/base/_text.sass +78 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_login-fields.sass +14 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_start-fields.sass +101 -0
- data/app/assets/stylesheets/study_engine/components/-nav/_global-nav.sass +19 -0
- data/app/assets/stylesheets/study_engine/components/-table/_results-table.sass +75 -0
- data/app/assets/stylesheets/study_engine/components/-table/_users-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/components/_assessment-questions.sass +30 -0
- data/app/assets/stylesheets/study_engine/components/_form-buttons.sass +102 -0
- data/app/assets/stylesheets/study_engine/components/_helpt-text.sass +2 -0
- data/app/assets/stylesheets/study_engine/components/_method-icons.sass +15 -0
- data/app/assets/stylesheets/study_engine/components/_notes-modal.sass +65 -0
- data/app/assets/stylesheets/study_engine/components/_progress-bar.sass +25 -0
- data/app/assets/stylesheets/study_engine/components/_sortable-columns.sass +26 -0
- data/app/assets/stylesheets/study_engine/components/_table-actions.sass +8 -0
- data/app/assets/stylesheets/study_engine/components/_table-buttons.sass +17 -0
- data/app/assets/stylesheets/study_engine/components/_user-privileges.sass +3 -0
- data/app/assets/stylesheets/study_engine/mixins/_actions-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/mixins/_buttons.sass +55 -0
- data/app/assets/stylesheets/study_engine/mixins/_checkbox-columns.sass +50 -0
- data/app/assets/stylesheets/study_engine/mixins/_custom-radios.sass +47 -0
- data/app/assets/stylesheets/study_engine/mixins/_icons.sass +38 -0
- data/app/assets/stylesheets/study_engine/mixins/_notification-text.sass +23 -0
- data/app/controllers/study_engine/admin/application_controller.rb +6 -0
- data/app/controllers/study_engine/admin/assessments_controller.rb +79 -0
- data/app/controllers/study_engine/admin/notes_controller.rb +17 -0
- data/app/controllers/study_engine/application_controller.rb +12 -0
- data/app/controllers/study_engine/assessments_controller.rb +94 -0
- data/app/helpers/study_engine/helpers.rb +15 -0
- data/app/helpers/study_engine/mailer_helpers.rb +11 -0
- data/app/mailers/study_engine/mailer.rb +25 -0
- data/app/models/study_engine/answer.rb +36 -0
- data/app/models/study_engine/assessment.rb +118 -0
- data/app/models/study_engine/begin_assessment_form.rb +110 -0
- data/app/models/study_engine/existing_assessments_form.rb +99 -0
- data/app/models/study_engine/form.rb +59 -0
- data/app/models/study_engine/report.rb +69 -0
- data/app/models/study_engine/result.rb +46 -0
- data/app/models/study_engine/screen_results.rb +54 -0
- data/app/models/study_engine/study_id.rb +47 -0
- data/app/models/study_engine/study_id/bank.rb +38 -0
- data/app/models/study_engine/study_id/sync.rb +52 -0
- data/app/models/study_engine/update_assessments_form.rb +53 -0
- data/app/views/study_engine/_progress_bar.html.slim +4 -0
- data/app/views/study_engine/admin/assessments/_assessment.html.slim +36 -0
- data/app/views/study_engine/admin/assessments/domain_results.csv.csvbuilder +17 -0
- data/app/views/study_engine/admin/assessments/edit.html.slim +68 -0
- data/app/views/study_engine/admin/assessments/index.html.slim +26 -0
- data/app/views/study_engine/admin/assessments/item_results.csv.csvbuilder +24 -0
- data/app/views/study_engine/admin/assessments/new.html.slim +46 -0
- data/app/views/study_engine/admin/assessments/screen_results.csv.csvbuilder +2 -0
- data/app/views/study_engine/assessments/complete.html.slim +25 -0
- data/app/views/study_engine/assessments/create.html.slim +46 -0
- data/app/views/study_engine/assessments/index.html.slim +43 -0
- data/app/views/study_engine/assessments/restart.html.slim +28 -0
- data/app/views/study_engine/assessments/show.html.slim +60 -0
- data/app/views/study_engine/mailer/assessment_recorded_notification.erb +8 -0
- data/app/views/study_engine/mailer/assessment_url_notification.erb +6 -0
- data/config/routes.rb +15 -0
- data/db/migrate/20160422185859_create_tables.rb +52 -0
- data/lib/study_engine.rb +5 -0
- data/lib/study_engine/config.rb +37 -0
- data/lib/study_engine/cucumber.rb +96 -0
- data/lib/study_engine/engine.rb +7 -0
- data/lib/study_engine/version.rb +3 -0
- data/lib/tasks/study_engine_tasks.rake +10 -0
- data/spec/ar_helper.rb +30 -0
- data/spec/models/study_engine/answer_spec.rb +28 -0
- data/spec/models/study_engine/assessment_spec.rb +250 -0
- data/spec/models/study_engine/begin_assessment_form_spec.rb +87 -0
- data/spec/models/study_engine/existing_assessments_form_spec.rb +171 -0
- data/spec/models/study_engine/report_spec.rb +48 -0
- data/spec/models/study_engine/result_spec.rb +102 -0
- data/spec/models/study_engine/screen_results_spec.rb +69 -0
- data/spec/models/study_engine/study_id/bank_spec.rb +72 -0
- data/spec/models/study_engine/study_id/sync_spec.rb +61 -0
- data/spec/models/study_engine/study_id_spec.rb +7 -0
- data/spec/models/study_engine/update_assessments_form_spec.rb +38 -0
- data/spec/rails_helper.rb +50 -0
- data/spec/schema.rb +65 -0
- data/spec/spec_helper.rb +72 -0
- data/spec/support/CATEngine3.exe +0 -0
- data/spec/support/forms/01. Physical Function Bank.xml +1213 -0
- data/spec/support/forms/02. Pain Interference Bank.xml +443 -0
- data/spec/support/forms/03. Anxiety Bank.xml +322 -0
- data/spec/support/forms/04. Depression Bank.xml +311 -0
- data/spec/support/forms/05. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/06. Psychosocial Illness Impact Pos Bank.xml +900 -0
- data/spec/support/forms/07. Applied Cognition Gen Concerns Bank.xml +377 -0
- data/spec/support/forms/08. Satisfaction with Roles and Activities Bank Version 2.xml +443 -0
- data/spec/support/forms/09. Sleep Disturbance Bank.xml +300 -0
- data/spec/support/forms/10. Emotional Support Bank.xml +163 -0
- data/spec/support/forms/A - 07. Psychosocial Illness Impact Pos Bank.xml +471 -0
- data/spec/support/forms/A - 08. Pain interference Bank.xml +443 -0
- data/spec/support/forms/A - 09. Depression Bank.xml +311 -0
- data/spec/support/forms/B - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/B - 08. Physical Function Remainder A.xml +543 -0
- data/spec/support/forms/B - 09. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/C - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/C - 08. Physical Function Remainder B.xml +553 -0
- data/spec/support/forms/C - 09. Anxiety Bank.xml +322 -0
- data/spec/support/parameters/01. Physical Function Bank.xml +682 -0
- data/spec/support/parameters/02. Pain Interference Bank.xml +256 -0
- data/spec/support/parameters/03. Anxiety Bank.xml +190 -0
- data/spec/support/parameters/04. Depression Bank.xml +184 -0
- data/spec/support/parameters/05. Ability to Participate Social bank Version 2.xml +226 -0
- data/spec/support/parameters/06. Psychosocial Illness Impact Pos Bank.xml +211 -0
- data/spec/support/parameters/07. Applied Cognition Gen Concerns Bank.xml +1 -0
- data/spec/support/parameters/08. Satisfaction with Roles and Activities Bank Version 2.xml +1 -0
- data/spec/support/parameters/09. Sleep Disturbance Bank.xml +1 -0
- data/spec/support/parameters/10. Emotional Support Bank.xml +1 -0
- metadata +394 -0
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<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ItemResponseOID="3D731034-B3E6-45A9-9541-FBBC6123253B" Value="2" Position="2"/>
|
|
58
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ItemResponseOID="C9D39372-71D6-4BCC-BA58-8965597BD015" Value="3" Position="3"/>
|
|
59
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ItemResponseOID="5C72C38A-C59C-4C52-8B5E-F609E71E651F" Value="4" Position="4"/>
|
|
60
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ItemResponseOID="058F4C37-481E-447E-993E-BDBA50E48A99" Value="5" Position="5"/>
|
|
61
|
+
</Element>
|
|
62
|
+
</Item>
|
|
63
|
+
<Item FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ID="PFB33" Order="80">
|
|
64
|
+
<Element ElementOID="D6178519-9599-4EC7-AC5C-E8A4EBAA1186" Description="Are you able to remove something from your back pocket?" 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="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ItemResponseOID="EA37E8C4-DE0A-4B34-A875-75E267788FE2" Value="1" Position="1"/>
|
|
67
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ItemResponseOID="AE643D00-6B13-4E23-A589-E6241240171D" Value="2" Position="2"/>
|
|
68
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ItemResponseOID="B4919106-DA76-4469-9F4F-B840B2A4B59F" Value="3" Position="3"/>
|
|
69
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ItemResponseOID="2B5C280C-C1A9-41F6-857A-7C2753CECC13" Value="4" Position="4"/>
|
|
70
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ItemResponseOID="1B8A87DA-9BF1-462D-9FD5-405FCFF7436C" Value="5" Position="5"/>
|
|
71
|
+
</Element>
|
|
72
|
+
</Item>
|
|
73
|
+
<Item FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ID="PFC31" Order="102">
|
|
74
|
+
<Element ElementOID="52A18B1F-F3A7-4DCD-AC69-56F1109C05E6" Description="Are you able to reach into a low cupboard?" 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="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ItemResponseOID="70216E04-2A42-4B02-8A4F-F50845775B5C" Value="1" Position="1"/>
|
|
77
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ItemResponseOID="964424BF-6FF7-477F-9F1C-E8D92F946C7B" Value="2" Position="2"/>
|
|
78
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ItemResponseOID="BC76D9C1-CF67-4B20-AD4D-5A74CF09CE30" Value="3" Position="3"/>
|
|
79
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ItemResponseOID="94D10450-2F5B-4E02-BCEB-CCD68A0F2233" Value="4" Position="4"/>
|
|
80
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ItemResponseOID="32A069EF-02EE-4DC0-B72E-A1AEE79FAFEE" Value="5" Position="5"/>
|
|
81
|
+
</Element>
|
|
82
|
+
</Item>
|
|
83
|
+
<Item FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ID="PFB56r1" Order="95">
|
|
84
|
+
<Element ElementOID="CD07E200-C134-46DB-B8AE-29ADBE0700B1" Description="Are you able to lift one pound (0.5 kg) to shoulder level without bending your elbow?" 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="6214F572-8D11-4496-9EA8-6B17E98EE354" ItemResponseOID="2321F489-C258-4CE3-A834-C99789D226E5" Value="1" Position="1"/>
|
|
87
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ItemResponseOID="3AB23076-C85C-43A9-B6D1-C0F74B2270FC" Value="2" Position="2"/>
|
|
88
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ItemResponseOID="8D845731-A06C-45B9-9375-97D5E4693797" Value="3" Position="3"/>
|
|
89
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ItemResponseOID="6579CA9B-6A4A-42A4-A2D8-7BCEDCFC2B66" Value="4" Position="4"/>
|
|
90
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ItemResponseOID="28D2D767-2B60-4356-87F6-91D7DF1D42D7" Value="5" Position="5"/>
|
|
91
|
+
</Element>
|
|
92
|
+
</Item>
|
|
93
|
+
<Item FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ID="PFC32" Order="103">
|
|
94
|
+
<Element ElementOID="EAEA35FC-BC71-4E4B-9881-46D6EA51FEB0" Description="Are you able to climb up 5 flights of stairs?" ElementOrder="2"/>
|
|
95
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
96
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ItemResponseOID="9C4B6D6F-AD51-42E8-A08F-E9377CA24819" Value="1" Position="1"/>
|
|
97
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ItemResponseOID="7CF07EFD-EEB8-4556-9710-5C823DE6A1C0" Value="2" Position="2"/>
|
|
98
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ItemResponseOID="39595E49-5021-48A5-B812-1E1DA463D5EA" Value="3" Position="3"/>
|
|
99
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ItemResponseOID="9CC3BAE8-07F5-4C7A-A135-BE6B7D0DDE41" Value="4" Position="4"/>
|
|
100
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ItemResponseOID="B97AA13B-7B1C-4E27-826C-C2C2146E8EEB" Value="5" Position="5"/>
|
|
101
|
+
</Element>
|
|
102
|
+
</Item>
|
|
103
|
+
<Item FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ID="PFB40" Order="85">
|
|
104
|
+
<Element ElementOID="6AE72A70-F774-4BC0-92C7-EED282C68A57" Description="Are you able to stand up on tiptoes?" 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="D6773900-CB17-4AF3-A329-E95CAF8DA125" ItemResponseOID="B7487A1C-7279-40CE-A98F-2879EC6D111D" Value="1" Position="1"/>
|
|
107
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ItemResponseOID="42793231-EECB-4B26-B538-BEC5075B5E0D" Value="2" Position="2"/>
|
|
108
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ItemResponseOID="94B1D626-C2E8-4A6C-B4A9-851FB2107999" Value="3" Position="3"/>
|
|
109
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ItemResponseOID="8A04ED7D-83EB-47B3-9A6E-05DAA70E8688" Value="4" Position="4"/>
|
|
110
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ItemResponseOID="AA5BAD04-4086-4F79-A411-FCA7189AF4D3" Value="5" Position="5"/>
|
|
111
|
+
</Element>
|
|
112
|
+
</Item>
|
|
113
|
+
<Item FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ID="PFB42" Order="87">
|
|
114
|
+
<Element ElementOID="6B40CFAA-F8B8-47E8-9073-6422E7DD868D" Description="Are you able to stand unsupported for 30 minutes?" 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="4C5336FB-DCD0-4513-94B6-75B0C134833C" ItemResponseOID="DD5BBF8C-6DF3-4510-A118-0CC9948469DF" Value="1" Position="1"/>
|
|
117
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ItemResponseOID="1549D290-DBDB-4328-A804-379167888CD6" Value="2" Position="2"/>
|
|
118
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ItemResponseOID="A7DAB8E6-3AA0-491C-86D6-645419CEA4C1" Value="3" Position="3"/>
|
|
119
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ItemResponseOID="4ABE3E99-7A4A-4503-8955-324E199C0F78" Value="4" Position="4"/>
|
|
120
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ItemResponseOID="E545A69A-55C4-483D-9EF0-6E7F6C0A6C62" Value="5" Position="5"/>
|
|
121
|
+
</Element>
|
|
122
|
+
</Item>
|
|
123
|
+
<Item FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ID="PFB30" Order="77">
|
|
124
|
+
<Element ElementOID="0206A87E-EAA4-464D-96C2-7BCAC76B5C03" Description="Are you able to open a new milk carton?" 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="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ItemResponseOID="0A6F8A2E-EC25-4719-B592-C02AF7C60B8F" Value="1" Position="1"/>
|
|
127
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ItemResponseOID="AAA0D863-DAC8-4E9F-BA17-16091D55D592" Value="2" Position="2"/>
|
|
128
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ItemResponseOID="624DBED8-4690-4AE8-B68A-0D593B9CB72E" Value="3" Position="3"/>
|
|
129
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ItemResponseOID="C19EBA92-4CFC-4F35-89B4-08C89DF081EA" Value="4" Position="4"/>
|
|
130
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ItemResponseOID="EF2C5A1B-928F-4D12-A323-86E9ACAA701F" Value="5" Position="5"/>
|
|
131
|
+
</Element>
|
|
132
|
+
</Item>
|
|
133
|
+
<Item FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ID="PFB19" Order="66">
|
|
134
|
+
<Element ElementOID="D6DAA884-1DB1-4927-AA70-D744856AF5BB" Description="Are you able to squeeze a new tube of toothpaste?" ElementOrder="2"/>
|
|
135
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
136
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ItemResponseOID="E9109429-3B27-424F-80E8-DE8AA93B9EC2" Value="1" Position="1"/>
|
|
137
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ItemResponseOID="4BED8200-C442-4BB4-8D51-71A6EE3EECD1" Value="2" Position="2"/>
|
|
138
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ItemResponseOID="AD21C7E0-8531-4CCD-9E81-F65892498376" Value="3" Position="3"/>
|
|
139
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ItemResponseOID="5041DF3D-223F-4CF9-9905-0AE49D7F2978" Value="4" Position="4"/>
|
|
140
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ItemResponseOID="02BEE445-EFC2-4365-AD35-03DC5E1893B8" Value="5" Position="5"/>
|
|
141
|
+
</Element>
|
|
142
|
+
</Item>
|
|
143
|
+
<Item FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ID="PFC46" Order="114">
|
|
144
|
+
<Element ElementOID="7DD55963-CCA2-4DB4-AD2D-E6F586E79E95" Description="Are you able to transfer from a bed to a chair and 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="E3CCBA8D-3718-498E-B855-A35B745F19F7" ItemResponseOID="3AFC1CD9-6E55-493A-B985-148DF91871CD" Value="1" Position="1"/>
|
|
147
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ItemResponseOID="8CEDE0AE-1F6D-45CE-B650-D18C1A1CFF29" Value="2" Position="2"/>
|
|
148
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ItemResponseOID="C164CA6B-BB25-40CC-8A5A-7DDC892210F9" Value="3" Position="3"/>
|
|
149
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ItemResponseOID="FABAEB24-9A20-4737-AAB5-B0E7F97E3411" Value="4" Position="4"/>
|
|
150
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ItemResponseOID="EDA653ED-BB8F-4141-8D7B-416B30885BE5" Value="5" Position="5"/>
|
|
151
|
+
</Element>
|
|
152
|
+
</Item>
|
|
153
|
+
<Item FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ID="PFB16" Order="63">
|
|
154
|
+
<Element ElementOID="3C6A92E7-4C44-4D1B-A9E8-3765391E66D1" Description="Are you able to press with your index finger (for example ringing a doorbell)?" ElementOrder="2"/>
|
|
155
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
156
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ItemResponseOID="A93AEB9A-5383-4514-9A27-E3FFBDB0B95D" Value="1" Position="1"/>
|
|
157
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ItemResponseOID="0492C01F-E2E7-4A91-AB53-0EB4B272AAEA" Value="2" Position="2"/>
|
|
158
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ItemResponseOID="B7C54D10-5808-4665-814C-D664C6527D94" Value="3" Position="3"/>
|
|
159
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ItemResponseOID="85044881-66BC-4434-BA9F-BA3C3E2784F7" Value="4" Position="4"/>
|
|
160
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ItemResponseOID="3EAADD22-40EF-4F34-A55F-21FE035C4CF9" Value="5" Position="5"/>
|
|
161
|
+
</Element>
|
|
162
|
+
</Item>
|
|
163
|
+
<Item FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ID="PFB37" Order="83">
|
|
164
|
+
<Element ElementOID="0E1F7796-42E8-4766-9C85-6AC05A8F40E6" Description="Are you able to turn faucets on and off?" 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="0CD11749-2FCC-4E3F-980D-83690951D960" ItemResponseOID="8110A37F-B32D-4D78-B6FA-D86024C7544A" Value="1" Position="1"/>
|
|
167
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ItemResponseOID="1873EE53-6ADA-4DCE-90BD-48F239C82AC5" Value="2" Position="2"/>
|
|
168
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ItemResponseOID="826B611E-E7B3-4269-A20E-6EA33FD7C176" Value="3" Position="3"/>
|
|
169
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ItemResponseOID="8743EF32-5800-4E25-BB29-A4B63B79F371" Value="4" Position="4"/>
|
|
170
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ItemResponseOID="DB123BF7-5A2C-45A5-B009-50B8CA4C1EC6" Value="5" Position="5"/>
|
|
171
|
+
</Element>
|
|
172
|
+
</Item>
|
|
173
|
+
<Item FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ID="PFC47" Order="115">
|
|
174
|
+
<Element ElementOID="33B89C92-ED65-4C71-91FF-DFE5F4F4BEF7" Description="Are you able to be out of bed most of the day?" 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="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ItemResponseOID="40288D39-5B3B-4712-8C9D-1371B12C93C9" Value="1" Position="1"/>
|
|
177
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ItemResponseOID="59BB71F7-C7A3-4F78-84A2-B0A1489EADE4" Value="2" Position="2"/>
|
|
178
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ItemResponseOID="19103103-66A8-41EF-9E11-49B6D769AD70" Value="3" Position="3"/>
|
|
179
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ItemResponseOID="080F1C8F-ED2E-4C2C-8795-F48D7429354A" Value="4" Position="4"/>
|
|
180
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ItemResponseOID="73F012DB-EF7A-4851-B83B-C04BBA5256B4" Value="5" Position="5"/>
|
|
181
|
+
</Element>
|
|
182
|
+
</Item>
|
|
183
|
+
<Item FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ID="PFC39" Order="109">
|
|
184
|
+
<Element ElementOID="6F3752B5-C8CB-4FC9-9D1F-056F3D146EF3" Description="Are you able to stand without losing your balance for several minutes?" 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="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ItemResponseOID="16392477-F715-4CAB-87E0-AE4F31FA7594" Value="1" Position="1"/>
|
|
187
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ItemResponseOID="A9856DEF-6B3E-4A38-93FE-B6AC1FB374D4" Value="2" Position="2"/>
|
|
188
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ItemResponseOID="A8F6ED14-37D5-4663-B9FE-36E602615367" Value="3" Position="3"/>
|
|
189
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ItemResponseOID="5E948ABE-3437-4C2C-9316-6EDCAA7C9804" Value="4" Position="4"/>
|
|
190
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ItemResponseOID="469DA817-3289-4CA7-A111-F2A02D2F7A85" Value="5" Position="5"/>
|
|
191
|
+
</Element>
|
|
192
|
+
</Item>
|
|
193
|
+
<Item FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ID="PFB21" Order="68">
|
|
194
|
+
<Element ElementOID="FC7EEF01-E270-4C76-BBE2-444E44E99D1F" Description="Are you able to pick up coins from a table top?" 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="4940EF65-9359-4B8D-90DA-82FB396064B6" ItemResponseOID="BC6B7A22-9D8D-4E89-9A36-5AFF40AAD09C" Value="1" Position="1"/>
|
|
197
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ItemResponseOID="A5AE7F34-4B07-49F2-9796-2D8D7E2981F6" Value="2" Position="2"/>
|
|
198
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ItemResponseOID="BF9EEAE1-6359-4BF1-99A0-58BD727F8401" Value="3" Position="3"/>
|
|
199
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ItemResponseOID="F3FA5315-038C-4E46-823D-04F79113E2D2" Value="4" Position="4"/>
|
|
200
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ItemResponseOID="2D41847A-085F-4620-8236-16BABF72ACB7" Value="5" Position="5"/>
|
|
201
|
+
</Element>
|
|
202
|
+
</Item>
|
|
203
|
+
<Item FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ID="PFB50" Order="92">
|
|
204
|
+
<Element ElementOID="B920413C-A6C8-4B33-9ED5-E8A2CF6C782C" Description="How much difficulty do you have doing your daily physical activities, because of your health?" ElementOrder="2"/>
|
|
205
|
+
<Element ElementOID="7F5DC59D-2BD2-4A8B-8F41-D4390BEFC8FC" Description="ContainerFor7F5DC59D-2BD2-4A8B-8F41-D4390BEFC8FC" ElementOrder="3">
|
|
206
|
+
<Map ElementOID="F8522242-3FF1-48E6-9C5C-D226539F0381" Description="No difficulty at all" FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ItemResponseOID="DC27F2F3-7530-4A4E-8885-EB2BA94FFAE7" Value="1" Position="1"/>
|
|
207
|
+
<Map ElementOID="EAE3A90C-5004-479F-9E25-7722E23A8BB2" Description="A little bit of difficulty" FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ItemResponseOID="2A2730C0-C113-41AE-8A31-17B26B78D6A4" Value="2" Position="2"/>
|
|
208
|
+
<Map ElementOID="DDD3327E-1AF6-4A0F-8177-20AA0F567F39" Description="Some difficulty" FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ItemResponseOID="27C2307C-B6FD-4551-8AFA-8E7562B133CE" Value="3" Position="3"/>
|
|
209
|
+
<Map ElementOID="639399B0-E0DC-4F91-831A-5957E865C278" Description="A lot of difficulty" FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ItemResponseOID="8EC55E98-5840-48F4-B5BC-97ECCAD32D76" Value="4" Position="4"/>
|
|
210
|
+
<Map ElementOID="A26CA7CC-7AE6-4F79-9943-A92B65C978AA" Description="Can't do because of health" FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ItemResponseOID="B3286DAB-BB64-4F67-B688-C8DDDD8572FC" Value="5" Position="5"/>
|
|
211
|
+
</Element>
|
|
212
|
+
</Item>
|
|
213
|
+
<Item FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ID="PFB27" Order="74">
|
|
214
|
+
<Element ElementOID="0E7BDFE5-F194-48E1-B3F0-32CF13AB36B5" Description="Are you able to tie a knot or a bow?" 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="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ItemResponseOID="D45E8D5F-6EB9-446D-9497-A5C64ABA418E" Value="1" Position="1"/>
|
|
217
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ItemResponseOID="600E9CAC-197E-41E5-8974-2F64CD057A76" Value="2" Position="2"/>
|
|
218
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ItemResponseOID="74660197-29C6-41A6-8000-E3472FF73DCD" Value="3" Position="3"/>
|
|
219
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ItemResponseOID="D8EB989B-1A60-4FCB-B397-37B112F29681" Value="4" Position="4"/>
|
|
220
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ItemResponseOID="FB628681-ED17-46BD-A74A-AB5089EF7D68" Value="5" Position="5"/>
|
|
221
|
+
</Element>
|
|
222
|
+
</Item>
|
|
223
|
+
<Item FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ID="PFB44" Order="89">
|
|
224
|
+
<Element ElementOID="2770FD8C-104E-440B-9916-DD1C867A10EF" Description="Does your health now limit you in doing moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf?" ElementOrder="2"/>
|
|
225
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
226
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ItemResponseOID="A9D48668-C37B-4D13-BB9F-33B68942F86A" Value="1" Position="1"/>
|
|
227
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ItemResponseOID="402BCD17-750F-415C-BB33-CD37038FB1B1" Value="2" Position="2"/>
|
|
228
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ItemResponseOID="CAA4E8C3-99F8-4CC5-87C6-AAF01CAEA70C" Value="3" Position="3"/>
|
|
229
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ItemResponseOID="53EEB9C4-6F85-4BB2-9BF6-36484B06651B" Value="4" Position="4"/>
|
|
230
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ItemResponseOID="902DFFF8-A6CB-4DC6-BFA6-300CAF2FD2DF" Value="5" Position="5"/>
|
|
231
|
+
</Element>
|
|
232
|
+
</Item>
|
|
233
|
+
<Item FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ID="PFB18" Order="65">
|
|
234
|
+
<Element ElementOID="4F5A8A08-F0F0-442A-BF9D-CB9DD6B9A9C1" Description="Are you able to shave your face or apply makeup?" 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="C46A0965-037D-4BE7-998D-56125F8A860F" ItemResponseOID="0950183B-560A-44FB-853D-829B09F991AE" Value="1" Position="1"/>
|
|
237
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ItemResponseOID="E38C5D80-CC93-49A7-AB86-E8EC08D0F099" Value="2" Position="2"/>
|
|
238
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ItemResponseOID="6F6433A2-7DC8-41A9-8A61-2F9530D561F2" Value="3" Position="3"/>
|
|
239
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ItemResponseOID="23EFE279-CBCE-4DF9-A779-F53CF68021BC" Value="4" Position="4"/>
|
|
240
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ItemResponseOID="ED90B40B-247A-4015-9C78-66662BF94F0F" Value="5" Position="5"/>
|
|
241
|
+
</Element>
|
|
242
|
+
</Item>
|
|
243
|
+
<Item FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ID="PFB15" Order="62">
|
|
244
|
+
<Element ElementOID="89615D9C-FEBC-434F-9A8C-DEB7258E12DB" Description="Are you able to change the bulb in a table lamp?" 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="EBA81583-721E-4613-9804-C961CAC74FE5" ItemResponseOID="63ABCAC8-A644-4CD0-85BC-CDBEE7574BFB" Value="1" Position="1"/>
|
|
247
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ItemResponseOID="65C204B5-841E-488E-98BE-32FB9125E801" Value="2" Position="2"/>
|
|
248
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ItemResponseOID="0EF9A476-D7B5-4380-9E84-F12AAD6ED323" Value="3" Position="3"/>
|
|
249
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ItemResponseOID="88190420-8E89-40C5-8BB3-9E61F5C9BE7A" Value="4" Position="4"/>
|
|
250
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ItemResponseOID="302B0EA8-3274-45E6-A9A0-5C4B92C03C52" Value="5" Position="5"/>
|
|
251
|
+
</Element>
|
|
252
|
+
</Item>
|
|
253
|
+
<Item FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ID="PFC40" Order="110">
|
|
254
|
+
<Element ElementOID="F41AC5F4-F7A6-4F5B-BD46-4B7D816212C7" Description="Are you able to kneel on the floor?" ElementOrder="2"/>
|
|
255
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
256
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ItemResponseOID="215D9A7D-F40B-4F67-A531-A7604C6962F3" Value="1" Position="1"/>
|
|
257
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ItemResponseOID="2B1541E6-75EF-421E-BC1B-B6262C5AA4A9" Value="2" Position="2"/>
|
|
258
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ItemResponseOID="256EB247-0E59-4A84-BD17-4EE38746C175" Value="3" Position="3"/>
|
|
259
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ItemResponseOID="9AB47DEC-0A6C-4AA1-B2C1-8B40EA268471" Value="4" Position="4"/>
|
|
260
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ItemResponseOID="4E60CD58-B3C2-450D-B3FE-176FF68F1ABA" Value="5" Position="5"/>
|
|
261
|
+
</Element>
|
|
262
|
+
</Item>
|
|
263
|
+
<Item FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ID="PFB26" Order="73">
|
|
264
|
+
<Element ElementOID="ECBC1783-FB0C-4599-A270-78AFDDCC39B7" Description="Are you able to shampoo your hair?" ElementOrder="2"/>
|
|
265
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
266
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ItemResponseOID="985C03A2-A059-4166-9C03-F1B5389E4BC1" Value="1" Position="1"/>
|
|
267
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ItemResponseOID="501F5862-5D18-40E3-86D2-E6CB0E4348B7" Value="2" Position="2"/>
|
|
268
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ItemResponseOID="4E1CE313-8262-4A84-9AAC-3A6B9FB770B4" Value="3" Position="3"/>
|
|
269
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ItemResponseOID="5F3D3A3A-D361-4CDB-AD22-0151D10E446A" Value="4" Position="4"/>
|
|
270
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ItemResponseOID="7C1EF655-C34C-4411-B7E6-ED34CEE8EB0B" Value="5" Position="5"/>
|
|
271
|
+
</Element>
|
|
272
|
+
</Item>
|
|
273
|
+
<Item FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ID="PFB17" Order="64">
|
|
274
|
+
<Element ElementOID="80C4028D-D509-4F4F-A928-D7A6B9A31449" Description="Are you able to put on and take off your socks?" 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="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ItemResponseOID="0308A70D-2B19-49F4-BA27-49583368DF88" Value="1" Position="1"/>
|
|
277
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ItemResponseOID="5257BA07-5FF8-444D-B2A5-B54E164A0A2F" Value="2" Position="2"/>
|
|
278
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ItemResponseOID="FEF00C8D-4B00-4452-B218-EF51A2E8419F" Value="3" Position="3"/>
|
|
279
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ItemResponseOID="75D54974-FFCA-419F-8DF2-6922201B8B21" Value="4" Position="4"/>
|
|
280
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ItemResponseOID="145D371D-B79A-4A16-AEC1-EA8CBE702415" Value="5" Position="5"/>
|
|
281
|
+
</Element>
|
|
282
|
+
</Item>
|
|
283
|
+
<Item FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ID="PFB22" Order="69">
|
|
284
|
+
<Element ElementOID="FCD9C123-5D7B-4972-BF11-86DA972F7CFD" Description="Are you able to hold a plate full of food?" 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="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ItemResponseOID="A21C363A-A954-411B-AF7D-54CF60CA8256" Value="1" Position="1"/>
|
|
287
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ItemResponseOID="7BB70A01-5052-4CA7-8E5E-6715FD770C4B" Value="2" Position="2"/>
|
|
288
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ItemResponseOID="1F98E195-D235-4524-A10D-C1E0E51CA628" Value="3" Position="3"/>
|
|
289
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ItemResponseOID="366A685E-9B66-49F6-BEF9-AB6D85D40188" Value="4" Position="4"/>
|
|
290
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ItemResponseOID="1176715E-2989-4488-ACFF-9AC20A40E16D" Value="5" Position="5"/>
|
|
291
|
+
</Element>
|
|
292
|
+
</Item>
|
|
293
|
+
<Item FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ID="PFB28r1" Order="75">
|
|
294
|
+
<Element ElementOID="F0FBE1EB-6BFA-4733-9A28-F0C0FAD56407" Description="Are you able to lift 10 pounds (5 kg) above your shoulder?" ElementOrder="1"/>
|
|
295
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
296
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ItemResponseOID="966AEB2F-466D-4361-8FF3-9451602CB036" Value="1" Position="1"/>
|
|
297
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ItemResponseOID="48E45452-8589-425A-96DE-13D9D699D4BF" Value="2" Position="2"/>
|
|
298
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ItemResponseOID="3E6C35AF-EAC3-4AEB-8EF8-0B8BBC2AFA64" Value="3" Position="3"/>
|
|
299
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ItemResponseOID="AF8615AA-25C2-44FF-93DD-40FE87E6F06D" Value="4" Position="4"/>
|
|
300
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ItemResponseOID="D02CC721-97E3-4EE1-97E8-CE43C46FD513" Value="5" Position="5"/>
|
|
301
|
+
</Element>
|
|
302
|
+
</Item>
|
|
303
|
+
<Item FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ID="PFB41" Order="86">
|
|
304
|
+
<Element ElementOID="D4A94715-61BD-4F90-A4E9-A2B294B1B29A" Description="Are you able to trim your fingernails?" 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="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ItemResponseOID="97818B5C-5DEC-4E32-B11A-3EA1FBFEE97A" Value="1" Position="1"/>
|
|
307
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ItemResponseOID="32ACE577-9C36-43AB-8384-D0B59AA46D95" Value="2" Position="2"/>
|
|
308
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ItemResponseOID="72783656-7662-4474-8723-8244ACD37583" Value="3" Position="3"/>
|
|
309
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ItemResponseOID="959A2F49-C3A2-47B7-88C5-19A49AB5A300" Value="4" Position="4"/>
|
|
310
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ItemResponseOID="FAB8AE46-D1C8-43FE-8AF7-F441A1FE3EE9" Value="5" Position="5"/>
|
|
311
|
+
</Element>
|
|
312
|
+
</Item>
|
|
313
|
+
<Item FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ID="PFC37" Order="107">
|
|
314
|
+
<Element ElementOID="3A43DC65-C685-4730-ADE2-06B146F1DE70" Description="Does your health now limit you in climbing one flight of stairs?" 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="986FA694-8819-41A3-B458-AF6DCF2A1100" ItemResponseOID="545A4E9A-2AB7-437C-81E4-C99EC5BEFD34" Value="1" Position="1"/>
|
|
317
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ItemResponseOID="0928D229-437F-4E62-988C-D0A4A220A782" Value="2" Position="2"/>
|
|
318
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ItemResponseOID="DB297EB4-B24C-4F40-B550-642AB2C5357F" Value="3" Position="3"/>
|
|
319
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ItemResponseOID="5244AD5D-CCB5-40C9-9C2E-56852BEDC7BC" Value="4" Position="4"/>
|
|
320
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ItemResponseOID="6745CC0C-B00F-4AF4-86A5-2D4562DB31F0" Value="5" Position="5"/>
|
|
321
|
+
</Element>
|
|
322
|
+
</Item>
|
|
323
|
+
<Item FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ID="PFB48" Order="90">
|
|
324
|
+
<Element ElementOID="0FB8532F-1397-408A-9143-8A57E5BD1703" Description="Does your health now limit you in taking a shower?" ElementOrder="2"/>
|
|
325
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
326
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ItemResponseOID="4AA990EE-70CA-4AFD-BB94-962845BF49AC" Value="1" Position="1"/>
|
|
327
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ItemResponseOID="A5BC506E-7146-44D3-AB76-E05863E4C37E" Value="2" Position="2"/>
|
|
328
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ItemResponseOID="3CE4A467-1195-4AC3-B0F1-34CB8B3F43F0" Value="3" Position="3"/>
|
|
329
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ItemResponseOID="02337479-7CDE-4069-8B98-20BDEAD79D55" Value="4" Position="4"/>
|
|
330
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ItemResponseOID="EC4AAD6A-84E9-46C0-B242-920754E2C398" Value="5" Position="5"/>
|
|
331
|
+
</Element>
|
|
332
|
+
</Item>
|
|
333
|
+
<Item FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ID="PFC41" Order="111">
|
|
334
|
+
<Element ElementOID="95C8B71E-96DC-4B35-9DF0-F5ACB4210EA3" Description="Are you able to sit down in and stand up from a low, soft couch?" 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="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ItemResponseOID="948E683A-905C-4159-A8A7-4C0FF493B45D" Value="1" Position="1"/>
|
|
337
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ItemResponseOID="0D2C2960-4D91-4349-B623-5E01EA308DBA" Value="2" Position="2"/>
|
|
338
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ItemResponseOID="D3187F9B-E449-4624-BF07-AD63965809EB" Value="3" Position="3"/>
|
|
339
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ItemResponseOID="AEF7AF33-137D-4964-B4B5-5B17A599B435" Value="4" Position="4"/>
|
|
340
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ItemResponseOID="BC81E6AB-F366-4490-AA79-A58EB1EC6451" Value="5" Position="5"/>
|
|
341
|
+
</Element>
|
|
342
|
+
</Item>
|
|
343
|
+
<Item FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ID="PFC52" Order="118">
|
|
344
|
+
<Element ElementOID="A778AD77-4CB2-4314-9966-591CE014B622" Description="Are you able to turn from side to side in bed?" ElementOrder="2"/>
|
|
345
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
346
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ItemResponseOID="4A8F0682-3F46-4F22-98C8-4D3D2D3F4A07" Value="1" Position="1"/>
|
|
347
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ItemResponseOID="5BB27170-2623-4097-ABC5-8F4BA0E5BE5A" Value="2" Position="2"/>
|
|
348
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ItemResponseOID="4B906F58-B614-49EF-AABE-826B163069D2" Value="3" Position="3"/>
|
|
349
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ItemResponseOID="999446E0-B137-4200-85DE-2CD581319F1E" Value="4" Position="4"/>
|
|
350
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ItemResponseOID="54555994-E3F6-4862-8413-A792C032BE56" Value="5" Position="5"/>
|
|
351
|
+
</Element>
|
|
352
|
+
</Item>
|
|
353
|
+
<Item FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ID="PFC13r1" Order="100">
|
|
354
|
+
<Element ElementOID="E0E3D227-FC2B-47DC-8621-1220770D0F3A" Description="Are you able to run 100 yards (100 m)?" ElementOrder="1"/>
|
|
355
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
356
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ItemResponseOID="646C9D78-F516-4967-B5B7-FD8E86389B73" Value="1" Position="1"/>
|
|
357
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ItemResponseOID="5B5D6AEA-6023-4023-9151-71ECB2BBB14C" Value="2" Position="2"/>
|
|
358
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ItemResponseOID="47E55EA9-F088-4DD5-9E89-FD2D7A17297F" Value="3" Position="3"/>
|
|
359
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ItemResponseOID="8585B028-A024-4FFF-BB13-2BD05321E2C2" Value="4" Position="4"/>
|
|
360
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ItemResponseOID="C7793E9E-F066-4DBC-9952-7CF66DE25555" Value="5" Position="5"/>
|
|
361
|
+
</Element>
|
|
362
|
+
</Item>
|
|
363
|
+
<Item FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ID="PFB51" Order="93">
|
|
364
|
+
<Element ElementOID="5EBB1319-8353-4292-8CEF-2B49CFAE654F" Description="Does your health now limit you in participating in active sports such as swimming, tennis, or basketball?" ElementOrder="2"/>
|
|
365
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
366
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ItemResponseOID="C19545A2-F14F-47F3-8562-B2FC86B53329" Value="1" Position="1"/>
|
|
367
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ItemResponseOID="2FB30FDC-2855-4B7A-BFA5-A94D3758D8C6" Value="2" Position="2"/>
|
|
368
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ItemResponseOID="9A70742A-41E2-4AD2-9FF5-AA8FBF0C60F5" Value="3" Position="3"/>
|
|
369
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ItemResponseOID="AD2A8EF2-E3D6-4561-9721-E66932DEB66E" Value="4" Position="4"/>
|
|
370
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ItemResponseOID="A9A85324-7DBA-4B81-9372-587A4900836F" Value="5" Position="5"/>
|
|
371
|
+
</Element>
|
|
372
|
+
</Item>
|
|
373
|
+
<Item FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ID="PFC33r1" Order="104">
|
|
374
|
+
<Element ElementOID="B640398D-1D4B-42DA-8A39-5AA038A48050" Description="Are you able to run ten miles (16 km)?" ElementOrder="1"/>
|
|
375
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
376
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ItemResponseOID="B6E0F629-CBCF-4EB1-B6B6-1FE90AAA79F8" Value="1" Position="1"/>
|
|
377
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ItemResponseOID="85C9FEFE-D21C-4028-9106-B68A48CFBEA9" Value="2" Position="2"/>
|
|
378
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ItemResponseOID="65186155-E3C9-49D7-A72C-60B22A56F61C" Value="3" Position="3"/>
|
|
379
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ItemResponseOID="CBE75B84-321C-43FB-A29E-0B107B9ECFE2" Value="4" Position="4"/>
|
|
380
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ItemResponseOID="F14BDA6A-F722-4E39-B4D6-C2244652EA4B" Value="5" Position="5"/>
|
|
381
|
+
</Element>
|
|
382
|
+
</Item>
|
|
383
|
+
<Item FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ID="PFC36r1" Order="106">
|
|
384
|
+
<Element ElementOID="F29FDC7E-F648-478B-A05C-D264591C3759" Description="Does your health now limit you in walking more than a mile (1.6 km)?" ElementOrder="1"/>
|
|
385
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="2">
|
|
386
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ItemResponseOID="0C90DE3F-A21C-46C2-9CFF-4B44E44529B4" Value="1" Position="1"/>
|
|
387
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ItemResponseOID="E5D7C308-83D5-4C39-9EE8-CC9D82DCDE5D" Value="2" Position="2"/>
|
|
388
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ItemResponseOID="1AA0A5D5-9D68-4FEC-81B4-A3EE55EED3EB" Value="3" Position="3"/>
|
|
389
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ItemResponseOID="E9BAAEF1-FB3A-4DD8-B1FD-A341F7DED469" Value="4" Position="4"/>
|
|
390
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ItemResponseOID="248A2117-D53E-4487-951D-D40D54BE63FC" Value="5" Position="5"/>
|
|
391
|
+
</Element>
|
|
392
|
+
</Item>
|
|
393
|
+
<Item FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ID="PFC38" Order="108">
|
|
394
|
+
<Element ElementOID="B3793830-B5AA-41B9-B833-0EEBE786E2DE" Description="Are you able to walk at a normal speed?" 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="329666BB-61F3-494E-B8A9-908B41B2EE22" ItemResponseOID="C3350D97-15E9-49E2-ACCA-09DAFF6959F7" Value="1" Position="1"/>
|
|
397
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ItemResponseOID="BBC9AAD0-0B07-4E65-9A2A-15B073FE4E84" Value="2" Position="2"/>
|
|
398
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ItemResponseOID="C4DFBFAF-A1AA-4E89-B1D3-ED40C23FDC15" Value="3" Position="3"/>
|
|
399
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ItemResponseOID="63421FC0-1FD4-4F13-A6B0-63948FA9C2EF" Value="4" Position="4"/>
|
|
400
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ItemResponseOID="3111F5A8-81CE-43FB-AC46-FEA288EC5BAC" Value="5" Position="5"/>
|
|
401
|
+
</Element>
|
|
402
|
+
</Item>
|
|
403
|
+
<Item FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ID="PFC43" Order="112">
|
|
404
|
+
<Element ElementOID="4178DB28-763C-45A4-A958-B5A3620DA31F" Description="Are you able to use your hands, such as for turning faucets, using kitchen gadgets, or sewing?" 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="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ItemResponseOID="7CFF3772-041E-4FC2-B3E1-2A4D628F9D96" Value="1" Position="1"/>
|
|
407
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ItemResponseOID="51D0D7B9-A8DA-4372-8395-C43A34B553C8" Value="2" Position="2"/>
|
|
408
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ItemResponseOID="4F0A3014-6E19-41B2-B04C-37F875A531AB" Value="3" Position="3"/>
|
|
409
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ItemResponseOID="A0D8F000-0E4D-43D7-A113-C633CA974669" Value="4" Position="4"/>
|
|
410
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ItemResponseOID="5D74D076-6E1A-4186-BCDB-19836DA08CE2" Value="5" Position="5"/>
|
|
411
|
+
</Element>
|
|
412
|
+
</Item>
|
|
413
|
+
<Item FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ID="PFC45r1" Order="113">
|
|
414
|
+
<Element ElementOID="EB373A4E-034E-4E93-8BF7-BAF809842B27" Description="Are you able to sit on and get up from the toilet?" ElementOrder="1"/>
|
|
415
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
416
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ItemResponseOID="2C338B89-F57A-40CB-9364-3767D1701A4A" Value="1" Position="1"/>
|
|
417
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ItemResponseOID="113D62C4-3228-4F65-89B7-0DC043A93247" Value="2" Position="2"/>
|
|
418
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ItemResponseOID="E30AA9CE-98E1-46F6-8E32-EF280FC86291" Value="3" Position="3"/>
|
|
419
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ItemResponseOID="A5C6360D-8480-41C7-82D2-A35EE3DEDADD" Value="4" Position="4"/>
|
|
420
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ItemResponseOID="EE960644-8A15-4593-A48C-49257FC9159B" Value="5" Position="5"/>
|
|
421
|
+
</Element>
|
|
422
|
+
</Item>
|
|
423
|
+
<Item FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ID="PFB24" Order="71">
|
|
424
|
+
<Element ElementOID="B390F9BD-16D7-46C7-A768-2A7B8E271989" Description="Are you able to run a short distance, such as to catch a bus?" 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="9FB4E174-2562-4B78-9F12-86E612CED151" ItemResponseOID="C9275FD7-2EA4-440F-A3CE-FEBCC06E7EBD" Value="1" Position="1"/>
|
|
427
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ItemResponseOID="BC1A86C1-DF4C-4ED9-AC11-D19705FF9C1F" Value="2" Position="2"/>
|
|
428
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ItemResponseOID="82BD730D-160E-4B6F-B285-8D75295E0C04" Value="3" Position="3"/>
|
|
429
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ItemResponseOID="4F435A83-7545-4C70-96AD-6788B60815CF" Value="4" Position="4"/>
|
|
430
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ItemResponseOID="94ED8968-56A0-4F78-8195-B2B8864C2459" Value="5" Position="5"/>
|
|
431
|
+
</Element>
|
|
432
|
+
</Item>
|
|
433
|
+
<Item FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ID="PFB23" Order="70">
|
|
434
|
+
<Element ElementOID="47A6C28B-F2ED-4046-A484-DBBF01D2940C" Description="Are you able to pour liquid from a bottle into a glass?" 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="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ItemResponseOID="5E694F07-91F1-4F34-8EBC-10E04CB26EF7" Value="1" Position="1"/>
|
|
437
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ItemResponseOID="D691E4F3-BDAD-408E-AFFC-05C13F0C03A4" Value="2" Position="2"/>
|
|
438
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ItemResponseOID="BF4C7941-2C62-4E48-939B-E2FD20C2CE13" Value="3" Position="3"/>
|
|
439
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ItemResponseOID="67A82A37-FCB0-4D4B-9115-6F4072412559" Value="4" Position="4"/>
|
|
440
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ItemResponseOID="378505F1-F279-4116-B28E-95CE8DA2E81E" Value="5" Position="5"/>
|
|
441
|
+
</Element>
|
|
442
|
+
</Item>
|
|
443
|
+
<Item FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ID="PFB34" Order="81">
|
|
444
|
+
<Element ElementOID="3C596964-422D-4D8C-B559-D99BA9891BB7" Description="Are you able to change a light bulb overhead?" ElementOrder="2"/>
|
|
445
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
446
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ItemResponseOID="7BDEAA46-6A7E-4C4D-8DE0-0C0E583405E7" Value="1" Position="1"/>
|
|
447
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ItemResponseOID="8D0A991F-5F18-499B-A717-88EBE98A58E1" Value="2" Position="2"/>
|
|
448
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ItemResponseOID="96B074A2-D306-40DE-ABEE-4EBEE9CACAF5" Value="3" Position="3"/>
|
|
449
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ItemResponseOID="A8F32A8E-C560-4CD9-B58D-D69A5813ED45" Value="4" Position="4"/>
|
|
450
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ItemResponseOID="4BD7589B-F73C-46D2-994B-5ADCE90E4996" Value="5" Position="5"/>
|
|
451
|
+
</Element>
|
|
452
|
+
</Item>
|
|
453
|
+
<Item FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ID="PFB32" Order="79">
|
|
454
|
+
<Element ElementOID="B87EA7AB-82C9-4EB3-B350-AC9B39A00E50" Description="Are you able to stand unsupported for 10 minutes?" 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="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ItemResponseOID="DFDC7BE7-AC6B-4E7D-8A9A-E6B1045EB627" Value="1" Position="1"/>
|
|
457
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ItemResponseOID="67048E9C-0A80-4506-92B7-C94E34536FA3" Value="2" Position="2"/>
|
|
458
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ItemResponseOID="8A4A718C-4AB4-4C6F-BE4A-5058CA17F880" Value="3" Position="3"/>
|
|
459
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ItemResponseOID="ACF8C9FB-CCB9-448D-ABD9-62E64AD95C17" Value="4" Position="4"/>
|
|
460
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ItemResponseOID="A60CBF22-55F9-4856-927F-CCAD8EA3D7D0" Value="5" Position="5"/>
|
|
461
|
+
</Element>
|
|
462
|
+
</Item>
|
|
463
|
+
<Item FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ID="PFB43" Order="88">
|
|
464
|
+
<Element ElementOID="65A294C1-AF9E-4258-AE27-4E32D38122BC" Description="Does your health now limit you in taking care of your personal needs (dress, comb hair, toilet, eat, bathe)?" ElementOrder="2"/>
|
|
465
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
466
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ItemResponseOID="445DAC19-04BF-4BD2-8716-4B081ECFABF8" Value="1" Position="1"/>
|
|
467
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ItemResponseOID="78342D5D-2DF4-486B-8087-C897A5776B18" Value="2" Position="2"/>
|
|
468
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ItemResponseOID="A7BAC9B4-6CCF-49A9-B6E1-356B66B03FAA" Value="3" Position="3"/>
|
|
469
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ItemResponseOID="08F5257C-5DEC-4F21-B98D-4AF8E1D68D66" Value="4" Position="4"/>
|
|
470
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ItemResponseOID="B814D183-177D-4660-8BC2-4705E1D4CEED" Value="5" Position="5"/>
|
|
471
|
+
</Element>
|
|
472
|
+
</Item>
|
|
473
|
+
<Item FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ID="PFB20" Order="67">
|
|
474
|
+
<Element ElementOID="16F51E44-0286-4897-9D0A-F58CC8485E32" Description="Are you able to cut a piece of paper with scissors?" 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="92D4E779-5907-41E5-BF2C-7E49401D00FC" ItemResponseOID="89C6B8F3-D803-4426-B672-42C57BF7A9BC" Value="1" Position="1"/>
|
|
477
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ItemResponseOID="CC6FC6BE-C2E8-487E-8DC2-A3F11A8D8E71" Value="2" Position="2"/>
|
|
478
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ItemResponseOID="06BFB375-EA6F-4164-B1DE-55BC492815DB" Value="3" Position="3"/>
|
|
479
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ItemResponseOID="5178240D-C887-45FB-8094-8C5330D9D664" Value="4" Position="4"/>
|
|
480
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ItemResponseOID="588C6704-6C81-438B-963C-85F9058CFD15" Value="5" Position="5"/>
|
|
481
|
+
</Element>
|
|
482
|
+
</Item>
|
|
483
|
+
<Item FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ID="PFB36" Order="82">
|
|
484
|
+
<Element ElementOID="6A544955-176C-4FC9-9345-A5FAD6806D72" Description="Are you able to put on a pullover sweater?" 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="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ItemResponseOID="538B9A58-D81E-41DC-A103-6A4C79B34BBC" Value="1" Position="1"/>
|
|
487
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ItemResponseOID="1F40D8CD-67FD-4008-B164-19B2E9D197F0" Value="2" Position="2"/>
|
|
488
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ItemResponseOID="A34BDB99-CA4B-4801-8478-EA73A3A012A5" Value="3" Position="3"/>
|
|
489
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ItemResponseOID="28042F41-DC9F-4218-A55C-A7AD0DA539A0" Value="4" Position="4"/>
|
|
490
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ItemResponseOID="66DFD580-90E4-429C-B718-F519543EB0BA" Value="5" Position="5"/>
|
|
491
|
+
</Element>
|
|
492
|
+
</Item>
|
|
493
|
+
<Item FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ID="PFC49" Order="116">
|
|
494
|
+
<Element ElementOID="3285653D-BB3F-4A30-8C78-1ED1B242ADEE" Description="Are you able to water a house plant?" 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="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ItemResponseOID="CBE0552F-1002-4CE9-99B2-12F6F84122BD" Value="1" Position="1"/>
|
|
497
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ItemResponseOID="E383ADCC-9C05-4D1E-A29A-A4BA05BAEFB1" Value="2" Position="2"/>
|
|
498
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ItemResponseOID="4FADB5E3-8D86-4037-B198-B0B805D54821" Value="3" Position="3"/>
|
|
499
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ItemResponseOID="A3AC93E3-336B-440D-B9C7-639F7AC0B649" Value="4" Position="4"/>
|
|
500
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ItemResponseOID="1C16EA42-EFE4-4841-959F-82019667C3E7" Value="5" Position="5"/>
|
|
501
|
+
</Element>
|
|
502
|
+
</Item>
|
|
503
|
+
<Item FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ID="PFC7r1" Order="97">
|
|
504
|
+
<Element ElementOID="65950603-288C-44C9-A3F6-88F61EDBF787" Description="Are you able to run five miles (8 km)?" ElementOrder="1"/>
|
|
505
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2">
|
|
506
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ItemResponseOID="9C4602A0-4CEB-4F41-BA35-1B900C027D3E" Value="1" Position="1"/>
|
|
507
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ItemResponseOID="C6D2121B-F519-4F02-8835-97CEEF51B996" Value="2" Position="2"/>
|
|
508
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ItemResponseOID="DE6D00DC-D342-4E92-A3BA-D054F35D7F81" Value="3" Position="3"/>
|
|
509
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ItemResponseOID="887B76A4-E30F-44BE-975C-368B5B6A5B00" Value="4" Position="4"/>
|
|
510
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ItemResponseOID="28A66EC8-FF16-462A-9C6D-1F829F69F4E3" Value="5" Position="5"/>
|
|
511
|
+
</Element>
|
|
512
|
+
</Item>
|
|
513
|
+
<Item FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ID="PFC56" Order="121">
|
|
514
|
+
<Element ElementOID="EA983CD8-11B3-4460-B84A-00FE2B5439FF" Description="Does your health now limit you in walking about the house?" ElementOrder="2"/>
|
|
515
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3">
|
|
516
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ItemResponseOID="D2391F0A-2683-401C-8D41-C33BC7ED0CEC" Value="1" Position="1"/>
|
|
517
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ItemResponseOID="E005E897-8966-4BFA-B4DF-A926FCD79391" Value="2" Position="2"/>
|
|
518
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ItemResponseOID="11D5A133-E3A4-4A65-9499-1287E995022A" Value="3" Position="3"/>
|
|
519
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ItemResponseOID="16D0EA34-B626-47DE-9D8A-94898E9318FB" Value="4" Position="4"/>
|
|
520
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ItemResponseOID="B762C7BA-A9A2-4AB8-B195-5BC4240B4012" Value="5" Position="5"/>
|
|
521
|
+
</Element>
|
|
522
|
+
</Item>
|
|
523
|
+
<Item FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ID="PFB29" Order="76">
|
|
524
|
+
<Element ElementOID="40437C4D-1EFE-421E-8935-58A963ECE3D6" Description="Are you able to lift a full cup or glass to your mouth?" ElementOrder="2"/>
|
|
525
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3">
|
|
526
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ItemResponseOID="F6616D05-FB7E-4A0B-A48C-A26CC27811BB" Value="1" Position="1"/>
|
|
527
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ItemResponseOID="B5DB2656-6326-44F3-8EA8-4C5AEB3868EE" Value="2" Position="2"/>
|
|
528
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ItemResponseOID="13FAD77D-82FE-46D5-B89A-F69E0C37B36D" Value="3" Position="3"/>
|
|
529
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ItemResponseOID="BE3728BC-7527-4231-9386-65289090798A" Value="4" Position="4"/>
|
|
530
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ItemResponseOID="9A763DE5-C391-4687-B391-141F6A59C1CB" Value="5" Position="5"/>
|
|
531
|
+
</Element>
|
|
532
|
+
</Item>
|
|
533
|
+
<Item FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ID="PFB54" Order="94">
|
|
534
|
+
<Element ElementOID="DFAD6036-DE2C-4012-9DE3-389B753A208C" Description="Does your health now limit you in going OUTSIDE the home, for example to shop or visit a doctor's office?" ElementOrder="2"/>
|
|
535
|
+
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536
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551
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552
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553
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