154 (154)    MH REPORT (601.93)

Name Value
REPORT NUMBER 154
INSTRUMENT WHODAS2.0-12
RPT
|  | World Health Organization Disability Assessment Schedule 2.0 - 
  Questions and Answers: | 
 S1. Standing for long periods such as 30 minutes?|      <*Answer_7810*>| 
 S2. Taking care of your household responsibilities?|
      <*Answer_7811*>|  S3. Learning a new task, for example, learning how
 to get to a new place? |       <*Answer_7812*>|  S4. How much of a
 problem did you have joining in community activities (for example,
 festivities, religious or other activities) in the same way
 as anyone else can?|      <*Answer_7813*>|  S5. How much have you
 been emotionally affected by your health problems? |      
<*Answer_7814*>|  S6. Concentrating on doing something for ten
12-item (WHODAS2.0-12) | |
 minutes?|      <*Answer_7815*>|  S7. Walking a long distance such as a
 kilometer (or equivalent)?|      <*Answer_7816*>|  S8.
 Washing your whole body?|      <*Answer_7817*>|  S9. Getting dressed?|
      <*Answer_7818*>|  S10. Dealing with people you do not know?|     
  <*Answer_7819*>|  S11. Maintaining a friendship?|
       <*Answer_7820*>|
  S12. Your day-to-day work?|       <*Answer_7821*>|
|  |Information contained in this note is based on a self-report 
assessment and is not sufficient to use alone for diagnostic purposes.
 Assessment results should be verified for accuracy and used in
  Date Given: <.Date_Given.>|  Clinician: <.Staff_Ordered_By.> |
 conjunction with other diagnostic activities.
|  |Copyright  World Health Organization. 2009. All Rights Reserved. 
Measuring health and disability: manual for WHO Disability Assessment
 Schedule (WHODAS 2.0), World Health Organization, 2010, Geneva.   $~
  Location: <.Location.>|   |  Veteran: <.Patient_Name_Last_First.>|  
SSN: <.Patient_SSN.>|  DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|  Gender: <.Patient_Gender.>   | | | 
 GLOBAL DISABILITY SCORE: <*Answer_7771*>|  Scores range from 0-48, with
 higher scores indicating more severe disability.
| |