Survey Text

1980
1979
top
1980
Survey form view entire document:  text  image
Mark box or ask:
4a. What (other) condition causes -- to (need help in activities in 1 and 2/(or) stay in bed)?

[] No H box (NP) ________

b. Does any other conditions cause -- to (need help in activities in 1 and 2/ (or) stay in bed)?

[] 1 Y (Reask 4a and b)
[] 2 N

Mark box or ask:
c. Which of these conditions would you say ins the main condition that causes -- to (need help in activities in 1 and 2/ (or) stay in bed)?

[] Old age only (NP)
[] Only one condition
Main condition ____

top
1979
Survey form view entire document:  text  image
Mark box or ask:
4 a. What (other) condition causes -- to (need help in activities in 1 and 2/ (or) stay in bed)?

____
[] No H box (NP)

b. Does any other condition cause -- to (need help in activities in 1 and 2/ (or) stay in bed)?

1 [] Y (Reask 4a and b)
2 [] N

Mark box or ask:
c. Which of these conditions would you say is the main condition that causes -- to (need help in activities in 1 and 2/ (or) stay in bed)?

[] Old age only (NP)
[] Only one condition
Main condition ____