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spaid
[p. 74]

SPECIAL AIDS SUPPLEMENT


46a. Does anyone in the family now use (any of the following special aids) -


1. An artificial arm?
[] Yes
[] No


2. An artificial leg?
[] Yes
[] No


3. A brace of any kind?
[] Yes
[] No


4. Crutches?
[] Yes
[] No


5. A cane or walking stick?
[] Yes
[] No


6. Special shoes?
[] Yes
[] No


7. A wheel chair?
[] Yes
[] No


8. A walker?
[] Yes
[] No


9. Guide dog?
[] Yes
[] No


10. Any other kind of aid for getting around?
[] Yes
[] No

If "Yes," specify: ____Enter in Table SA

b. Who is this? ____

c. Anyone else? ____

Table SA


[Rows 1-5]

a. Person No. ____

b. Type of aid ____

If 1-6 in (b), ASK:

c. Does he use one or two ____ (at a time)?

[] 1
[] 2
[] Other


If 3-10 in (b), ASK:

d. For what condition does he need this ____? (Item C)


If "brace," Ask: On what part of the body is the brace worn? ____

Table SA - Continued
[Rows 1-5]


e. Is the ____ used all of the time, most of the time or only occasionally?

1 [] All
2 [] Most
3 [] Occasionally


f. How long has he used ____?

[] Less than 1 month
[] Months ____
[] Years ____


g. How was the _____ obtained? Was it purchased, rented, borrowed or a gift?

1 [] Purchased
2 [] Rented
3 [] Borrowed
4 [] Gift