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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require "ar_helper"
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require "study_engine/study_id/bank"
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module StudyEngine
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describe StudyID::Bank do
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let!(:study_id_a) { described_class.find_or_create_from_full_study_id("FIX-AAA-1000") }
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let!(:study_id_b) { described_class.find_or_create_from_full_study_id("FIX-AAA-1001") }
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let!(:study_id_c) { described_class.find_or_create_from_full_study_id("FIX-BBB-1000") }
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let!(:study_id_d) { described_class.find_or_create_from_full_study_id("OUT-AAA-1000") }
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describe ".find_or_create_from_full_study_id study_id" do
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it "returns a record if one already exists" do
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expect {
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subject = described_class.find_or_create_from_full_study_id("FIX-BBB-1000")
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subject.should == study_id_c
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}.to_not change { described_class.count }
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end
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it "creates a new record if one doesn't exist" do
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expect {
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described_class.find_or_create_from_full_study_id("TAU-BAM-1000")
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}.to change { described_class.count }.by(1)
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end
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end
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it ".studies" do
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described_class.studies.should == %w(FIX OUT)
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end
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it ".sites" do
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described_class.sites.should == %w(AAA BBB)
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end
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it ".ids_grouped_by_study_and_site" do
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described_class.ids_grouped_by_study_and_site.should == {
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"FIXAAA" => ["1000","1001"],
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"FIXBBB" => ["1000"],
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"OUTAAA" => ["1000"],
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}
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end
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it ".studies_grouped_by_site" do
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described_class.studies_grouped_by_site.should == {
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"AAA" => Set.new(["FIX", "OUT"]),
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"BBB" => Set.new(["FIX"]),
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}
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end
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describe "valid?" do
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subject { study_id_a }
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it "ensures study is three uppercase letters" do
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subject.study_id_study = "AB"
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subject.should_not be_valid
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subject.errors.full_messages.should == ["Study id study is invalid"]
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end
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it "ensures site is three uppercase letters" do
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subject.study_id_site = "abc"
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subject.should_not be_valid
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subject.errors.full_messages.should == ["Study id site is invalid"]
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end
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it "ensures id is four numbers" do
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subject.study_id_id = "123"
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subject.should_not be_valid
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subject.errors.full_messages.should == ["Study id is invalid"]
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end
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end
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end
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end
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require "ar_helper"
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require "study_engine/study_id/sync"
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require "study_engine/study_id/bank"
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require "webmock/rspec"
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module StudyEngine
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describe StudyID::Sync do
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let(:csv) { <<-CSV }
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study_id,stream_api_complete
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FIX-AAA-1000,0
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FIX-AAA-1001,0
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FIX-BBB-1001,0
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OUT-AAA-1000,0
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CSV
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before do
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StudyEngine.redcap_token = "omgwtfbbq"
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stub_request(:post, "https://metrcdata.org/redcap/api/").
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with(body: { "content"=>"record", "format"=>"csv", "token"=>"omgwtfbbq" }).
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to_return(body: csv)
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end
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describe ".call" do
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it "adds new study ids" do
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expect {
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described_class.call
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}.to change { StudyID::Bank.count }.by(4)
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end
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it "deletes old nonexistent study ids" do
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attributes = { study_id_study: "OMG", study_id_site: "WTF", study_id_id: "1234" }
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StudyID::Bank.create(attributes.merge(updated_at: 1.hour.ago))
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expect {
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described_class.call
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}.to change { StudyID::Bank.where(attributes).count }.by(-1)
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end
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it "raises an error when redcap token is not configured" do
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StudyEngine.redcap_token = ""
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expect { described_class.call }.to raise_exception("Cannot sync with REDCap without setting StudyEngine.redcap_token")
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end
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it "retries request on network timeout" do
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call_count = 0
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allow(Faraday).to receive(:new).and_wrap_original do |original, *args|
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call_count += 1
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if call_count == 1
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raise Faraday::TimeoutError
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else
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original.call(*args)
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end
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end
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expect {
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described_class.call
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}.to change { StudyID::Bank.count }.by(4)
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expect(call_count).to eq(2)
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end
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end
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end
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end
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require "ar_helper"
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require "study_engine/result"
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require "study_engine/assessment"
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require "study_engine/update_assessments_form"
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module StudyEngine
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describe UpdateAssessmentsForm do
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let(:study_id) { "FIX-ABC-1234" }
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subject do
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described_class.new(study_id)
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end
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it "knows about study id components" do
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aggregate_failures "study id components" do
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subject.study_id.should == StudyID.new("FIX-ABC-1234")
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subject.study_id_study.should == "FIX"
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subject.study_id_site.should == "ABC"
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subject.study_id_id.should == "1234"
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end
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end
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it "can update some asssessments' study ids" do
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baseline = Assessment.by_event("Baseline").create! study_id: "FIX-ABC-1234"
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six_month = Assessment.by_event("6 month").create! study_id: "FIX-ABC-1234"
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twelve_month = Assessment.by_event("12 month").create! study_id: "FIX-ABC-1234"
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subject.update_attributes! study_id_study: "OUT", study_id_site: "NEW", study_id_id: "6789"
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aggregate_failures "update assessments" do
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baseline.reload.study_id.should == StudyID.new("OUT-NEW-6789")
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six_month.reload.study_id.should == StudyID.new("OUT-NEW-6789")
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twelve_month.reload.study_id.should == StudyID.new("OUT-NEW-6789")
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end
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end
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end
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end
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# This file is copied to spec/ when you run 'rails generate rspec:install'
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ENV["RAILS_ENV"] ||= 'test'
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require 'spec_helper'
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require File.expand_path("../../config/environment", __FILE__)
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require 'rspec/rails'
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# Add additional requires below this line. Rails is not loaded until this point!
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# Requires supporting ruby files with custom matchers and macros, etc, in
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# spec/support/ and its subdirectories. Files matching `spec/**/*_spec.rb` are
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# run as spec files by default. This means that files in spec/support that end
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# in _spec.rb will both be required and run as specs, causing the specs to be
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# run twice. It is recommended that you do not name files matching this glob to
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# end with _spec.rb. You can configure this pattern with the --pattern
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# option on the command line or in ~/.rspec, .rspec or `.rspec-local`.
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#
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# The following line is provided for convenience purposes. It has the downside
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# of increasing the boot-up time by auto-requiring all files in the support
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# directory. Alternatively, in the individual `*_spec.rb` files, manually
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# require only the support files necessary.
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#
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# Dir[Rails.root.join("spec/support/**/*.rb")].each { |f| require f }
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# Checks for pending migrations before tests are run.
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# If you are not using ActiveRecord, you can remove this line.
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ActiveRecord::Migration.maintain_test_schema!
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RSpec.configure do |config|
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# Remove this line if you're not using ActiveRecord or ActiveRecord fixtures
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config.fixture_path = "#{::Rails.root}/spec/fixtures"
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# If you're not using ActiveRecord, or you'd prefer not to run each of your
|
32
|
+
# examples within a transaction, remove the following line or assign false
|
33
|
+
# instead of true.
|
34
|
+
config.use_transactional_fixtures = true
|
35
|
+
|
36
|
+
# RSpec Rails can automatically mix in different behaviours to your tests
|
37
|
+
# based on their file location, for example enabling you to call `get` and
|
38
|
+
# `post` in specs under `spec/controllers`.
|
39
|
+
#
|
40
|
+
# You can disable this behaviour by removing the line below, and instead
|
41
|
+
# explicitly tag your specs with their type, e.g.:
|
42
|
+
#
|
43
|
+
# RSpec.describe UsersController, :type => :controller do
|
44
|
+
# # ...
|
45
|
+
# end
|
46
|
+
#
|
47
|
+
# The different available types are documented in the features, such as in
|
48
|
+
# https://relishapp.com/rspec/rspec-rails/docs
|
49
|
+
config.infer_spec_type_from_file_location!
|
50
|
+
end
|
data/spec/schema.rb
ADDED
@@ -0,0 +1,65 @@
|
|
1
|
+
# encoding: UTF-8
|
2
|
+
# This file is auto-generated from the current state of the database. Instead
|
3
|
+
# of editing this file, please use the migrations feature of Active Record to
|
4
|
+
# incrementally modify your database, and then regenerate this schema definition.
|
5
|
+
#
|
6
|
+
# Note that this schema.rb definition is the authoritative source for your
|
7
|
+
# database schema. If you need to create the application database on another
|
8
|
+
# system, you should be using db:schema:load, not running all the migrations
|
9
|
+
# from scratch. The latter is a flawed and unsustainable approach (the more migrations
|
10
|
+
# you'll amass, the slower it'll run and the greater likelihood for issues).
|
11
|
+
#
|
12
|
+
# It's strongly recommended that you check this file into your version control system.
|
13
|
+
|
14
|
+
ActiveRecord::Schema.define(version: 20151208012348) do
|
15
|
+
|
16
|
+
create_table "answers", force: :cascade do |t|
|
17
|
+
t.integer "result_id", limit: 4
|
18
|
+
t.string "question_context", limit: 255
|
19
|
+
t.string "response_title", limit: 255
|
20
|
+
t.string "response_id", limit: 255
|
21
|
+
t.datetime "created_at", null: false
|
22
|
+
t.datetime "updated_at", null: false
|
23
|
+
t.string "question_id", limit: 255
|
24
|
+
t.string "question_title", limit: 255
|
25
|
+
t.string "question_promis_id", limit: 255
|
26
|
+
t.string "response_promis_id", limit: 255
|
27
|
+
t.string "response_before", limit: 255
|
28
|
+
end
|
29
|
+
|
30
|
+
create_table "assessments", force: :cascade do |t|
|
31
|
+
t.text "finished_cat_assessment_ids", limit: 65535
|
32
|
+
t.datetime "created_at", null: false
|
33
|
+
t.datetime "updated_at", null: false
|
34
|
+
t.string "study_id", limit: 255
|
35
|
+
t.string "event", limit: 255
|
36
|
+
t.integer "group_index", limit: 4
|
37
|
+
t.string "method_applied", limit: 255
|
38
|
+
t.integer "coordinator_id", limit: 4
|
39
|
+
t.datetime "assessment_updated_at", null: false
|
40
|
+
t.text "notes", limit: 65535
|
41
|
+
t.datetime "completed_at"
|
42
|
+
end
|
43
|
+
|
44
|
+
create_table "results", force: :cascade do |t|
|
45
|
+
t.integer "assessment_id", limit: 4
|
46
|
+
t.string "bank_id", limit: 255
|
47
|
+
t.boolean "finished", default: false
|
48
|
+
t.decimal "theta", precision: 10, scale: 5
|
49
|
+
t.decimal "standard_error", precision: 10, scale: 5
|
50
|
+
t.datetime "created_at", null: false
|
51
|
+
t.datetime "updated_at", null: false
|
52
|
+
end
|
53
|
+
|
54
|
+
add_index "results", ["assessment_id"], name: "index_results_on_assessment_id", using: :btree
|
55
|
+
add_index "results", ["bank_id"], name: "index_results_on_cat_assessment_id", using: :btree
|
56
|
+
|
57
|
+
create_table "study_engine_study_ids", force: :cascade do |t|
|
58
|
+
t.string "study_id_study", limit: 255
|
59
|
+
t.string "study_id_site", limit: 255
|
60
|
+
t.string "study_id_id", limit: 255
|
61
|
+
t.datetime "created_at"
|
62
|
+
t.datetime "updated_at"
|
63
|
+
end
|
64
|
+
end
|
65
|
+
|
data/spec/spec_helper.rb
ADDED
@@ -0,0 +1,72 @@
|
|
1
|
+
require "rspec/its"
|
2
|
+
require "byebug"
|
3
|
+
|
4
|
+
$LOAD_PATH << "app/models"
|
5
|
+
|
6
|
+
RSpec.configure do |config|
|
7
|
+
# rspec-expectations config goes here. You can use an alternate
|
8
|
+
# assertion/expectation library such as wrong or the stdlib/minitest
|
9
|
+
# assertions if you prefer.
|
10
|
+
config.expect_with :rspec do |expectations|
|
11
|
+
# This option will default to `true` in RSpec 4. It makes the `description`
|
12
|
+
# and `failure_message` of custom matchers include text for helper methods
|
13
|
+
# defined using `chain`, e.g.:
|
14
|
+
# be_bigger_than(2).and_smaller_than(4).description
|
15
|
+
# # => "be bigger than 2 and smaller than 4"
|
16
|
+
# ...rather than:
|
17
|
+
# # => "be bigger than 2"
|
18
|
+
expectations.include_chain_clauses_in_custom_matcher_descriptions = true
|
19
|
+
expectations.syntax = [:should, :expect]
|
20
|
+
end
|
21
|
+
|
22
|
+
# rspec-mocks config goes here. You can use an alternate test double
|
23
|
+
# library (such as bogus or mocha) by changing the `mock_with` option here.
|
24
|
+
config.mock_with :rspec do |mocks|
|
25
|
+
# Prevents you from mocking or stubbing a method that does not exist on
|
26
|
+
# a real object. This is generally recommended, and will default to
|
27
|
+
# `true` in RSpec 4.
|
28
|
+
mocks.verify_partial_doubles = true
|
29
|
+
mocks.syntax = [:should, :expect]
|
30
|
+
end
|
31
|
+
|
32
|
+
# These two settings work together to allow you to limit a spec run
|
33
|
+
# to individual examples or groups you care about by tagging them with
|
34
|
+
# `:focus` metadata. When nothing is tagged with `:focus`, all examples
|
35
|
+
# get run.
|
36
|
+
config.filter_run :focus
|
37
|
+
config.run_all_when_everything_filtered = true
|
38
|
+
|
39
|
+
# Limits the available syntax to the non-monkey patched syntax that is recommended.
|
40
|
+
# For more details, see:
|
41
|
+
# - http://myronmars.to/n/dev-blog/2012/06/rspecs-new-expectation-syntax
|
42
|
+
# - http://teaisaweso.me/blog/2013/05/27/rspecs-new-message-expectation-syntax/
|
43
|
+
# - http://myronmars.to/n/dev-blog/2014/05/notable-changes-in-rspec-3#new__config_option_to_disable_rspeccore_monkey_patching
|
44
|
+
# config.disable_monkey_patching!
|
45
|
+
|
46
|
+
# Many RSpec users commonly either run the entire suite or an individual
|
47
|
+
# file, and it's useful to allow more verbose output when running an
|
48
|
+
# individual spec file.
|
49
|
+
if config.files_to_run.one?
|
50
|
+
# Use the documentation formatter for detailed output,
|
51
|
+
# unless a formatter has already been configured
|
52
|
+
# (e.g. via a command-line flag).
|
53
|
+
config.default_formatter = 'doc'
|
54
|
+
end
|
55
|
+
|
56
|
+
# Print the 10 slowest examples and example groups at the
|
57
|
+
# end of the spec run, to help surface which specs are running
|
58
|
+
# particularly slow.
|
59
|
+
# config.profile_examples = 10
|
60
|
+
|
61
|
+
# Run specs in random order to surface order dependencies. If you find an
|
62
|
+
# order dependency and want to debug it, you can fix the order by providing
|
63
|
+
# the seed, which is printed after each run.
|
64
|
+
# --seed 1234
|
65
|
+
config.order = :random
|
66
|
+
|
67
|
+
# Seed global randomization in this process using the `--seed` CLI option.
|
68
|
+
# Setting this allows you to use `--seed` to deterministically reproduce
|
69
|
+
# test failures related to randomization by passing the same `--seed` value
|
70
|
+
# as the one that triggered the failure.
|
71
|
+
Kernel.srand config.seed
|
72
|
+
end
|
Binary file
|
@@ -0,0 +1,1213 @@
|
|
1
|
+
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|
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<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="DEAE5A56-38DF-4010-AEE6-8BD3755773FB" Value="4" Position="4" />
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<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="DBE887A2-2EC3-435E-9C03-CE6E99E1985B" ItemResponseOID="0E7D78FB-5853-4BC2-92E0-3850BD024EB1" Value="5" Position="5" />
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|
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|
21
|
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|
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|
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|
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|
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<Element ElementOID="2B613D19-8D42-4CE7-ACF5-52DC8F90E63E" Description="Does your health now limit you in doing heavy work around the house like scrubbing floors, or lifting or moving heavy furniture?" ElementOrder="2" />
|
24
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
25
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="8A548999-BD77-45F1-A3CE-BEE5A04BDB71" Value="1" Position="1" />
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+
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<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="7E98A307-7158-457D-A6CD-228D56C1C7B9" ItemResponseOID="2CAE0D23-60D8-49D0-9783-85F275D5E940" Value="3" Position="3" />
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|
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|
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|
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</Item>
|
32
|
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<Item FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ID="PFA5" Order="4" >
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|
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<Element ElementOID="2A2E24C4-25E9-499F-937E-C2CFC7900D38" Description="Does your health now limit you in lifting or carrying groceries?" ElementOrder="2" />
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|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
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|
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|
37
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="D4532E89-A5AD-4F99-8591-E8BFC826DE25" Value="3" Position="3" />
|
38
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="2B99E9D6-11AF-4D57-A409-5EB4979EF4EE" Value="4" Position="4" />
|
39
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="7D63850D-EE56-4894-A09B-792508127FD3" ItemResponseOID="2B7860F9-31C8-4C64-864A-BB085FA016A2" Value="5" Position="5" />
|
40
|
+
</Element>
|
41
|
+
</Item>
|
42
|
+
<Item FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ID="PFA6" Order="5" >
|
43
|
+
<Element ElementOID="6552A8EB-E9B5-4601-8EA5-5C08488EC6D2" Description="Does your health now limit you in bathing or dressing yourself?" ElementOrder="2" />
|
44
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
45
|
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<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="74F93748-E91F-4120-A625-DAEB48BAE550" Value="1" Position="1" />
|
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|
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<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="F3D24B93-6048-4B06-BCA2-56AA6260CFD5" Value="2" Position="2" />
|
47
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="5155BA5E-3EBB-4403-8DB6-2753CF897100" Value="3" Position="3" />
|
48
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="79BC832D-4880-4702-BF23-B7BA51F04F32" Value="4" Position="4" />
|
49
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="E4AFA0B0-95F6-4357-AD1F-B40CE3B997D2" ItemResponseOID="9D021D6F-8D90-444B-AF4B-0812461F128C" Value="5" Position="5" />
|
50
|
+
</Element>
|
51
|
+
</Item>
|
52
|
+
<Item FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ID="PFA8" Order="6" >
|
53
|
+
<Element ElementOID="3496CB3B-441E-4113-BC8F-37E2DA0E7B34" Description="Are you able to move a chair from one room to another?" ElementOrder="2" />
|
54
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
55
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="100A78ED-3949-496E-AE2D-0F647AE4632D" Value="1" Position="1" />
|
56
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="C83B6A69-4373-4E8B-8C62-C1858C4EB121" Value="2" Position="2" />
|
57
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="1A0B52B3-EB80-4695-8985-0A8FE5554EFC" Value="3" Position="3" />
|
58
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="F05E059D-F938-4D74-96E0-31B88BF5D827" Value="4" Position="4" />
|
59
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="884A89A7-9B08-4353-B16D-1F6B75A0516A" ItemResponseOID="8C521DD3-DBA1-41BA-B36E-73F36B41B31E" Value="5" Position="5" />
|
60
|
+
</Element>
|
61
|
+
</Item>
|
62
|
+
<Item FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ID="PFA9" Order="7" >
|
63
|
+
<Element ElementOID="BED78803-8B2C-48B7-AC81-7BF9635A0059" Description="Are you able to bend down and pick up clothing from the floor?" ElementOrder="2" />
|
64
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
65
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="1839B63E-FE87-4360-8F1D-5F701D8AA60E" Value="1" Position="1" />
|
66
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="5F720166-14D6-42F2-8A77-F244669CF0DE" Value="2" Position="2" />
|
67
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="6887235B-5B86-4DFB-BABD-FAB7FA49B1C1" Value="3" Position="3" />
|
68
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="F773CE59-6973-4DF6-8467-8CA47C5565D2" Value="4" Position="4" />
|
69
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0B430820-5857-4005-ABED-0FC6B9F7248D" ItemResponseOID="654B05BA-4B6C-4AAC-A8D2-32110DA1AB1A" Value="5" Position="5" />
|
70
|
+
</Element>
|
71
|
+
</Item>
|
72
|
+
<Item FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ID="PFA10" Order="8" >
|
73
|
+
<Element ElementOID="0D7AC282-7101-4528-86FE-9F7089480012" Description="Are you able to stand for one hour?" ElementOrder="2" />
|
74
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
75
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="E9444DD7-AEC9-41E9-9E25-CCC2E5F87E42" Value="1" Position="1" />
|
76
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="7CF284DC-CE3D-48DD-8312-475AF9FF1F7A" Value="2" Position="2" />
|
77
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="F4B2CB64-A4B0-43AE-ABAE-A35F9E47D729" Value="3" Position="3" />
|
78
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="A06A4812-5730-433C-BA0A-13907885021C" Value="4" Position="4" />
|
79
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="65DF2AD9-9E88-4497-9E6B-7295FD8CFF5D" ItemResponseOID="E533DC33-3511-4399-9AC6-0A34E0A90A8A" Value="5" Position="5" />
|
80
|
+
</Element>
|
81
|
+
</Item>
|
82
|
+
<Item FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ID="PFA11" Order="9" >
|
83
|
+
<Element ElementOID="8139E821-386D-4CF7-868E-4238B9D571AB" Description="Are you able to do chores such as vacuuming or yard work?" ElementOrder="2" />
|
84
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
85
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="9DA8E613-62AD-478A-9A9D-A769459AD100" Value="1" Position="1" />
|
86
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="9C4A6E4B-785A-4C4D-AD01-9BD9CD0715A8" Value="2" Position="2" />
|
87
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="28F0DAC6-31C4-441A-9549-1C6456685557" Value="3" Position="3" />
|
88
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="A4D553FD-2CF1-46AE-943B-7B3922F70C19" Value="4" Position="4" />
|
89
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="187CA792-05DE-4B9C-8B0E-7F15FF055D3B" ItemResponseOID="38E5FB56-9CC4-405C-AD08-F1402A7D0F21" Value="5" Position="5" />
|
90
|
+
</Element>
|
91
|
+
</Item>
|
92
|
+
<Item FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ID="PFA12" Order="10" >
|
93
|
+
<Element ElementOID="3C7A78DD-4FEA-46D8-BD52-FEC9AE0A4203" Description="Are you able to push open a heavy door?" ElementOrder="2" />
|
94
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
95
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="0DA32E2B-80AF-4AF5-BD4E-FD6F520493DD" Value="1" Position="1" />
|
96
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="0422BCF4-62B8-4DC4-BCB9-51F522043493" Value="2" Position="2" />
|
97
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="8737EE32-B361-4B2E-9E12-FE88163EFF36" Value="3" Position="3" />
|
98
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="B1FA4C21-DEFE-4F5B-BBB9-91A1531B2DF6" Value="4" Position="4" />
|
99
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C6DF7626-8C46-4E1A-96E2-FCE7B316026A" ItemResponseOID="52FA1FCD-9818-4792-95DC-EAD8A49EEC06" Value="5" Position="5" />
|
100
|
+
</Element>
|
101
|
+
</Item>
|
102
|
+
<Item FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ID="PFA13" Order="11" >
|
103
|
+
<Element ElementOID="F2D23576-DAF6-4A79-AE1C-775935816F41" Description="Are you able to exercise for an hour?" ElementOrder="2" />
|
104
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
105
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="007B869B-27BB-4A79-BB49-EF30A30B5212" Value="1" Position="1" />
|
106
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="0F28C205-BE4A-477A-AF98-7D868A8AE417" Value="2" Position="2" />
|
107
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="5A6CBF6D-427F-49C8-8A96-A48B750D7328" Value="3" Position="3" />
|
108
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="BFCFC9DF-1CCF-4E69-AD92-8B4387EBB438" Value="4" Position="4" />
|
109
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="B9203D37-CC31-488D-984B-BABD05C3605E" ItemResponseOID="9584778E-34D5-4ACA-B149-175E3EA13DEB" Value="5" Position="5" />
|
110
|
+
</Element>
|
111
|
+
</Item>
|
112
|
+
<Item FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ID="PFA14r1" Order="12" >
|
113
|
+
<Element ElementOID="BB6BA0B0-5D29-47FE-9961-D370AA44C3E1" Description="Are you able to carry a heavy object (over 10 pounds /5 kg)?" ElementOrder="1" />
|
114
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
115
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="5CD4E6FC-B377-428D-B19D-09ADBDA9AD1F" Value="1" Position="1" />
|
116
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="0D18B8B2-3615-4444-9876-CF6796D5C198" Value="2" Position="2" />
|
117
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="29BC6F55-0256-4373-A313-2907B8579399" Value="3" Position="3" />
|
118
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="00382AF9-EC3C-43F1-AD6C-910326EFD09D" Value="4" Position="4" />
|
119
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2099B7D8-4DA1-477E-8C64-A85F0497EDC2" ItemResponseOID="673E331B-1B9F-4565-89DF-099E3B2E4AB8" Value="5" Position="5" />
|
120
|
+
</Element>
|
121
|
+
</Item>
|
122
|
+
<Item FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ID="PFA15" Order="13" >
|
123
|
+
<Element ElementOID="5AA75A60-8A08-465E-AE4D-F9AD60E52045" Description="Are you able to stand up from an armless straight chair?" ElementOrder="2" />
|
124
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
125
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="9C613E53-13CD-4B4A-B674-F3D3F7AB2120" Value="1" Position="1" />
|
126
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="2AA95BEC-DECA-464F-A8F4-E93F80F2B87E" Value="2" Position="2" />
|
127
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="45FE4007-3582-4CDE-BEAE-39E8C0AB6476" Value="3" Position="3" />
|
128
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="94711FA9-E59B-497B-A52C-2BD26C1E261F" Value="4" Position="4" />
|
129
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2A5A71D9-CCB3-4F92-A3AB-C25ABC460369" ItemResponseOID="B4B09630-9BA0-44DC-AC5D-77C7908AF1CD" Value="5" Position="5" />
|
130
|
+
</Element>
|
131
|
+
</Item>
|
132
|
+
<Item FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ID="PFA16r1" Order="14" >
|
133
|
+
<Element ElementOID="5D0955F3-B229-46C5-B6D3-15A0F2DC5295" Description="Are you able to dress yourself, including tying shoelaces and buttoning your clothes?" ElementOrder="1" />
|
134
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
135
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="6231597E-26B0-4E32-AF03-C6564BA2DB2A" Value="1" Position="1" />
|
136
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="AEE6DC2F-83A8-4F89-9E4D-C9E65EECDEB9" Value="2" Position="2" />
|
137
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="31F53FF0-733D-461B-B549-004D55A2DE22" Value="3" Position="3" />
|
138
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="326DA98D-DA6B-4B16-9EF2-5B0EB03CB219" Value="4" Position="4" />
|
139
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="50BD7386-6550-471E-B1A5-FDD1209FB65D" ItemResponseOID="BE5DC566-E5D4-42CB-BB92-587B48353D01" Value="5" Position="5" />
|
140
|
+
</Element>
|
141
|
+
</Item>
|
142
|
+
<Item FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ID="PFA17" Order="15" >
|
143
|
+
<Element ElementOID="7D214313-7629-4D6F-AEC9-44335CF98241" Description="Are you able to reach into a high cupboard?" ElementOrder="2" />
|
144
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
145
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="5EF0EC1D-EE9D-48FA-ABE3-B6095DC070F0" Value="1" Position="1" />
|
146
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="79D0EF6D-F919-42A8-BA68-484235692EFE" Value="2" Position="2" />
|
147
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="2E941732-9660-485C-86B5-0425CFC78EBC" Value="3" Position="3" />
|
148
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="CAF8ED82-398E-4875-B7D1-6E55F0A6A87D" Value="4" Position="4" />
|
149
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="D07B1E85-B0B0-4B65-A187-702050428AF3" ItemResponseOID="92FDF0F4-E9FD-492E-B879-D5C2809FCE13" Value="5" Position="5" />
|
150
|
+
</Element>
|
151
|
+
</Item>
|
152
|
+
<Item FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ID="PFA18" Order="16" >
|
153
|
+
<Element ElementOID="6030769E-74C3-4121-8F98-FCE92D7AED29" Description="Are you able to use a hammer to pound a nail?" ElementOrder="2" />
|
154
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
155
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="FF9FE56C-6F28-4BB0-80F4-337E44811280" Value="1" Position="1" />
|
156
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="532F35A5-6B2C-4227-A484-FFECC284941C" Value="2" Position="2" />
|
157
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="8BCACD89-CDB5-453E-B450-2FE96B7596FB" Value="3" Position="3" />
|
158
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="ED472611-9E4D-4578-83CC-FA1A79B9C763" Value="4" Position="4" />
|
159
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E4159485-B8A4-4C2D-9AB9-C371192EF781" ItemResponseOID="B46FCF14-E0A5-4055-AFF1-92E82EA3AB86" Value="5" Position="5" />
|
160
|
+
</Element>
|
161
|
+
</Item>
|
162
|
+
<Item FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ID="PFA19r1" Order="17" >
|
163
|
+
<Element ElementOID="727D9C38-C5D5-48F7-A5B5-CD2279B24CD4" Description="Are you able to run or jog for two miles (3 km)?" ElementOrder="1" />
|
164
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
165
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="60232F89-A5FD-464B-BD55-8BA07761D20B" Value="1" Position="1" />
|
166
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="383004EE-32DF-4EF4-BD83-44E47D64A594" Value="2" Position="2" />
|
167
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="326BB15F-5FE2-4938-8345-7CF15516EEDE" Value="3" Position="3" />
|
168
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="5DD828B9-DA3F-43BE-932B-F66ECC287DBE" Value="4" Position="4" />
|
169
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="77BFEB4B-E82E-4551-A906-094E713B84BA" ItemResponseOID="B99D23ED-BCD2-4D2F-9E92-97F20FEDD8B7" Value="5" Position="5" />
|
170
|
+
</Element>
|
171
|
+
</Item>
|
172
|
+
<Item FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ID="PFA20" Order="18" >
|
173
|
+
<Element ElementOID="63AD93BE-140B-4E03-A077-6817DF52E9AF" Description="Are you able to cut your food using eating utensils?" ElementOrder="2" />
|
174
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
175
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="AE6CCD3C-8B22-4890-AC38-6F3AF804E85E" Value="1" Position="1" />
|
176
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="CF05D01F-3BDF-476A-9BE3-4BAAAD739C8C" Value="2" Position="2" />
|
177
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="3A04CC40-6610-48F0-8F82-9BE93CFA93FF" Value="3" Position="3" />
|
178
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="05A88FC7-4A26-4010-A8CB-E74C4C75ECC2" Value="4" Position="4" />
|
179
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="A113F7FB-455E-4884-BC74-5ABAB2940CF4" ItemResponseOID="FE993528-2E9C-4B56-995F-DD239C17B416" Value="5" Position="5" />
|
180
|
+
</Element>
|
181
|
+
</Item>
|
182
|
+
<Item FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ID="PFA21" Order="19" >
|
183
|
+
<Element ElementOID="1E839D6D-4E88-4BCA-BF28-4355AB7EAC31" Description="Are you able to go up and down stairs at a normal pace?" ElementOrder="2" />
|
184
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
185
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="FE3D1266-95D5-4260-94C0-5DA84F378188" Value="1" Position="1" />
|
186
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="81CB22A2-0277-4FEB-9555-EFFD610B6F00" Value="2" Position="2" />
|
187
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="6A0F1C9C-0FB0-41EC-88E3-6AC6EEAD62A8" Value="3" Position="3" />
|
188
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="180C0EF9-8675-4E2A-A052-56179C145FCC" Value="4" Position="4" />
|
189
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2635FD30-CDB6-4FD4-996C-F4C7971CB0A6" ItemResponseOID="80872952-2FAE-4596-B44D-3FC89EC91C46" Value="5" Position="5" />
|
190
|
+
</Element>
|
191
|
+
</Item>
|
192
|
+
<Item FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ID="PFA22" Order="20" >
|
193
|
+
<Element ElementOID="13E93D3D-A04B-4A6D-89E3-C9F6B5BB17AF" Description="Are you able to open previously opened jars?" ElementOrder="2" />
|
194
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
195
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="BCEE1E17-A4A0-4907-970D-31A110BEF07B" Value="1" Position="1" />
|
196
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="3D371C03-862C-4A3B-B71E-83EC50E3937B" Value="2" Position="2" />
|
197
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="1A5FF944-966E-4046-9A7D-89532138E05C" Value="3" Position="3" />
|
198
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="8FABB657-4241-407C-8085-A3FD3CB71579" Value="4" Position="4" />
|
199
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BCE08911-62B0-4861-BECE-92AAAF40C7BC" ItemResponseOID="5FB23EBC-FE12-4A6A-A382-C3EDE29F610A" Value="5" Position="5" />
|
200
|
+
</Element>
|
201
|
+
</Item>
|
202
|
+
<Item FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ID="PFA23" Order="21" >
|
203
|
+
<Element ElementOID="99FFC37C-AA68-4ED4-B8BC-CF96610CC3CE" Description="Are you able to go for a walk of at least 15 minutes?" ElementOrder="2" />
|
204
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
205
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="FD2B69CE-A7CD-40EC-8CC8-259A8CF3011B" Value="1" Position="1" />
|
206
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="420D3F7F-69ED-4845-AED6-E39D657F661C" Value="2" Position="2" />
|
207
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="71C7606A-7B9C-4030-BB7A-263347DBFF7E" Value="3" Position="3" />
|
208
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="7276D336-10A9-4FBF-8C35-8F294541F583" Value="4" Position="4" />
|
209
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C82EE934-7360-4C30-A022-0CF5ECA2A7D1" ItemResponseOID="C0F62A05-B98F-45A8-81D7-E6E5B177F4DD" Value="5" Position="5" />
|
210
|
+
</Element>
|
211
|
+
</Item>
|
212
|
+
<Item FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ID="PFA25" Order="22" >
|
213
|
+
<Element ElementOID="89568D9C-483E-4E98-B3CC-6EFA1701D997" Description="Are you able to do yard work like raking leaves, weeding, or pushing a lawn mower?" ElementOrder="2" />
|
214
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
215
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="1E931201-2CBE-4FD9-AF51-6FC86EE56996" Value="1" Position="1" />
|
216
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="8B97E4F4-BB7D-462D-B03C-DCFAD994B41F" Value="2" Position="2" />
|
217
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="0ED46A4D-13EB-4AD1-B1D2-ABCFBB8771A8" Value="3" Position="3" />
|
218
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="A5996F6D-747C-425F-8E33-20E25BDA3EA5" Value="4" Position="4" />
|
219
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="47236CF3-CDBA-45D0-9F20-5F64EFA289A3" ItemResponseOID="28A0373E-A983-4A4E-BB50-9B1DD4A0F56B" Value="5" Position="5" />
|
220
|
+
</Element>
|
221
|
+
</Item>
|
222
|
+
<Item FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ID="PFA28" Order="23" >
|
223
|
+
<Element ElementOID="8081059F-27FD-43CB-BAC6-1625DF00266E" Description="Are you able to open a can with a hand can opener?" ElementOrder="2" />
|
224
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
225
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="9C0A4CEC-33DB-4019-8AC4-BDECBF154086" Value="1" Position="1" />
|
226
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="80E777FF-11DB-493F-AAA4-FE1CDFCD459C" Value="2" Position="2" />
|
227
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="F4D9A819-B74C-4031-B9D3-F9202617A7A1" Value="3" Position="3" />
|
228
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="1E82C485-1430-43BE-9CF3-4AA6E9508E02" Value="4" Position="4" />
|
229
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="CD171C84-AAF6-46E6-A881-4E4DA8935FB1" ItemResponseOID="751266BF-B1BE-4C3E-951C-A5FC2C430732" Value="5" Position="5" />
|
230
|
+
</Element>
|
231
|
+
</Item>
|
232
|
+
<Item FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ID="PFA29r1" Order="24" >
|
233
|
+
<Element ElementOID="9158C498-D38D-4866-9F0A-BB36AEFE21BE" Description="Are you able to pull heavy objects (10 pounds/ 5 kg) towards yourself?" ElementOrder="1" />
|
234
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
235
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="AA9AD8EB-CC3C-4C8B-BB8A-6FAEE0925FBC" Value="1" Position="1" />
|
236
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="AD99B30A-474E-499D-86AD-3641EB05061B" Value="2" Position="2" />
|
237
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="9DB3094C-D704-4009-9421-C3C2138D3400" Value="3" Position="3" />
|
238
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="07EA1C3F-7491-4BB1-B654-13100DDD538E" Value="4" Position="4" />
|
239
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E251AD48-390E-43CD-AA99-E777ADDD2638" ItemResponseOID="69F596C1-7C3A-44F4-AA0A-3297B654F9FE" Value="5" Position="5" />
|
240
|
+
</Element>
|
241
|
+
</Item>
|
242
|
+
<Item FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ID="PFA30" Order="25" >
|
243
|
+
<Element ElementOID="0D08EEC7-F65C-4BB1-A173-542F6702E09A" Description="Are you able to step up and down curbs?" ElementOrder="2" />
|
244
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
245
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="9492DCEC-C47E-4A21-9163-9B8EAAD25720" Value="1" Position="1" />
|
246
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="F1A39B23-3B10-439B-97CF-08FDC330E751" Value="2" Position="2" />
|
247
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="5DE01DA2-2EE2-45EE-AD5C-88AB7FF70629" Value="3" Position="3" />
|
248
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="7EE314A7-18E6-4CA4-A309-9AD3E4C463D8" Value="4" Position="4" />
|
249
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2962097A-890E-47E1-AE9A-76ED2A99D16A" ItemResponseOID="136BF0F7-FC43-43D8-BFC8-4F527B0F7829" Value="5" Position="5" />
|
250
|
+
</Element>
|
251
|
+
</Item>
|
252
|
+
<Item FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ID="PFA31r1" Order="26" >
|
253
|
+
<Element ElementOID="BA5D18D1-8697-46F8-8DB4-8CD32E1F61A3" Description="Are you able to get up from the floor from lying on your back without help?" ElementOrder="1" />
|
254
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
255
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="A213E77D-4845-4BE1-AD2D-63F2889D0B7B" Value="1" Position="1" />
|
256
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="B6B3964F-687D-4738-B7E6-001E08655A67" Value="2" Position="2" />
|
257
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="2CD15B58-B4DF-4A9B-A81F-CAD5E93C6830" Value="3" Position="3" />
|
258
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="27059662-B5DF-41A3-AAF5-C18B20C03432" Value="4" Position="4" />
|
259
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EC773C1F-D15D-4DB6-8FF1-6AAF621C0DBE" ItemResponseOID="0FDAFC83-88E7-426D-B1FD-ECD99400C3C5" Value="5" Position="5" />
|
260
|
+
</Element>
|
261
|
+
</Item>
|
262
|
+
<Item FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ID="PFA32" Order="27" >
|
263
|
+
<Element ElementOID="1A1D7432-D219-4148-AD5C-3C0E36D9A977" Description="Are you able to stand with your knees straight?" ElementOrder="2" />
|
264
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
265
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="75400B76-D3F5-46FE-87D7-28D3F3013900" Value="1" Position="1" />
|
266
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="4AC17E78-6F6C-49F1-9475-7365F92D6878" Value="2" Position="2" />
|
267
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="CB040E76-0BA9-46DF-BCBC-445A878D75B6" Value="3" Position="3" />
|
268
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="9831E9B1-EAE3-4126-8A32-AAEE7AAA7E98" Value="4" Position="4" />
|
269
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="1B852BDB-7310-4492-90E6-99CCC10CF048" ItemResponseOID="A11FBB1D-0D61-4AFC-9051-219F0BC5CC43" Value="5" Position="5" />
|
270
|
+
</Element>
|
271
|
+
</Item>
|
272
|
+
<Item FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ID="PFA33" Order="28" >
|
273
|
+
<Element ElementOID="9F12A1E5-B57C-4900-BBE4-1C6FEA8DBA57" Description="Are you able to exercise hard for half an hour?" ElementOrder="2" />
|
274
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
275
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="F4C9209F-E632-4D42-AFF0-1F35ABA8FFA6" Value="1" Position="1" />
|
276
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="B05064D0-4EF7-4CA6-9370-32852700F713" Value="2" Position="2" />
|
277
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="F7119A19-4B5D-4BD1-B68F-B5A7ABED2DD2" Value="3" Position="3" />
|
278
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="8FF63410-B945-4EF3-9D19-739DC6C1B2D9" Value="4" Position="4" />
|
279
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="37E8C41E-8033-4970-A49A-23269DBEAA3B" ItemResponseOID="6A485EA2-C2C3-4022-8A17-D77F11996829" Value="5" Position="5" />
|
280
|
+
</Element>
|
281
|
+
</Item>
|
282
|
+
<Item FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ID="PFA34" Order="29" >
|
283
|
+
<Element ElementOID="0ADEBD37-FC8F-4ED0-B118-FCF1D7D22FC9" Description="Are you able to wash your back?" ElementOrder="2" />
|
284
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
285
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="7D6F9E9E-0508-4D76-A398-8A3A34777970" Value="1" Position="1" />
|
286
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="6E1955D6-867C-4CFB-943C-605C287893A3" Value="2" Position="2" />
|
287
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="439A243E-DCAD-4A4F-99C2-03FFCCDE8F12" Value="3" Position="3" />
|
288
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="70E499DF-1881-4911-AAAB-B85B2206D7DC" Value="4" Position="4" />
|
289
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="579B9B80-F6F6-470F-BC00-3035390DF048" ItemResponseOID="3631ABA6-A9AB-4D9F-9D5A-1C7C293BF8CC" Value="5" Position="5" />
|
290
|
+
</Element>
|
291
|
+
</Item>
|
292
|
+
<Item FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ID="PFA35" Order="30" >
|
293
|
+
<Element ElementOID="35C59AF6-80A8-4DEA-A146-5E065CBD7998" Description="Are you able to open and close a zipper?" ElementOrder="2" />
|
294
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
295
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="AE9AAC8D-24FB-4AC2-B40C-B73762F51845" Value="1" Position="1" />
|
296
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="9BD1C3B6-EA84-4271-9576-3F6163E2CEA6" Value="2" Position="2" />
|
297
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="EEFC3F56-8859-44CD-AF5F-F1DFD5748302" Value="3" Position="3" />
|
298
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="AD805055-9D5D-409B-8107-577DF7AE9A3C" Value="4" Position="4" />
|
299
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="9121908A-4CB5-42B7-8BB8-380C4684B5BB" ItemResponseOID="4194086C-92D8-4A6F-B1AA-3DB8F3A7E17C" Value="5" Position="5" />
|
300
|
+
</Element>
|
301
|
+
</Item>
|
302
|
+
<Item FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ID="PFA36" Order="31" >
|
303
|
+
<Element ElementOID="06E46D12-D8CA-497A-A721-CAD491FD879D" Description="Are you able to put on and take off a coat or jacket?" ElementOrder="2" />
|
304
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
305
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="A64AE07B-8386-4332-B0FE-B1460131798B" Value="1" Position="1" />
|
306
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="C7191C70-E643-444A-BE19-81C758416003" Value="2" Position="2" />
|
307
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="1448218F-5322-47DD-B8BF-9F72212CBDCB" Value="3" Position="3" />
|
308
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="4F860E42-8518-4C76-9383-96D566735A87" Value="4" Position="4" />
|
309
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="7C75DC60-6F00-4A18-848A-9C4C0C9C9C03" ItemResponseOID="55916686-5897-4542-A4C3-E3C22EAE049D" Value="5" Position="5" />
|
310
|
+
</Element>
|
311
|
+
</Item>
|
312
|
+
<Item FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ID="PFA37" Order="32" >
|
313
|
+
<Element ElementOID="C9DD5DFB-DC70-4B37-85D5-09E47C0F535E" Description="Are you able to stand for short periods of time?" ElementOrder="2" />
|
314
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
315
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="91BE4B56-C287-45A1-A524-BC6966223CCD" Value="1" Position="1" />
|
316
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="96A024D4-2B09-406F-A7C5-39BEADF48AC1" Value="2" Position="2" />
|
317
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="67A6144F-CBF4-45E3-9E38-F2BB1CAEBFBD" Value="3" Position="3" />
|
318
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="33FCAF17-3BF3-49BF-82A0-3739025F2D46" Value="4" Position="4" />
|
319
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="08232E65-1D1C-4A05-98C8-A11599CD85F5" ItemResponseOID="58B8B2E1-26C9-42D7-914C-CE7049AAA471" Value="5" Position="5" />
|
320
|
+
</Element>
|
321
|
+
</Item>
|
322
|
+
<Item FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ID="PFA38" Order="33" >
|
323
|
+
<Element ElementOID="946C93FF-8FE4-4177-A7A0-E748F75E7392" Description="Are you able to dry your back with a towel?" ElementOrder="2" />
|
324
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
325
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="983F2C40-BB05-4F81-AA27-776D34A3215B" Value="1" Position="1" />
|
326
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="FED3DE72-0874-471F-B07D-829E7762F542" Value="2" Position="2" />
|
327
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="7BBC799D-2BEA-40A7-A09F-79AB258CF22C" Value="3" Position="3" />
|
328
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="B6DBF63C-877D-4FBA-B27B-0B1946D56E1F" Value="4" Position="4" />
|
329
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F2115138-C8FB-4C2A-B144-771A9C19E9B3" ItemResponseOID="825E4D90-1814-4403-AB02-FD70DD4FA359" Value="5" Position="5" />
|
330
|
+
</Element>
|
331
|
+
</Item>
|
332
|
+
<Item FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ID="PFA39r1" Order="34" >
|
333
|
+
<Element ElementOID="7061133B-572A-412E-9A14-B182142F5696" Description="Are you able to run at a fast pace for two miles (3 km)?" ElementOrder="1" />
|
334
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
335
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ItemResponseOID="0C328484-4356-432D-9F2A-5FAA4F060D15" Value="1" Position="1" />
|
336
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ItemResponseOID="EC165A4B-5A98-45C4-920F-6D9B94E80E6D" Value="2" Position="2" />
|
337
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ItemResponseOID="45DC39F3-E471-4D3E-A6A0-41BC72330D7F" Value="3" Position="3" />
|
338
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ItemResponseOID="6B410DEE-2A1D-4569-990E-775F2A683980" Value="4" Position="4" />
|
339
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="8E3F1B50-5254-4E69-A279-C01CF8215144" ItemResponseOID="01A7085A-8F82-4B17-90B6-D67DCFDD98CB" Value="5" Position="5" />
|
340
|
+
</Element>
|
341
|
+
</Item>
|
342
|
+
<Item FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ID="PFA40" Order="35" >
|
343
|
+
<Element ElementOID="505A0EF6-5DCC-4B20-9AD3-419167C5D8DE" Description="Are you able to turn a key in a lock?" ElementOrder="2" />
|
344
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
345
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="4C8D0ED5-8966-48F9-85C9-768136BC2762" Value="1" Position="1" />
|
346
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="B9A5D309-A1F9-49D3-8CEC-6F2010CD02F2" Value="2" Position="2" />
|
347
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="453B9C1A-0FFB-4D9E-A3E4-E4AEEDDD6FE1" Value="3" Position="3" />
|
348
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="252673D2-DE4D-483B-824E-525CBB6F5C86" Value="4" Position="4" />
|
349
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F528C824-E4F4-4BE5-9EE3-DE5120F86853" ItemResponseOID="5B3B53F1-DFE0-457D-B031-B586F09B7BBF" Value="5" Position="5" />
|
350
|
+
</Element>
|
351
|
+
</Item>
|
352
|
+
<Item FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ID="PFA41" Order="36" >
|
353
|
+
<Element ElementOID="00B4926D-8162-4360-AD5D-066C302605AD" Description="Are you able to squat and get up?" ElementOrder="2" />
|
354
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
355
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="78B3789E-CC4D-444D-AEDE-8F64361129EE" Value="1" Position="1" />
|
356
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="6642C1F3-6C61-49D5-BE9E-2CA985D4B4FC" Value="2" Position="2" />
|
357
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="91281D76-F109-4B65-8890-A38C3DCB7F18" Value="3" Position="3" />
|
358
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="D74CAA24-9D0A-4370-86E7-E19BA1762290" Value="4" Position="4" />
|
359
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="26D22BD6-F961-4AB8-BF09-42E5184A5E28" ItemResponseOID="F7B33C7F-5EA8-4596-A544-9C9BF4891E62" Value="5" Position="5" />
|
360
|
+
</Element>
|
361
|
+
</Item>
|
362
|
+
<Item FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ID="PFA42" Order="37" >
|
363
|
+
<Element ElementOID="24153E80-9CE9-406A-AEB6-508E625C2819" Description="Are you able to carry a laundry basket up a flight of stairs?" ElementOrder="2" />
|
364
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
365
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="D009EB87-3631-4C80-9458-ABC8501A601E" Value="1" Position="1" />
|
366
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="7219E03C-1BC6-4C93-98BE-40BF9E74B2BE" Value="2" Position="2" />
|
367
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="A7CBE389-6BAF-422F-B37A-23C814B3A98D" Value="3" Position="3" />
|
368
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="817394F7-F88A-4C72-AB88-DE17EC2E7B8B" Value="4" Position="4" />
|
369
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="EA115725-4859-4A17-9722-B3A12151C80A" ItemResponseOID="21B288EF-E914-477B-A337-E32FFF222A8E" Value="5" Position="5" />
|
370
|
+
</Element>
|
371
|
+
</Item>
|
372
|
+
<Item FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ID="PFA43" Order="38" >
|
373
|
+
<Element ElementOID="E2F73F1C-1C29-402E-832F-F5619E7DC733" Description="Are you able to write with a pen or pencil?" ElementOrder="2" />
|
374
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
375
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="776B756A-966C-41B0-B378-3D0F5274F53A" Value="1" Position="1" />
|
376
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="E8C81E44-1B38-49F7-AD21-E204786FE348" Value="2" Position="2" />
|
377
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="C5F3BEF0-ADE8-40EE-9E9E-8AA025CA66D1" Value="3" Position="3" />
|
378
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="05452552-7EEE-4423-9784-F5D19B569A40" Value="4" Position="4" />
|
379
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="533E27A1-4815-442F-97C3-CDFE5F17EB0D" ItemResponseOID="26D6C8EB-62E4-4423-8A47-E21179ADF1AE" Value="5" Position="5" />
|
380
|
+
</Element>
|
381
|
+
</Item>
|
382
|
+
<Item FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ID="PFA44" Order="39" >
|
383
|
+
<Element ElementOID="DF863891-8A25-40E5-9F7D-4A71DD8674EA" Description="Are you able to put on a shirt or blouse?" ElementOrder="2" />
|
384
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
385
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="6A16DDDF-8813-4AA4-A5FD-850FFC898ADF" Value="1" Position="1" />
|
386
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="411D83A8-B89B-4BE1-B774-55C0E1844F27" Value="2" Position="2" />
|
387
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="754AAAF5-D22B-460F-A3DD-D87ABB2350E2" Value="3" Position="3" />
|
388
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="24F2729E-E86E-426D-BD66-C17B02DDF35B" Value="4" Position="4" />
|
389
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="E545E26C-75F6-4B92-9EF3-F9E8C1615D0D" ItemResponseOID="DF5AFC1C-D203-411F-8F7F-BBE881138B95" Value="5" Position="5" />
|
390
|
+
</Element>
|
391
|
+
</Item>
|
392
|
+
<Item FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ID="PFA45" Order="40" >
|
393
|
+
<Element ElementOID="DBFCC80E-2D05-44F9-958C-0AC24A7D5631" Description="Are you able to get out of bed into a chair?" ElementOrder="2" />
|
394
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
395
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="0618C458-F487-4BCD-B969-A15304F19B5D" Value="1" Position="1" />
|
396
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="4A263000-8D23-44DE-BDB5-73C61A814555" Value="2" Position="2" />
|
397
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="86FB001F-0339-4CBE-9DAF-9E16A37B2F29" Value="3" Position="3" />
|
398
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="D8C76DBB-4069-4CBF-9012-3AA4DA841A4D" Value="4" Position="4" />
|
399
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="77DB1A1F-A9E8-412A-B951-8C18DDAB8573" ItemResponseOID="629989AC-8AD2-40EC-810C-155344B0129F" Value="5" Position="5" />
|
400
|
+
</Element>
|
401
|
+
</Item>
|
402
|
+
<Item FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ID="PFA47" Order="41" >
|
403
|
+
<Element ElementOID="892BC880-A169-4CB2-8AEC-44882EEE1A36" Description="Are you able to pull on trousers?" ElementOrder="2" />
|
404
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
405
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="65E16B78-06B1-41B6-ABA0-9F2BEA57E968" Value="1" Position="1" />
|
406
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="CC0C752C-7157-4DB7-9AB8-6236426B2AE5" Value="2" Position="2" />
|
407
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="668A164F-3D7B-4C8F-A189-D5DBD7A225DC" Value="3" Position="3" />
|
408
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="558BDC67-38DA-43AE-BADF-556FBDD8170C" Value="4" Position="4" />
|
409
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="43EB37FC-3BD7-4803-AD27-16FAEC8CAE4C" ItemResponseOID="F2708681-97B3-45B3-9D4C-38E1ECB95CEC" Value="5" Position="5" />
|
410
|
+
</Element>
|
411
|
+
</Item>
|
412
|
+
<Item FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ID="PFA48" Order="42" >
|
413
|
+
<Element ElementOID="0A1BC41B-E241-41C4-813F-250D2F4A3E9D" Description="Are you able to peel fruit?" ElementOrder="2" />
|
414
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
415
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="71F3A352-94AB-4E2A-89D6-C6ED5F3B7578" Value="1" Position="1" />
|
416
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="2CF66FE9-0949-4775-B948-CF7A8375DD8B" Value="2" Position="2" />
|
417
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="1E44C509-C614-46C1-A1AC-2B1AC00EBCD4" Value="3" Position="3" />
|
418
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="0006814F-58A9-434A-A604-A4DF5F7FB279" Value="4" Position="4" />
|
419
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="F6C8A338-247B-466A-ACF5-6C597F724A04" ItemResponseOID="98D75F96-70E3-44D9-B6E2-788304AEEE60" Value="5" Position="5" />
|
420
|
+
</Element>
|
421
|
+
</Item>
|
422
|
+
<Item FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ID="PFA49" Order="43" >
|
423
|
+
<Element ElementOID="58B89040-62F3-4E77-A07B-B88F4A47C982" Description="Are you able to bend or twist your back?" ElementOrder="2" />
|
424
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
425
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="A6BC67EA-7ECE-4E2E-83D1-64C802C8B89C" Value="1" Position="1" />
|
426
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="7C24D299-651C-4592-8ED4-5B6C054B5AB0" Value="2" Position="2" />
|
427
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="874838E9-21F4-4CEF-B20C-526A3081873B" Value="3" Position="3" />
|
428
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="0B0FA2AF-375D-4652-9675-043B9D7DA4BD" Value="4" Position="4" />
|
429
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="736C68B9-798A-40E4-A280-C978F0046B0F" ItemResponseOID="2CEE04CB-0163-459F-9B8A-FED635D039B1" Value="5" Position="5" />
|
430
|
+
</Element>
|
431
|
+
</Item>
|
432
|
+
<Item FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ID="PFA50" Order="44" >
|
433
|
+
<Element ElementOID="25F10D4A-D29B-4ED7-A33A-2DBBEF6B96D7" Description="Are you able to brush your teeth?" ElementOrder="2" />
|
434
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
435
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="E81E4F8C-8901-4A49-B7B7-5DCE5A744215" Value="1" Position="1" />
|
436
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="801ADB4D-07EA-40D6-86AF-821BCC19670F" Value="2" Position="2" />
|
437
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="5747F875-7051-4658-8B2C-01CD2358E261" Value="3" Position="3" />
|
438
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="B46CB324-268C-4026-9D79-904215AC5A49" Value="4" Position="4" />
|
439
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="763CBE5B-29D7-4E4B-A16C-CEC61BD960E1" ItemResponseOID="F8321894-6D3A-461C-9C6A-A3151023E2C1" Value="5" Position="5" />
|
440
|
+
</Element>
|
441
|
+
</Item>
|
442
|
+
<Item FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ID="PFA51" Order="45" >
|
443
|
+
<Element ElementOID="A2F3E839-1C85-4AE4-8388-4315751589C5" Description="Are you able to sit on the edge of a bed?" ElementOrder="2" />
|
444
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
445
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="B3B4CA1D-0AC0-4532-9740-B2FD60C2FBCB" Value="1" Position="1" />
|
446
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="BA1A75F7-0E38-43E5-9D59-B40931EC91E0" Value="2" Position="2" />
|
447
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="BC7DB9FD-8222-4AFA-B732-646AA1756379" Value="3" Position="3" />
|
448
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="EAEE6FC0-9F05-4DD0-A621-496811544A46" Value="4" Position="4" />
|
449
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2289EDA3-366E-4659-850D-F576B4F28054" ItemResponseOID="4E1184FC-2A2F-4F0F-BCEA-77CB8DBF4F5D" Value="5" Position="5" />
|
450
|
+
</Element>
|
451
|
+
</Item>
|
452
|
+
<Item FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ID="PFA52" Order="46" >
|
453
|
+
<Element ElementOID="42158F6C-C66D-49D9-A15C-B67208A6421D" Description="Are you able to tie your shoelaces?" ElementOrder="2" />
|
454
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
455
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="94006C9D-CA58-46D0-B6EA-9B0DD80830FC" Value="1" Position="1" />
|
456
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="CB212C09-2DD6-408D-B20A-ED8881DCC7CA" Value="2" Position="2" />
|
457
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="0C8DAB05-ED25-4629-8C00-9E39E37D081C" Value="3" Position="3" />
|
458
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="F9BED045-D24E-4E74-A15E-C6224F732F53" Value="4" Position="4" />
|
459
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2A472654-9E16-4FD7-A269-5351BEF1B222" ItemResponseOID="EBD8DAAD-963E-43DF-88A4-DF72EAF1CC48" Value="5" Position="5" />
|
460
|
+
</Element>
|
461
|
+
</Item>
|
462
|
+
<Item FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ID="PFA53" Order="47" >
|
463
|
+
<Element ElementOID="645F21B5-F0C0-4665-AC60-5EC7101C18A5" Description="Are you able to run errands and shop?" ElementOrder="2" />
|
464
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
465
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="E0F29A0B-2D24-4C03-B739-5906045A7370" Value="1" Position="1" />
|
466
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="30268CD3-7651-4714-BCF5-84EB6EFD205D" Value="2" Position="2" />
|
467
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="714983D6-C592-45CC-BB8D-25113917F817" Value="3" Position="3" />
|
468
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="1225C318-7D2D-4DE3-BE9A-379A13C37287" Value="4" Position="4" />
|
469
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="01B927D4-B3CB-4CBF-89B9-84B7507392A1" ItemResponseOID="2591E67D-0BE0-48C0-A761-7A96F44B9703" Value="5" Position="5" />
|
470
|
+
</Element>
|
471
|
+
</Item>
|
472
|
+
<Item FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ID="PFA54" Order="48" >
|
473
|
+
<Element ElementOID="6C134388-565C-4AEB-B2E4-F4D690A7EA61" Description="Are you able to button your shirt?" ElementOrder="2" />
|
474
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
475
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="15075CA3-3139-4286-97C6-9B237F67AD18" Value="1" Position="1" />
|
476
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="9B9E2E78-D8E5-4F58-BB79-3A192AF46551" Value="2" Position="2" />
|
477
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="3B9D46E3-2633-4F2B-8859-501E8150E52D" Value="3" Position="3" />
|
478
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="08D331D3-EE34-4845-8415-B68085CB2C34" Value="4" Position="4" />
|
479
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="C95257C9-9F6A-445C-9727-B531951AE8B8" ItemResponseOID="5D29995F-1379-4685-A24C-7A3B14A13A57" Value="5" Position="5" />
|
480
|
+
</Element>
|
481
|
+
</Item>
|
482
|
+
<Item FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ID="PFA55" Order="49" >
|
483
|
+
<Element ElementOID="7A993F16-688A-45BF-B5EE-C0C5418CA263" Description="Are you able to wash and dry your body?" ElementOrder="2" />
|
484
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
485
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ItemResponseOID="B3F6FD66-0B0C-4674-A055-7DCE06BDE6D1" Value="1" Position="1" />
|
486
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ItemResponseOID="734772C1-F6DE-4133-8544-CFABCDE0E82C" Value="2" Position="2" />
|
487
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ItemResponseOID="C1343A1D-7BAB-4629-A036-791ECA8B2BC1" Value="3" Position="3" />
|
488
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ItemResponseOID="138A3B03-1977-426A-BDB2-DBB577D84605" Value="4" Position="4" />
|
489
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="8CA4D4C9-97AA-4183-88DD-9EF4ADBFCF55" ItemResponseOID="3F884EAD-AA8A-4675-8CF9-9D8F114C7CA8" Value="5" Position="5" />
|
490
|
+
</Element>
|
491
|
+
</Item>
|
492
|
+
<Item FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ID="PFA56" Order="50" >
|
493
|
+
<Element ElementOID="843E803D-FF2D-4E95-8AE1-9C48794C822E" Description="Are you able to get in and out of a car?" ElementOrder="2" />
|
494
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
495
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="D6970AC9-69FA-4551-A061-4F430254596A" Value="1" Position="1" />
|
496
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="5DD1F064-8E75-4CD8-A3EF-3FE43E089BE2" Value="2" Position="2" />
|
497
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="89FAD7AB-ED89-43F0-BBFC-6225D7BCA849" Value="3" Position="3" />
|
498
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="6B053C5D-CF48-428E-9EBA-F51B6C2A94CE" Value="4" Position="4" />
|
499
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="16A1C0B6-436F-49F5-B872-7E88819A4B59" ItemResponseOID="51D5D3E3-2C3A-498D-82E0-D7EB70E939A5" Value="5" Position="5" />
|
500
|
+
</Element>
|
501
|
+
</Item>
|
502
|
+
<Item FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ID="PFB1" Order="51" >
|
503
|
+
<Element ElementOID="E72C0E84-ACDD-43B4-8804-FDF00E724073" Description="Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries?" ElementOrder="2" />
|
504
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
505
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="B026E94E-50B7-4019-AD7F-6466B3C15EF3" Value="1" Position="1" />
|
506
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="EFA3123D-F75B-409E-83B4-8A8C1C604854" Value="2" Position="2" />
|
507
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="84A29153-E2D5-493F-B210-8458C5C40830" Value="3" Position="3" />
|
508
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="1634FE91-34FE-4C9B-BE0A-A5D2204CC4A3" Value="4" Position="4" />
|
509
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="33A5BA8C-63E8-4EED-B89F-A310B6E0A1B5" ItemResponseOID="334FD050-373F-42F4-AEC8-E8CC1AB09827" Value="5" Position="5" />
|
510
|
+
</Element>
|
511
|
+
</Item>
|
512
|
+
<Item FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ID="PFB3" Order="52" >
|
513
|
+
<Element ElementOID="E749AAD0-44CA-4EC0-A36C-36B4F2072074" Description="Does your health now limit you in putting a trash bag outside?" ElementOrder="2" />
|
514
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
515
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ItemResponseOID="BF35D06D-9077-47E9-A427-7911218174BB" Value="1" Position="1" />
|
516
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ItemResponseOID="C802E6F4-C898-4824-B949-A02ACADF1ABE" Value="2" Position="2" />
|
517
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ItemResponseOID="265F10EE-CB4C-47CB-9CEB-0BF3DCD6836C" Value="3" Position="3" />
|
518
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ItemResponseOID="ED22C0BC-A9CB-4CC9-8ABF-180CEA51D066" Value="4" Position="4" />
|
519
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="34C906F3-D505-42D8-BF98-756815BA6235" ItemResponseOID="26D18E27-DB20-4E95-9DB3-CDB480F0535D" Value="5" Position="5" />
|
520
|
+
</Element>
|
521
|
+
</Item>
|
522
|
+
<Item FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ID="PFB5r1" Order="53" >
|
523
|
+
<Element ElementOID="1E12D36E-0CBB-4C1E-BD83-0039ACE0E152" Description="Does your health now limit you in hiking a couple of miles (3 km) on uneven surfaces, including hills?" ElementOrder="1" />
|
524
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="2" >
|
525
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="6AA7C4AA-6FC8-4E0E-857E-04CE82B17F51" Value="1" Position="1" />
|
526
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="919AF903-2FC9-446C-A013-6F2964672668" Value="2" Position="2" />
|
527
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="9C593F38-B15D-4545-9F32-6C9166EC9058" Value="3" Position="3" />
|
528
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="7ACDEE19-B935-4FA3-9A6B-A4FA818EFD2E" Value="4" Position="4" />
|
529
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="54019AC3-6606-42A0-9B41-EA13579D1F17" ItemResponseOID="5C7D8AE4-5C9D-4C2F-9D90-DF0F160F6FB4" Value="5" Position="5" />
|
530
|
+
</Element>
|
531
|
+
</Item>
|
532
|
+
<Item FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ID="PFB7" Order="54" >
|
533
|
+
<Element ElementOID="06F94122-92D2-42B8-A9EF-2E014F6F38C4" Description="Does your health now limit you in doing strenuous activities such as backpacking, skiing, playing tennis, bicycling or jogging?" ElementOrder="2" />
|
534
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
535
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ItemResponseOID="46E6F9D5-9DD3-471B-BF33-F69AC375CFEB" Value="1" Position="1" />
|
536
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ItemResponseOID="88C2DBCA-FA99-4AFB-8D68-0ACA0748A8D2" Value="2" Position="2" />
|
537
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ItemResponseOID="562CF2B4-B722-4621-9588-FF33C78FF0E0" Value="3" Position="3" />
|
538
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ItemResponseOID="7CE8211F-B0EE-4676-9375-BBCE95468427" Value="4" Position="4" />
|
539
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="5B6DB167-47C6-48D4-8428-EDD1A2440798" ItemResponseOID="C60E2629-36BC-49BF-982A-5518815DA3A5" Value="5" Position="5" />
|
540
|
+
</Element>
|
541
|
+
</Item>
|
542
|
+
<Item FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ID="PFB8r1" Order="55" >
|
543
|
+
<Element ElementOID="F9A9E329-4D25-47EA-AD34-27292D8B30E0" Description="Are you able to carry two bags filled with groceries 100 yards (100 m)?" ElementOrder="1" />
|
544
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
545
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="A78C0DD4-54B5-4022-841E-1334A2A94713" Value="1" Position="1" />
|
546
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="24C36055-AB49-45BB-97D0-2085CE69DB42" Value="2" Position="2" />
|
547
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="F908BB77-6B9C-44FD-BB5C-DBC003F0E270" Value="3" Position="3" />
|
548
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="1E1E9742-F23C-4BF4-93E4-E1A1469EA7F8" Value="4" Position="4" />
|
549
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="5FBC33C6-68EB-4FAB-B30A-2EBF3F4B9204" ItemResponseOID="503AA403-C6B3-4D7F-BA5B-5F14E9B1A84C" Value="5" Position="5" />
|
550
|
+
</Element>
|
551
|
+
</Item>
|
552
|
+
<Item FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ID="PFB9" Order="56" >
|
553
|
+
<Element ElementOID="0A3B39C3-A742-4E63-94E8-6A2B334E4F41" Description="Are you able to jump up and down?" ElementOrder="2" />
|
554
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
555
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="A2AE8796-1DA8-4216-876E-410288E48754" Value="1" Position="1" />
|
556
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="596170BA-D09A-4D10-8306-0C5FDF50B7E7" Value="2" Position="2" />
|
557
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="D13C4A0B-8358-485B-AB95-DE23B5BCBBCE" Value="3" Position="3" />
|
558
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="890DAB13-01D3-4FB6-BC33-F102F6CF7B3D" Value="4" Position="4" />
|
559
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="BCB5287E-3F5C-4B4E-B9F2-26C4C77E362A" ItemResponseOID="A6683A82-2B4C-4012-B300-DC2A2F86389F" Value="5" Position="5" />
|
560
|
+
</Element>
|
561
|
+
</Item>
|
562
|
+
<Item FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ID="PFB10" Order="57" >
|
563
|
+
<Element ElementOID="E9AEDF64-D5F9-4077-ABBA-F1D0EB3C4F86" Description="Are you able to climb up five steps?" ElementOrder="2" />
|
564
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
565
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="FD0D42BC-6333-4BC1-A71F-16E93952C278" Value="1" Position="1" />
|
566
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="2F5C8799-245F-48F4-84EE-C87E889FA28C" Value="2" Position="2" />
|
567
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="F3B1EF4E-E88A-4AEF-B718-E240B60DABA4" Value="3" Position="3" />
|
568
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="E9362F71-0E07-4670-B527-597B74FEF891" Value="4" Position="4" />
|
569
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="792B8438-A166-4EAB-B6AA-F6BF2B969C3E" ItemResponseOID="8C87C81E-06F2-4729-A46F-AD623CE723CF" Value="5" Position="5" />
|
570
|
+
</Element>
|
571
|
+
</Item>
|
572
|
+
<Item FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ID="PFB11" Order="58" >
|
573
|
+
<Element ElementOID="F0580F23-7D2F-451C-8B01-56FF49167F82" Description="Are you able to wash dishes, pots, and utensils by hand while standing at a sink?" ElementOrder="2" />
|
574
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
575
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="4B6717BC-2FAF-4BAD-96FF-30391197E959" Value="1" Position="1" />
|
576
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="EB08C924-CB43-4E44-916C-ED669C4C23F4" Value="2" Position="2" />
|
577
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="418C932D-2DEE-4353-8226-A9ACFB91F18E" Value="3" Position="3" />
|
578
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="C3E1A8D2-5E07-45FE-BE4D-2D4886B988FD" Value="4" Position="4" />
|
579
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="580DD07E-FA3B-4246-A585-410CFE0BF87A" ItemResponseOID="C036BDE8-0140-4E70-9381-7257285FA741" Value="5" Position="5" />
|
580
|
+
</Element>
|
581
|
+
</Item>
|
582
|
+
<Item FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ID="PFB12" Order="59" >
|
583
|
+
<Element ElementOID="FF337CCA-E64E-427D-BA4E-F2C3B674271C" Description="Are you able to make a bed, including spreading and tucking in bed sheets?" ElementOrder="2" />
|
584
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
585
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="CF180264-8E96-48D5-8202-F930E9FB4832" Value="1" Position="1" />
|
586
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="E56CCA26-6DFB-4BE7-A76D-05A25028D7C8" Value="2" Position="2" />
|
587
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="D7A8A402-D24A-46E1-9EC3-D8DD6E512FDF" Value="3" Position="3" />
|
588
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="B367736C-7F9E-4E46-A232-15D23F36A25B" Value="4" Position="4" />
|
589
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2413ABB9-104C-4A33-8233-B67AD9A2D5BF" ItemResponseOID="4280567D-4DFA-4BD2-B73F-1103445C3C6F" Value="5" Position="5" />
|
590
|
+
</Element>
|
591
|
+
</Item>
|
592
|
+
<Item FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ID="PFB13" Order="60" >
|
593
|
+
<Element ElementOID="F7E0557A-79BB-4670-9F70-7D8C7F70E080" Description="Are you able to carry a shopping bag or briefcase?" ElementOrder="2" />
|
594
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
595
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="C63925FF-6AFF-4D9D-8F07-5DA59EC77561" Value="1" Position="1" />
|
596
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="693B950C-D539-4321-82BF-0A5825FAC3D8" Value="2" Position="2" />
|
597
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="DF642025-5535-400E-8841-8D5E96661A19" Value="3" Position="3" />
|
598
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="C7E85741-3B98-4890-9418-E48892DD3B02" Value="4" Position="4" />
|
599
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="99E45ABE-9B91-4CA6-8087-DEE5BBAB61F2" ItemResponseOID="CF45409D-93C8-4507-8EEE-2880464525DA" Value="5" Position="5" />
|
600
|
+
</Element>
|
601
|
+
</Item>
|
602
|
+
<Item FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ID="PFB14" Order="61" >
|
603
|
+
<Element ElementOID="33B9740F-D91A-4C00-8939-11A71DB613B5" Description="Are you able to take a tub bath?" ElementOrder="2" />
|
604
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
605
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="2E51A68A-1A9C-4796-A8D8-00FBB023A666" Value="1" Position="1" />
|
606
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="84EF456F-C910-4191-BE02-3F4DC95014A8" Value="2" Position="2" />
|
607
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="8C8FE821-767F-4900-B835-7036B6A8D846" Value="3" Position="3" />
|
608
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="9A56F268-6980-4A77-BC86-BB8A6EF8554E" Value="4" Position="4" />
|
609
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2FEDC171-0124-43F3-A84F-9D721C6F9F71" ItemResponseOID="57C1A0A6-E38B-452F-8517-172B061745C1" Value="5" Position="5" />
|
610
|
+
</Element>
|
611
|
+
</Item>
|
612
|
+
<Item FormItemOID="EBA81583-721E-4613-9804-C961CAC74FE5" ID="PFB15" Order="62" >
|
613
|
+
<Element ElementOID="89615D9C-FEBC-434F-9A8C-DEB7258E12DB" Description="Are you able to change the bulb in a table lamp?" ElementOrder="2" />
|
614
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
615
|
+
<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" />
|
616
|
+
<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" />
|
617
|
+
<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" />
|
618
|
+
<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" />
|
619
|
+
<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" />
|
620
|
+
</Element>
|
621
|
+
</Item>
|
622
|
+
<Item FormItemOID="736CA8E9-621C-4D7A-BEE0-E7C65A05AA63" ID="PFB16" Order="63" >
|
623
|
+
<Element ElementOID="3C6A92E7-4C44-4D1B-A9E8-3765391E66D1" Description="Are you able to press with your index finger (for example ringing a doorbell)?" ElementOrder="2" />
|
624
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
625
|
+
<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" />
|
626
|
+
<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" />
|
627
|
+
<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" />
|
628
|
+
<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" />
|
629
|
+
<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" />
|
630
|
+
</Element>
|
631
|
+
</Item>
|
632
|
+
<Item FormItemOID="CD6DD41B-5F2D-41E4-B33B-6E23718810A4" ID="PFB17" Order="64" >
|
633
|
+
<Element ElementOID="80C4028D-D509-4F4F-A928-D7A6B9A31449" Description="Are you able to put on and take off your socks?" ElementOrder="2" />
|
634
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
635
|
+
<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" />
|
636
|
+
<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" />
|
637
|
+
<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" />
|
638
|
+
<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" />
|
639
|
+
<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" />
|
640
|
+
</Element>
|
641
|
+
</Item>
|
642
|
+
<Item FormItemOID="C46A0965-037D-4BE7-998D-56125F8A860F" ID="PFB18" Order="65" >
|
643
|
+
<Element ElementOID="4F5A8A08-F0F0-442A-BF9D-CB9DD6B9A9C1" Description="Are you able to shave your face or apply makeup?" ElementOrder="2" />
|
644
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
645
|
+
<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" />
|
646
|
+
<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" />
|
647
|
+
<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" />
|
648
|
+
<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" />
|
649
|
+
<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" />
|
650
|
+
</Element>
|
651
|
+
</Item>
|
652
|
+
<Item FormItemOID="51B72820-9469-4641-8A3D-12AD33FCD5CA" ID="PFB19" Order="66" >
|
653
|
+
<Element ElementOID="D6DAA884-1DB1-4927-AA70-D744856AF5BB" Description="Are you able to squeeze a new tube of toothpaste?" ElementOrder="2" />
|
654
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
655
|
+
<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" />
|
656
|
+
<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" />
|
657
|
+
<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" />
|
658
|
+
<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" />
|
659
|
+
<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" />
|
660
|
+
</Element>
|
661
|
+
</Item>
|
662
|
+
<Item FormItemOID="92D4E779-5907-41E5-BF2C-7E49401D00FC" ID="PFB20" Order="67" >
|
663
|
+
<Element ElementOID="16F51E44-0286-4897-9D0A-F58CC8485E32" Description="Are you able to cut a piece of paper with scissors?" ElementOrder="2" />
|
664
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
665
|
+
<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" />
|
666
|
+
<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" />
|
667
|
+
<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" />
|
668
|
+
<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" />
|
669
|
+
<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" />
|
670
|
+
</Element>
|
671
|
+
</Item>
|
672
|
+
<Item FormItemOID="4940EF65-9359-4B8D-90DA-82FB396064B6" ID="PFB21" Order="68" >
|
673
|
+
<Element ElementOID="FC7EEF01-E270-4C76-BBE2-444E44E99D1F" Description="Are you able to pick up coins from a table top?" ElementOrder="2" />
|
674
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
675
|
+
<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" />
|
676
|
+
<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" />
|
677
|
+
<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" />
|
678
|
+
<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" />
|
679
|
+
<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" />
|
680
|
+
</Element>
|
681
|
+
</Item>
|
682
|
+
<Item FormItemOID="F8FC45A7-3136-4661-9CB5-3EFE8E87454D" ID="PFB22" Order="69" >
|
683
|
+
<Element ElementOID="FCD9C123-5D7B-4972-BF11-86DA972F7CFD" Description="Are you able to hold a plate full of food?" ElementOrder="2" />
|
684
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
685
|
+
<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" />
|
686
|
+
<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" />
|
687
|
+
<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" />
|
688
|
+
<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" />
|
689
|
+
<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" />
|
690
|
+
</Element>
|
691
|
+
</Item>
|
692
|
+
<Item FormItemOID="660AAAD3-C52F-4863-8B3F-EC58BFAF5F45" ID="PFB23" Order="70" >
|
693
|
+
<Element ElementOID="47A6C28B-F2ED-4046-A484-DBBF01D2940C" Description="Are you able to pour liquid from a bottle into a glass?" ElementOrder="2" />
|
694
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
695
|
+
<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" />
|
696
|
+
<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" />
|
697
|
+
<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" />
|
698
|
+
<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" />
|
699
|
+
<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" />
|
700
|
+
</Element>
|
701
|
+
</Item>
|
702
|
+
<Item FormItemOID="9FB4E174-2562-4B78-9F12-86E612CED151" ID="PFB24" Order="71" >
|
703
|
+
<Element ElementOID="B390F9BD-16D7-46C7-A768-2A7B8E271989" Description="Are you able to run a short distance, such as to catch a bus?" ElementOrder="2" />
|
704
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
705
|
+
<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" />
|
706
|
+
<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" />
|
707
|
+
<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" />
|
708
|
+
<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" />
|
709
|
+
<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" />
|
710
|
+
</Element>
|
711
|
+
</Item>
|
712
|
+
<Item FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ID="PFB25" Order="72" >
|
713
|
+
<Element ElementOID="E0B60D10-8975-480D-8134-295B1950C0F0" Description="Are you able to push open a door after turning the knob?" ElementOrder="2" />
|
714
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
715
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ItemResponseOID="D25A7B32-4776-41C1-ACCE-6B731472789F" Value="1" Position="1" />
|
716
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ItemResponseOID="90751C8B-038B-428A-B3CD-6D0C834D186A" Value="2" Position="2" />
|
717
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ItemResponseOID="AE1610FD-F28F-46F7-9FB8-C73246272F1F" Value="3" Position="3" />
|
718
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ItemResponseOID="057E2EE8-59C7-4964-9C8B-271798F06428" Value="4" Position="4" />
|
719
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0F66AE3F-2BE9-43C6-A116-48012ECE8104" ItemResponseOID="12179AA8-8714-411F-A624-EE34FFC55F50" Value="5" Position="5" />
|
720
|
+
</Element>
|
721
|
+
</Item>
|
722
|
+
<Item FormItemOID="EFC5CD91-E921-42B3-B973-FFAEAAF51629" ID="PFB26" Order="73" >
|
723
|
+
<Element ElementOID="ECBC1783-FB0C-4599-A270-78AFDDCC39B7" Description="Are you able to shampoo your hair?" ElementOrder="2" />
|
724
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
725
|
+
<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" />
|
726
|
+
<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" />
|
727
|
+
<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" />
|
728
|
+
<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" />
|
729
|
+
<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" />
|
730
|
+
</Element>
|
731
|
+
</Item>
|
732
|
+
<Item FormItemOID="53BDC7BD-91CE-4C75-A907-12B52F4FF6B5" ID="PFB27" Order="74" >
|
733
|
+
<Element ElementOID="0E7BDFE5-F194-48E1-B3F0-32CF13AB36B5" Description="Are you able to tie a knot or a bow?" ElementOrder="2" />
|
734
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
735
|
+
<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" />
|
736
|
+
<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" />
|
737
|
+
<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" />
|
738
|
+
<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" />
|
739
|
+
<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" />
|
740
|
+
</Element>
|
741
|
+
</Item>
|
742
|
+
<Item FormItemOID="439847A3-A1FF-45A0-A865-8D42BFBF5A65" ID="PFB28r1" Order="75" >
|
743
|
+
<Element ElementOID="F0FBE1EB-6BFA-4733-9A28-F0C0FAD56407" Description="Are you able to lift 10 pounds (5 kg) above your shoulder?" ElementOrder="1" />
|
744
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
745
|
+
<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" />
|
746
|
+
<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" />
|
747
|
+
<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" />
|
748
|
+
<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" />
|
749
|
+
<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" />
|
750
|
+
</Element>
|
751
|
+
</Item>
|
752
|
+
<Item FormItemOID="8A530ECA-7253-4D67-B963-5C99B610744D" ID="PFB29" Order="76" >
|
753
|
+
<Element ElementOID="40437C4D-1EFE-421E-8935-58A963ECE3D6" Description="Are you able to lift a full cup or glass to your mouth?" ElementOrder="2" />
|
754
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
755
|
+
<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" />
|
756
|
+
<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" />
|
757
|
+
<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" />
|
758
|
+
<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" />
|
759
|
+
<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" />
|
760
|
+
</Element>
|
761
|
+
</Item>
|
762
|
+
<Item FormItemOID="8C1594EF-EC64-4E65-BC9B-B347FDC988CC" ID="PFB30" Order="77" >
|
763
|
+
<Element ElementOID="0206A87E-EAA4-464D-96C2-7BCAC76B5C03" Description="Are you able to open a new milk carton?" ElementOrder="2" />
|
764
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
765
|
+
<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" />
|
766
|
+
<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" />
|
767
|
+
<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" />
|
768
|
+
<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" />
|
769
|
+
<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" />
|
770
|
+
</Element>
|
771
|
+
</Item>
|
772
|
+
<Item FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ID="PFB31" Order="78" >
|
773
|
+
<Element ElementOID="D22E061A-215B-4197-A771-4FE67EA28882" Description="Are you able to open car doors?" ElementOrder="2" />
|
774
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
775
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ItemResponseOID="CE8D1D58-ED9E-483E-BD33-3DA04B437D99" Value="1" Position="1" />
|
776
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ItemResponseOID="1B89A43A-5317-4E6A-9901-499DC6D88FE0" Value="2" Position="2" />
|
777
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ItemResponseOID="A77C4396-3DE9-4CDA-BA4D-4C21C45E33D8" Value="3" Position="3" />
|
778
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ItemResponseOID="7A17BF2A-A63B-4FB6-9CE9-4B162F265709" Value="4" Position="4" />
|
779
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="DCE6BA79-D85E-4724-B70C-AB0991CD969E" ItemResponseOID="2B7B1318-8326-49C9-9DA1-04234ABF2D36" Value="5" Position="5" />
|
780
|
+
</Element>
|
781
|
+
</Item>
|
782
|
+
<Item FormItemOID="7B2D63C5-96D4-4A0B-8222-E9DBED29F78F" ID="PFB32" Order="79" >
|
783
|
+
<Element ElementOID="B87EA7AB-82C9-4EB3-B350-AC9B39A00E50" Description="Are you able to stand unsupported for 10 minutes?" ElementOrder="2" />
|
784
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
785
|
+
<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" />
|
786
|
+
<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" />
|
787
|
+
<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" />
|
788
|
+
<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" />
|
789
|
+
<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" />
|
790
|
+
</Element>
|
791
|
+
</Item>
|
792
|
+
<Item FormItemOID="9E83AD36-70BD-45B7-88B6-AE189A57CCAA" ID="PFB33" Order="80" >
|
793
|
+
<Element ElementOID="D6178519-9599-4EC7-AC5C-E8A4EBAA1186" Description="Are you able to remove something from your back pocket?" ElementOrder="2" />
|
794
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
795
|
+
<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" />
|
796
|
+
<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" />
|
797
|
+
<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" />
|
798
|
+
<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" />
|
799
|
+
<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" />
|
800
|
+
</Element>
|
801
|
+
</Item>
|
802
|
+
<Item FormItemOID="BDFF35D5-8D30-4EA3-9552-F99DB7DB4D6F" ID="PFB34" Order="81" >
|
803
|
+
<Element ElementOID="3C596964-422D-4D8C-B559-D99BA9891BB7" Description="Are you able to change a light bulb overhead?" ElementOrder="2" />
|
804
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
805
|
+
<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" />
|
806
|
+
<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" />
|
807
|
+
<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" />
|
808
|
+
<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" />
|
809
|
+
<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" />
|
810
|
+
</Element>
|
811
|
+
</Item>
|
812
|
+
<Item FormItemOID="2CE1B495-A9A5-4D6C-8422-3F85A76A6AC5" ID="PFB36" Order="82" >
|
813
|
+
<Element ElementOID="6A544955-176C-4FC9-9345-A5FAD6806D72" Description="Are you able to put on a pullover sweater?" ElementOrder="2" />
|
814
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
815
|
+
<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" />
|
816
|
+
<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" />
|
817
|
+
<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" />
|
818
|
+
<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" />
|
819
|
+
<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" />
|
820
|
+
</Element>
|
821
|
+
</Item>
|
822
|
+
<Item FormItemOID="0CD11749-2FCC-4E3F-980D-83690951D960" ID="PFB37" Order="83" >
|
823
|
+
<Element ElementOID="0E1F7796-42E8-4766-9C85-6AC05A8F40E6" Description="Are you able to turn faucets on and off?" ElementOrder="2" />
|
824
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
825
|
+
<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" />
|
826
|
+
<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" />
|
827
|
+
<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" />
|
828
|
+
<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" />
|
829
|
+
<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" />
|
830
|
+
</Element>
|
831
|
+
</Item>
|
832
|
+
<Item FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ID="PFB39r1" Order="84" >
|
833
|
+
<Element ElementOID="F64ADA16-08AE-4CE4-BD34-B9054B78F213" Description="Are you able to reach and get down a 5 pound (2 kg) object from above your head?" ElementOrder="1" />
|
834
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
835
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ItemResponseOID="CA9C1F08-095C-41F7-9C80-8B7A3708F4EE" Value="1" Position="1" />
|
836
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ItemResponseOID="6BDA7DA7-D155-447C-9F96-70AE1E4443F2" Value="2" Position="2" />
|
837
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ItemResponseOID="CB393484-F4C2-4903-9842-6951DBF1FB61" Value="3" Position="3" />
|
838
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ItemResponseOID="539B3E18-E080-47B8-8841-0B0BBCCBB3B7" Value="4" Position="4" />
|
839
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="971DB348-610A-4DBA-AC5F-14CCA150E6E9" ItemResponseOID="E6D609B5-75DC-45DA-A09E-E1430F97E90C" Value="5" Position="5" />
|
840
|
+
</Element>
|
841
|
+
</Item>
|
842
|
+
<Item FormItemOID="D6773900-CB17-4AF3-A329-E95CAF8DA125" ID="PFB40" Order="85" >
|
843
|
+
<Element ElementOID="6AE72A70-F774-4BC0-92C7-EED282C68A57" Description="Are you able to stand up on tiptoes?" ElementOrder="2" />
|
844
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
845
|
+
<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" />
|
846
|
+
<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" />
|
847
|
+
<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" />
|
848
|
+
<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" />
|
849
|
+
<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" />
|
850
|
+
</Element>
|
851
|
+
</Item>
|
852
|
+
<Item FormItemOID="04DA80EC-7FDB-43BF-A992-0E3DECD0B169" ID="PFB41" Order="86" >
|
853
|
+
<Element ElementOID="D4A94715-61BD-4F90-A4E9-A2B294B1B29A" Description="Are you able to trim your fingernails?" ElementOrder="2" />
|
854
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
855
|
+
<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" />
|
856
|
+
<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" />
|
857
|
+
<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" />
|
858
|
+
<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" />
|
859
|
+
<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" />
|
860
|
+
</Element>
|
861
|
+
</Item>
|
862
|
+
<Item FormItemOID="4C5336FB-DCD0-4513-94B6-75B0C134833C" ID="PFB42" Order="87" >
|
863
|
+
<Element ElementOID="6B40CFAA-F8B8-47E8-9073-6422E7DD868D" Description="Are you able to stand unsupported for 30 minutes?" ElementOrder="2" />
|
864
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
865
|
+
<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" />
|
866
|
+
<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" />
|
867
|
+
<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" />
|
868
|
+
<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" />
|
869
|
+
<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" />
|
870
|
+
</Element>
|
871
|
+
</Item>
|
872
|
+
<Item FormItemOID="2145720D-9035-4E1C-BC28-A6EC39F6A03A" ID="PFB43" Order="88" >
|
873
|
+
<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" />
|
874
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
875
|
+
<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" />
|
876
|
+
<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" />
|
877
|
+
<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" />
|
878
|
+
<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" />
|
879
|
+
<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" />
|
880
|
+
</Element>
|
881
|
+
</Item>
|
882
|
+
<Item FormItemOID="934D9CC8-306B-4690-88C8-EF4BE751060D" ID="PFB44" Order="89" >
|
883
|
+
<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" />
|
884
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
885
|
+
<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" />
|
886
|
+
<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" />
|
887
|
+
<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" />
|
888
|
+
<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" />
|
889
|
+
<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" />
|
890
|
+
</Element>
|
891
|
+
</Item>
|
892
|
+
<Item FormItemOID="D2F12A09-F6D1-452B-A5B4-637F8CC76A94" ID="PFB48" Order="90" >
|
893
|
+
<Element ElementOID="0FB8532F-1397-408A-9143-8A57E5BD1703" Description="Does your health now limit you in taking a shower?" ElementOrder="2" />
|
894
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
895
|
+
<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" />
|
896
|
+
<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" />
|
897
|
+
<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" />
|
898
|
+
<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" />
|
899
|
+
<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" />
|
900
|
+
</Element>
|
901
|
+
</Item>
|
902
|
+
<Item FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ID="PFB49" Order="91" >
|
903
|
+
<Element ElementOID="ADBCC2E3-CD42-420F-B0BC-F878A34896F8" Description="Does your health now limit you in going for a short walk (less than 15 minutes)?" ElementOrder="2" />
|
904
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
905
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ItemResponseOID="E54E9973-A168-4CEE-9CA2-E031104FDC33" Value="1" Position="1" />
|
906
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ItemResponseOID="6CC3EF9F-4011-444C-9284-7B0C42394382" Value="2" Position="2" />
|
907
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ItemResponseOID="EBC33649-BFA2-40F9-AA3C-296F30C3DFFD" Value="3" Position="3" />
|
908
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ItemResponseOID="14AED5E6-783D-4E31-A9C5-6806E1085623" Value="4" Position="4" />
|
909
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="89E552BE-1B5E-4897-8469-AF7DFC555260" ItemResponseOID="6156A795-1561-4D97-95CE-0DE87427077D" Value="5" Position="5" />
|
910
|
+
</Element>
|
911
|
+
</Item>
|
912
|
+
<Item FormItemOID="CE5E0761-35D6-43AD-9FE5-6DA78A30E35F" ID="PFB50" Order="92" >
|
913
|
+
<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" />
|
914
|
+
<Element ElementOID="7F5DC59D-2BD2-4A8B-8F41-D4390BEFC8FC" Description="ContainerFor7F5DC59D-2BD2-4A8B-8F41-D4390BEFC8FC" ElementOrder="3" >
|
915
|
+
<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" />
|
916
|
+
<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" />
|
917
|
+
<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" />
|
918
|
+
<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" />
|
919
|
+
<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" />
|
920
|
+
</Element>
|
921
|
+
</Item>
|
922
|
+
<Item FormItemOID="4A52597F-DC63-4762-9447-2E7744B5648F" ID="PFB51" Order="93" >
|
923
|
+
<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" />
|
924
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
925
|
+
<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" />
|
926
|
+
<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" />
|
927
|
+
<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" />
|
928
|
+
<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" />
|
929
|
+
<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" />
|
930
|
+
</Element>
|
931
|
+
</Item>
|
932
|
+
<Item FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ID="PFB54" Order="94" >
|
933
|
+
<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" />
|
934
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
935
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ItemResponseOID="D8A6674C-FF7C-4966-9CA0-EE3FFF46440A" Value="1" Position="1" />
|
936
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ItemResponseOID="6EF72009-AFE1-4592-864C-A3156F9A441B" Value="2" Position="2" />
|
937
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ItemResponseOID="3017F927-289D-47AB-A82E-EEEB7984E07B" Value="3" Position="3" />
|
938
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ItemResponseOID="3F507C8B-D02C-499E-9074-838C2AC9D145" Value="4" Position="4" />
|
939
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="EFA073F9-B819-4101-884B-53B9F9F5968B" ItemResponseOID="01781B6F-300B-41F4-A1DE-F46B2CD99F31" Value="5" Position="5" />
|
940
|
+
</Element>
|
941
|
+
</Item>
|
942
|
+
<Item FormItemOID="6214F572-8D11-4496-9EA8-6B17E98EE354" ID="PFB56r1" Order="95" >
|
943
|
+
<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" />
|
944
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
945
|
+
<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" />
|
946
|
+
<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" />
|
947
|
+
<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" />
|
948
|
+
<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" />
|
949
|
+
<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" />
|
950
|
+
</Element>
|
951
|
+
</Item>
|
952
|
+
<Item FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ID="PFC6r1" Order="96" >
|
953
|
+
<Element ElementOID="D5F35DE3-155A-4E85-9AF4-1611AF98F237" Description="Are you able to walk a block (about 100 m) on flat ground?" ElementOrder="1" />
|
954
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
955
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ItemResponseOID="6B5A2691-D557-4FE0-A422-6E632791165F" Value="1" Position="1" />
|
956
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ItemResponseOID="9C9A632E-BD48-4CD1-95D0-818F33D143ED" Value="2" Position="2" />
|
957
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ItemResponseOID="649ECBA7-6AA4-4508-96D4-D30E9865F821" Value="3" Position="3" />
|
958
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ItemResponseOID="E30471A3-F638-4966-8B0A-9C5ECD6115EF" Value="4" Position="4" />
|
959
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="2E05DF9D-9737-4574-8E50-B7E06A04ABE4" ItemResponseOID="7A76B6C1-B4BD-4D7D-A492-E0503767CED0" Value="5" Position="5" />
|
960
|
+
</Element>
|
961
|
+
</Item>
|
962
|
+
<Item FormItemOID="D40D4E7F-9536-49F9-A2B5-ACD6F7BEB641" ID="PFC7r1" Order="97" >
|
963
|
+
<Element ElementOID="65950603-288C-44C9-A3F6-88F61EDBF787" Description="Are you able to run five miles (8 km)?" ElementOrder="1" />
|
964
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
965
|
+
<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" />
|
966
|
+
<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" />
|
967
|
+
<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" />
|
968
|
+
<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" />
|
969
|
+
<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" />
|
970
|
+
</Element>
|
971
|
+
</Item>
|
972
|
+
<Item FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ID="PFC10" Order="98" >
|
973
|
+
<Element ElementOID="7C07AB85-3F68-42D1-9EE3-10996514FB55" Description="Does your health now limit you in climbing several flights of stairs?" ElementOrder="2" />
|
974
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
975
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ItemResponseOID="8A2254FA-90DB-4696-B155-AD55B5DE8A9E" Value="1" Position="1" />
|
976
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ItemResponseOID="B6370E2F-F9CD-4C7B-AB1E-37111E25A959" Value="2" Position="2" />
|
977
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ItemResponseOID="B8649F33-0D1B-4BB1-883A-C2F3C0D65AC5" Value="3" Position="3" />
|
978
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ItemResponseOID="44378674-D13A-4F81-A5CA-EFE06B30A571" Value="4" Position="4" />
|
979
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="9EB51983-344B-4AC8-99F3-64531B86255F" ItemResponseOID="249867F5-9C9C-48D1-AC4D-5D766558DD5D" Value="5" Position="5" />
|
980
|
+
</Element>
|
981
|
+
</Item>
|
982
|
+
<Item FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ID="PFC12" Order="99" >
|
983
|
+
<Element ElementOID="B976ACCF-08F4-4C5B-A822-82867F278B52" Description="Does your health now limit you in doing two hours of physical labor?" ElementOrder="2" />
|
984
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
985
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="F6A78B97-04AD-497D-9521-5B7B747D428C" ItemResponseOID="E344E9D7-2392-46BD-9D8E-A3321C6E73BB" Value="1" Position="1" />
|
986
|
+
<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" />
|
987
|
+
<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" />
|
988
|
+
<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" />
|
989
|
+
<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" />
|
990
|
+
</Element>
|
991
|
+
</Item>
|
992
|
+
<Item FormItemOID="BF591285-7126-47B1-84F6-D75A6E5FEB51" ID="PFC13r1" Order="100" >
|
993
|
+
<Element ElementOID="E0E3D227-FC2B-47DC-8621-1220770D0F3A" Description="Are you able to run 100 yards (100 m)?" ElementOrder="1" />
|
994
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
995
|
+
<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" />
|
996
|
+
<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" />
|
997
|
+
<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" />
|
998
|
+
<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" />
|
999
|
+
<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" />
|
1000
|
+
</Element>
|
1001
|
+
</Item>
|
1002
|
+
<Item FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ID="PFC29" Order="101" >
|
1003
|
+
<Element ElementOID="E6629497-2067-4CEC-87F0-780045C2A10F" Description="Are you able to walk up and down two steps?" ElementOrder="2" />
|
1004
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1005
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ItemResponseOID="99D1176D-CF4E-41AF-B2A8-056F4C9E22AA" Value="1" Position="1" />
|
1006
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ItemResponseOID="784CE380-B1C7-4B7B-A6B1-2BDBC3CEAB97" Value="2" Position="2" />
|
1007
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ItemResponseOID="76D54354-C0BD-437A-BD43-F74AA77DA64A" Value="3" Position="3" />
|
1008
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ItemResponseOID="7CC6ADA4-A7AA-408C-824B-6B83C5334ADA" Value="4" Position="4" />
|
1009
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="943FF5FE-7CCB-4399-946B-D38DFF959017" ItemResponseOID="44ABA003-AF39-4446-A4C8-A5B119A882D7" Value="5" Position="5" />
|
1010
|
+
</Element>
|
1011
|
+
</Item>
|
1012
|
+
<Item FormItemOID="2DC963F2-47B7-4DF6-AF4E-1B176F48BB68" ID="PFC31" Order="102" >
|
1013
|
+
<Element ElementOID="52A18B1F-F3A7-4DCD-AC69-56F1109C05E6" Description="Are you able to reach into a low cupboard?" ElementOrder="2" />
|
1014
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1015
|
+
<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" />
|
1016
|
+
<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" />
|
1017
|
+
<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" />
|
1018
|
+
<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" />
|
1019
|
+
<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" />
|
1020
|
+
</Element>
|
1021
|
+
</Item>
|
1022
|
+
<Item FormItemOID="3A0CBCF8-4E8D-4BDE-9BDF-9B0A5F3B6E52" ID="PFC32" Order="103" >
|
1023
|
+
<Element ElementOID="EAEA35FC-BC71-4E4B-9881-46D6EA51FEB0" Description="Are you able to climb up 5 flights of stairs?" ElementOrder="2" />
|
1024
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1025
|
+
<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" />
|
1026
|
+
<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" />
|
1027
|
+
<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" />
|
1028
|
+
<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" />
|
1029
|
+
<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" />
|
1030
|
+
</Element>
|
1031
|
+
</Item>
|
1032
|
+
<Item FormItemOID="D1ED151B-86E6-40FF-8A7D-B80D10A4DF74" ID="PFC33r1" Order="104" >
|
1033
|
+
<Element ElementOID="B640398D-1D4B-42DA-8A39-5AA038A48050" Description="Are you able to run ten miles (16 km)?" ElementOrder="1" />
|
1034
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
1035
|
+
<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" />
|
1036
|
+
<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" />
|
1037
|
+
<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" />
|
1038
|
+
<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" />
|
1039
|
+
<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" />
|
1040
|
+
</Element>
|
1041
|
+
</Item>
|
1042
|
+
<Item FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ID="PFC35" Order="105" >
|
1043
|
+
<Element ElementOID="3BF20BB8-57F9-467E-8C34-057517C75D68" Description="Does your health now limit you in doing eight hours of physical labor?" ElementOrder="2" />
|
1044
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
1045
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ItemResponseOID="B46D656C-F434-4468-8BAA-43FBB8E73C8E" Value="1" Position="1" />
|
1046
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ItemResponseOID="BA7D1793-2399-4D5D-B6DE-AB3EC12DF29B" Value="2" Position="2" />
|
1047
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ItemResponseOID="C4B9F167-EEEC-469F-B30C-44A5AF303C99" Value="3" Position="3" />
|
1048
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ItemResponseOID="1E44516A-89C7-4A84-8B18-DE65E0BE2DBA" Value="4" Position="4" />
|
1049
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="F1611BFA-A878-425C-A871-DA090A7C07BF" ItemResponseOID="E73BC064-7197-4E82-888E-5DB645CE5FA4" Value="5" Position="5" />
|
1050
|
+
</Element>
|
1051
|
+
</Item>
|
1052
|
+
<Item FormItemOID="324B18D0-389E-4390-8239-A7E990C6F547" ID="PFC36r1" Order="106" >
|
1053
|
+
<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" />
|
1054
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="2" >
|
1055
|
+
<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" />
|
1056
|
+
<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" />
|
1057
|
+
<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" />
|
1058
|
+
<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" />
|
1059
|
+
<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" />
|
1060
|
+
</Element>
|
1061
|
+
</Item>
|
1062
|
+
<Item FormItemOID="986FA694-8819-41A3-B458-AF6DCF2A1100" ID="PFC37" Order="107" >
|
1063
|
+
<Element ElementOID="3A43DC65-C685-4730-ADE2-06B146F1DE70" Description="Does your health now limit you in climbing one flight of stairs?" ElementOrder="2" />
|
1064
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
1065
|
+
<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" />
|
1066
|
+
<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" />
|
1067
|
+
<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" />
|
1068
|
+
<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" />
|
1069
|
+
<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" />
|
1070
|
+
</Element>
|
1071
|
+
</Item>
|
1072
|
+
<Item FormItemOID="329666BB-61F3-494E-B8A9-908B41B2EE22" ID="PFC38" Order="108" >
|
1073
|
+
<Element ElementOID="B3793830-B5AA-41B9-B833-0EEBE786E2DE" Description="Are you able to walk at a normal speed?" ElementOrder="2" />
|
1074
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1075
|
+
<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" />
|
1076
|
+
<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" />
|
1077
|
+
<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" />
|
1078
|
+
<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" />
|
1079
|
+
<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" />
|
1080
|
+
</Element>
|
1081
|
+
</Item>
|
1082
|
+
<Item FormItemOID="7E07201D-CD2E-4BD7-9247-449F5D4C8EFE" ID="PFC39" Order="109" >
|
1083
|
+
<Element ElementOID="6F3752B5-C8CB-4FC9-9D1F-056F3D146EF3" Description="Are you able to stand without losing your balance for several minutes?" ElementOrder="2" />
|
1084
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1085
|
+
<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" />
|
1086
|
+
<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" />
|
1087
|
+
<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" />
|
1088
|
+
<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" />
|
1089
|
+
<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" />
|
1090
|
+
</Element>
|
1091
|
+
</Item>
|
1092
|
+
<Item FormItemOID="351E3C99-2F40-4CB9-B55F-DFEB56D7D539" ID="PFC40" Order="110" >
|
1093
|
+
<Element ElementOID="F41AC5F4-F7A6-4F5B-BD46-4B7D816212C7" Description="Are you able to kneel on the floor?" ElementOrder="2" />
|
1094
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1095
|
+
<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" />
|
1096
|
+
<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" />
|
1097
|
+
<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" />
|
1098
|
+
<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" />
|
1099
|
+
<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" />
|
1100
|
+
</Element>
|
1101
|
+
</Item>
|
1102
|
+
<Item FormItemOID="A5F5ED1A-E94B-4CF3-A67C-08D015D3F381" ID="PFC41" Order="111" >
|
1103
|
+
<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" />
|
1104
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1105
|
+
<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" />
|
1106
|
+
<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" />
|
1107
|
+
<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" />
|
1108
|
+
<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" />
|
1109
|
+
<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" />
|
1110
|
+
</Element>
|
1111
|
+
</Item>
|
1112
|
+
<Item FormItemOID="361B11C9-3ACE-4917-A745-CDC2BC9CFE24" ID="PFC43" Order="112" >
|
1113
|
+
<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" />
|
1114
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1115
|
+
<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" />
|
1116
|
+
<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" />
|
1117
|
+
<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" />
|
1118
|
+
<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" />
|
1119
|
+
<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" />
|
1120
|
+
</Element>
|
1121
|
+
</Item>
|
1122
|
+
<Item FormItemOID="2F7A348D-7878-4799-9AD8-30D49AC1DB5C" ID="PFC45r1" Order="113" >
|
1123
|
+
<Element ElementOID="EB373A4E-034E-4E93-8BF7-BAF809842B27" Description="Are you able to sit on and get up from the toilet?" ElementOrder="1" />
|
1124
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="2" >
|
1125
|
+
<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" />
|
1126
|
+
<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" />
|
1127
|
+
<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" />
|
1128
|
+
<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" />
|
1129
|
+
<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" />
|
1130
|
+
</Element>
|
1131
|
+
</Item>
|
1132
|
+
<Item FormItemOID="E3CCBA8D-3718-498E-B855-A35B745F19F7" ID="PFC46" Order="114" >
|
1133
|
+
<Element ElementOID="7DD55963-CCA2-4DB4-AD2D-E6F586E79E95" Description="Are you able to transfer from a bed to a chair and back?" ElementOrder="2" />
|
1134
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1135
|
+
<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" />
|
1136
|
+
<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" />
|
1137
|
+
<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" />
|
1138
|
+
<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" />
|
1139
|
+
<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" />
|
1140
|
+
</Element>
|
1141
|
+
</Item>
|
1142
|
+
<Item FormItemOID="071FCDDE-17E5-44B7-9EB1-5A47987F13D4" ID="PFC47" Order="115" >
|
1143
|
+
<Element ElementOID="33B89C92-ED65-4C71-91FF-DFE5F4F4BEF7" Description="Are you able to be out of bed most of the day?" ElementOrder="2" />
|
1144
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1145
|
+
<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" />
|
1146
|
+
<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" />
|
1147
|
+
<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" />
|
1148
|
+
<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" />
|
1149
|
+
<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" />
|
1150
|
+
</Element>
|
1151
|
+
</Item>
|
1152
|
+
<Item FormItemOID="6A1F8385-5A91-4BAE-A319-E5AF4F5043DB" ID="PFC49" Order="116" >
|
1153
|
+
<Element ElementOID="3285653D-BB3F-4A30-8C78-1ED1B242ADEE" Description="Are you able to water a house plant?" ElementOrder="2" />
|
1154
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1155
|
+
<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" />
|
1156
|
+
<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" />
|
1157
|
+
<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" />
|
1158
|
+
<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" />
|
1159
|
+
<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" />
|
1160
|
+
</Element>
|
1161
|
+
</Item>
|
1162
|
+
<Item FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ID="PFC51" Order="117" >
|
1163
|
+
<Element ElementOID="AC8537A4-6772-4EB9-8336-DF3D3739BBAB" Description="Are you able to wipe yourself after using the toilet?" ElementOrder="2" />
|
1164
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1165
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ItemResponseOID="B8850C00-8C6B-43E5-8C26-9E512CB7DBB6" Value="1" Position="1" />
|
1166
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ItemResponseOID="95EBBA41-C225-4849-8485-AAA987E3CB7F" Value="2" Position="2" />
|
1167
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ItemResponseOID="712F0C02-30DE-4CDE-97C2-590A07769600" Value="3" Position="3" />
|
1168
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ItemResponseOID="12317860-8863-4FA9-AE3F-7C6AA8105CBA" Value="4" Position="4" />
|
1169
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0E2B9733-052F-4D89-860B-B3D582FAEE07" ItemResponseOID="936B3877-233B-4536-8A83-30CB85788141" Value="5" Position="5" />
|
1170
|
+
</Element>
|
1171
|
+
</Item>
|
1172
|
+
<Item FormItemOID="45D0A786-782F-4B05-AB63-3037F1BC1FB8" ID="PFC52" Order="118" >
|
1173
|
+
<Element ElementOID="A778AD77-4CB2-4314-9966-591CE014B622" Description="Are you able to turn from side to side in bed?" ElementOrder="2" />
|
1174
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1175
|
+
<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" />
|
1176
|
+
<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" />
|
1177
|
+
<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" />
|
1178
|
+
<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" />
|
1179
|
+
<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" />
|
1180
|
+
</Element>
|
1181
|
+
</Item>
|
1182
|
+
<Item FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ID="PFC53" Order="119" >
|
1183
|
+
<Element ElementOID="713B5162-FA6C-46F8-8AF5-636A7EDBD122" Description="Are you able to get in and out of bed?" ElementOrder="2" />
|
1184
|
+
<Element ElementOID="EDF1DB4F-5914-480E-8A54-3F6F6E857AA9" Description="ContainerForEDF1DB4F-5914-480E-8A54-3F6F6E857AA9" ElementOrder="3" >
|
1185
|
+
<Map ElementOID="DD11506B-FD1D-4220-926E-66DB8DB8BFA8" Description="Unable to do" FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ItemResponseOID="BCFAB09B-152D-4BE8-B72B-65389A01336E" Value="1" Position="1" />
|
1186
|
+
<Map ElementOID="EB0FF522-ECD5-40B0-8203-F3F0BC4D94BD" Description="With much difficulty" FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ItemResponseOID="B9E1E2A4-4E58-4B54-A9FA-D6EF8328C95F" Value="2" Position="2" />
|
1187
|
+
<Map ElementOID="236512E6-147D-4AE0-91FA-652316242895" Description="With some difficulty" FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ItemResponseOID="3676B76B-3974-417F-881B-94AE3BFF51DC" Value="3" Position="3" />
|
1188
|
+
<Map ElementOID="1D0C782C-53FE-4FA0-8DA4-1752151D3033" Description="With a little difficulty" FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ItemResponseOID="615FB9F8-71A5-4F38-91D6-B618BD0464F3" Value="4" Position="4" />
|
1189
|
+
<Map ElementOID="77458098-58B1-457A-8578-E480C601472E" Description="Without any difficulty" FormItemOID="0B8F5CAB-15F5-4F2D-98CA-FF0603BF42EB" ItemResponseOID="AE2DDF72-0277-438E-8C99-819BD859FCD9" Value="5" Position="5" />
|
1190
|
+
</Element>
|
1191
|
+
</Item>
|
1192
|
+
<Item FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ID="PFC54" Order="120" >
|
1193
|
+
<Element ElementOID="5D471BF8-ECDD-4BAC-B198-BD54820B546D" Description="Does your health now limit you in getting in and out of the bathtub?" ElementOrder="2" />
|
1194
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
1195
|
+
<Map ElementOID="EDC9A934-AD7E-41E6-A0F0-DF8AAF5A4538" Description="Cannot do" FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ItemResponseOID="0B86347A-0348-44A9-8698-55F59035AE9A" Value="1" Position="1" />
|
1196
|
+
<Map ElementOID="8E5F36F6-4D7F-425E-A11B-BEE344283405" Description="Quite a lot" FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ItemResponseOID="2FA48A3F-BEB1-4DEA-8AFA-0150C7955F47" Value="2" Position="2" />
|
1197
|
+
<Map ElementOID="AC9C3BDE-1299-4D8C-8D14-0F141CE3F997" Description="Somewhat" FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ItemResponseOID="088BEF58-ADE0-45F6-8885-BA888C7DBD61" Value="3" Position="3" />
|
1198
|
+
<Map ElementOID="AF0B2948-CBA3-4259-A3CD-1CFF56E39776" Description="Very little" FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ItemResponseOID="72BA65CB-ED7D-4011-8376-C3003CE54E51" Value="4" Position="4" />
|
1199
|
+
<Map ElementOID="89561801-13AB-46E8-8465-7A7A97CB8BE4" Description="Not at all" FormItemOID="DE08401B-FC1E-43B2-90D6-078EE923F74B" ItemResponseOID="45C26BE5-06C8-4CE9-803A-15AEA56381FD" Value="5" Position="5" />
|
1200
|
+
</Element>
|
1201
|
+
</Item>
|
1202
|
+
<Item FormItemOID="A5C01CCE-A55A-421C-AA98-242A8B8B5C43" ID="PFC56" Order="121" >
|
1203
|
+
<Element ElementOID="EA983CD8-11B3-4460-B84A-00FE2B5439FF" Description="Does your health now limit you in walking about the house?" ElementOrder="2" />
|
1204
|
+
<Element ElementOID="3E9A1FE1-2BF0-4165-A178-ADC555D62151" Description="ContainerFor3E9A1FE1-2BF0-4165-A178-ADC555D62151" ElementOrder="3" >
|
1205
|
+
<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" />
|
1206
|
+
<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" />
|
1207
|
+
<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" />
|
1208
|
+
<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" />
|
1209
|
+
<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" />
|
1210
|
+
</Element>
|
1211
|
+
</Item>
|
1212
|
+
</Form>
|
1213
|
+
|