study_engine 0.0.2
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- checksums.yaml +7 -0
- data/Rakefile +42 -0
- data/app/assets/images/study_engine/spinner.gif +0 -0
- data/app/assets/images/study_engine/sprite/delete.png +0 -0
- data/app/assets/images/study_engine/sprite/download.png +0 -0
- data/app/assets/images/study_engine/sprite/edit.png +0 -0
- data/app/assets/images/study_engine/sprite/incomplete.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc-sm.png +0 -0
- data/app/assets/images/study_engine/sprite/metrc.png +0 -0
- data/app/assets/images/study_engine/sprite/new.png +0 -0
- data/app/assets/javascripts/study_engine/admin_notes.js.coffee +12 -0
- data/app/assets/javascripts/study_engine/assessment_notifications.js.coffee +36 -0
- data/app/assets/javascripts/study_engine/assessment_timeout.js.coffee +24 -0
- data/app/assets/javascripts/study_engine/disable_buttons_after_click.js.coffee +6 -0
- data/app/assets/javascripts/study_engine/fire_click_event_immediately_on_mobile.js.coffee.erb +10 -0
- data/app/assets/javascripts/study_engine/response_validation.js.coffee +8 -0
- data/app/assets/javascripts/study_engine/restart_assessment_button.js.coffee +3 -0
- data/app/assets/javascripts/study_engine/study_engine.js.coffee +9 -0
- data/app/assets/javascripts/study_engine/study_id_picker.js.coffee +28 -0
- data/app/assets/stylesheets/study_engine.sass +1 -0
- data/app/assets/stylesheets/study_engine/_constant.sass +52 -0
- data/app/assets/stylesheets/study_engine/_mobile.sass +8 -0
- data/app/assets/stylesheets/study_engine/_tablet.sass +36 -0
- data/app/assets/stylesheets/study_engine/application.sass +101 -0
- data/app/assets/stylesheets/study_engine/base/_form.sass +131 -0
- data/app/assets/stylesheets/study_engine/base/_list.sass +38 -0
- data/app/assets/stylesheets/study_engine/base/_tables.sass +33 -0
- data/app/assets/stylesheets/study_engine/base/_text.sass +78 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_login-fields.sass +14 -0
- data/app/assets/stylesheets/study_engine/components/-fields/_start-fields.sass +101 -0
- data/app/assets/stylesheets/study_engine/components/-nav/_global-nav.sass +19 -0
- data/app/assets/stylesheets/study_engine/components/-table/_results-table.sass +75 -0
- data/app/assets/stylesheets/study_engine/components/-table/_users-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/components/_assessment-questions.sass +30 -0
- data/app/assets/stylesheets/study_engine/components/_form-buttons.sass +102 -0
- data/app/assets/stylesheets/study_engine/components/_helpt-text.sass +2 -0
- data/app/assets/stylesheets/study_engine/components/_method-icons.sass +15 -0
- data/app/assets/stylesheets/study_engine/components/_notes-modal.sass +65 -0
- data/app/assets/stylesheets/study_engine/components/_progress-bar.sass +25 -0
- data/app/assets/stylesheets/study_engine/components/_sortable-columns.sass +26 -0
- data/app/assets/stylesheets/study_engine/components/_table-actions.sass +8 -0
- data/app/assets/stylesheets/study_engine/components/_table-buttons.sass +17 -0
- data/app/assets/stylesheets/study_engine/components/_user-privileges.sass +3 -0
- data/app/assets/stylesheets/study_engine/mixins/_actions-table.sass +11 -0
- data/app/assets/stylesheets/study_engine/mixins/_buttons.sass +55 -0
- data/app/assets/stylesheets/study_engine/mixins/_checkbox-columns.sass +50 -0
- data/app/assets/stylesheets/study_engine/mixins/_custom-radios.sass +47 -0
- data/app/assets/stylesheets/study_engine/mixins/_icons.sass +38 -0
- data/app/assets/stylesheets/study_engine/mixins/_notification-text.sass +23 -0
- data/app/controllers/study_engine/admin/application_controller.rb +6 -0
- data/app/controllers/study_engine/admin/assessments_controller.rb +79 -0
- data/app/controllers/study_engine/admin/notes_controller.rb +17 -0
- data/app/controllers/study_engine/application_controller.rb +12 -0
- data/app/controllers/study_engine/assessments_controller.rb +94 -0
- data/app/helpers/study_engine/helpers.rb +15 -0
- data/app/helpers/study_engine/mailer_helpers.rb +11 -0
- data/app/mailers/study_engine/mailer.rb +25 -0
- data/app/models/study_engine/answer.rb +36 -0
- data/app/models/study_engine/assessment.rb +118 -0
- data/app/models/study_engine/begin_assessment_form.rb +110 -0
- data/app/models/study_engine/existing_assessments_form.rb +99 -0
- data/app/models/study_engine/form.rb +59 -0
- data/app/models/study_engine/report.rb +69 -0
- data/app/models/study_engine/result.rb +46 -0
- data/app/models/study_engine/screen_results.rb +54 -0
- data/app/models/study_engine/study_id.rb +47 -0
- data/app/models/study_engine/study_id/bank.rb +38 -0
- data/app/models/study_engine/study_id/sync.rb +52 -0
- data/app/models/study_engine/update_assessments_form.rb +53 -0
- data/app/views/study_engine/_progress_bar.html.slim +4 -0
- data/app/views/study_engine/admin/assessments/_assessment.html.slim +36 -0
- data/app/views/study_engine/admin/assessments/domain_results.csv.csvbuilder +17 -0
- data/app/views/study_engine/admin/assessments/edit.html.slim +68 -0
- data/app/views/study_engine/admin/assessments/index.html.slim +26 -0
- data/app/views/study_engine/admin/assessments/item_results.csv.csvbuilder +24 -0
- data/app/views/study_engine/admin/assessments/new.html.slim +46 -0
- data/app/views/study_engine/admin/assessments/screen_results.csv.csvbuilder +2 -0
- data/app/views/study_engine/assessments/complete.html.slim +25 -0
- data/app/views/study_engine/assessments/create.html.slim +46 -0
- data/app/views/study_engine/assessments/index.html.slim +43 -0
- data/app/views/study_engine/assessments/restart.html.slim +28 -0
- data/app/views/study_engine/assessments/show.html.slim +60 -0
- data/app/views/study_engine/mailer/assessment_recorded_notification.erb +8 -0
- data/app/views/study_engine/mailer/assessment_url_notification.erb +6 -0
- data/config/routes.rb +15 -0
- data/db/migrate/20160422185859_create_tables.rb +52 -0
- data/lib/study_engine.rb +5 -0
- data/lib/study_engine/config.rb +37 -0
- data/lib/study_engine/cucumber.rb +96 -0
- data/lib/study_engine/engine.rb +7 -0
- data/lib/study_engine/version.rb +3 -0
- data/lib/tasks/study_engine_tasks.rake +10 -0
- data/spec/ar_helper.rb +30 -0
- data/spec/models/study_engine/answer_spec.rb +28 -0
- data/spec/models/study_engine/assessment_spec.rb +250 -0
- data/spec/models/study_engine/begin_assessment_form_spec.rb +87 -0
- data/spec/models/study_engine/existing_assessments_form_spec.rb +171 -0
- data/spec/models/study_engine/report_spec.rb +48 -0
- data/spec/models/study_engine/result_spec.rb +102 -0
- data/spec/models/study_engine/screen_results_spec.rb +69 -0
- data/spec/models/study_engine/study_id/bank_spec.rb +72 -0
- data/spec/models/study_engine/study_id/sync_spec.rb +61 -0
- data/spec/models/study_engine/study_id_spec.rb +7 -0
- data/spec/models/study_engine/update_assessments_form_spec.rb +38 -0
- data/spec/rails_helper.rb +50 -0
- data/spec/schema.rb +65 -0
- data/spec/spec_helper.rb +72 -0
- data/spec/support/CATEngine3.exe +0 -0
- data/spec/support/forms/01. Physical Function Bank.xml +1213 -0
- data/spec/support/forms/02. Pain Interference Bank.xml +443 -0
- data/spec/support/forms/03. Anxiety Bank.xml +322 -0
- data/spec/support/forms/04. Depression Bank.xml +311 -0
- data/spec/support/forms/05. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/06. Psychosocial Illness Impact Pos Bank.xml +900 -0
- data/spec/support/forms/07. Applied Cognition Gen Concerns Bank.xml +377 -0
- data/spec/support/forms/08. Satisfaction with Roles and Activities Bank Version 2.xml +443 -0
- data/spec/support/forms/09. Sleep Disturbance Bank.xml +300 -0
- data/spec/support/forms/10. Emotional Support Bank.xml +163 -0
- data/spec/support/forms/A - 07. Psychosocial Illness Impact Pos Bank.xml +471 -0
- data/spec/support/forms/A - 08. Pain interference Bank.xml +443 -0
- data/spec/support/forms/A - 09. Depression Bank.xml +311 -0
- data/spec/support/forms/B - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/B - 08. Physical Function Remainder A.xml +543 -0
- data/spec/support/forms/B - 09. Ability to Participate Social bank Version 2.xml +353 -0
- data/spec/support/forms/C - 07. Physical Function Short Form.xml +123 -0
- data/spec/support/forms/C - 08. Physical Function Remainder B.xml +553 -0
- data/spec/support/forms/C - 09. Anxiety Bank.xml +322 -0
- data/spec/support/parameters/01. Physical Function Bank.xml +682 -0
- data/spec/support/parameters/02. Pain Interference Bank.xml +256 -0
- data/spec/support/parameters/03. Anxiety Bank.xml +190 -0
- data/spec/support/parameters/04. Depression Bank.xml +184 -0
- data/spec/support/parameters/05. Ability to Participate Social bank Version 2.xml +226 -0
- data/spec/support/parameters/06. Psychosocial Illness Impact Pos Bank.xml +211 -0
- data/spec/support/parameters/07. Applied Cognition Gen Concerns Bank.xml +1 -0
- data/spec/support/parameters/08. Satisfaction with Roles and Activities Bank Version 2.xml +1 -0
- data/spec/support/parameters/09. Sleep Disturbance Bank.xml +1 -0
- data/spec/support/parameters/10. Emotional Support Bank.xml +1 -0
- metadata +394 -0
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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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+
|
31
|
+
# 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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|
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|
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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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|
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|
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|
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|
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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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|
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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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|
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|
+
<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" />
|
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|
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|
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" >
|
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|
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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
|
+
|