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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<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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