Survey Text

1980
1979
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1980
Survey form view entire document:  text  image
Some people are limited in what they can do because of physical or mental condition; that is, the cannot do some of the daily activities that other people do.

1a. Because of a disability or health problem, does anyone in the family, (that is you, your -- etc.), receive or need help from another person, or use special equipment in -
If "Yes," ask 1b and c

(1) Walking, except for using stairs?
[] Y or "doesn't do"
[] N
(2) Going outside?
[] Y or "doesn't do"
[] N
(3) Using the toilet in the bathroom including getting to the bathroom?
[] Y or "doesn't do"
[] N
(4) Bathing, including sponge baths?
[] Y or "doesn't do"
[] N
(5) Dressing?
[] Y or "doesn't do"
[] N
(6) Eating?
[] Y or "doesn't do"
[] N
(7) Getting in and out of bed or chairs?
[] Y or "doesn't do"
[] N

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1979
Survey form view entire document:  text  image
(1) Walking, except for using stairs?
[] Y or "doesn't do"
[] N
(2) Going outside?
[] Y or "doesn't do"
[] N
(3) Using the toilet in the bathroom including getting to the bathroom?
[] Y or "doesn't do"
[] N
(4) Bathing, including sponge baths?
[] Y or "doesn't do"
[] N
(5) Dressing?
[] Y or "doesn't do"
[] N
(6) Eating?
[] Y or "doesn't do"
[] N
(7) Getting in and out of bed or chairs?
[] Y or "doesn't do"
[] N