| RPT |
.| .| World Health Organization Disability Assessment Schedule 2.0| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|
equivalent]?| <*Answer_5693*>| | Self-care| | D3.1 Washing your whole body?| <*Answer_5694*>| D3.2 Getting dressed?| <*Answer_5695*>| D3.3 Eating?| <*Answer_5696*>| D3.4 Staying
by yourself for a few days?| <*Answer_5697*>| | Getting along| | D4.1 Dealing with people you do not know?| <*Answer_5698*>| D4.2 Maintaining a friendship?| <*Answer_5699*>| D4.3
Getting along with people who are close to you?| <*Answer_5700*>| D4.4 Making new friends?| <*Answer_5701*>| D4.5 Sexual activities?| <*Answer_5702*>| | Life activities| | D5.1 Taking
care of your household responsibilities?| <*Answer_5703*>| D5.2 Doing most important household tasks well?| <*Answer_5704*>| D5.3 Getting all the household work done that you needed to do?|
<*Answer_5705*>| D5.4 Getting your household work done as quickly as needed?| <*Answer_5706*>| Do you work (paid, non-paid, self-employed) or go to school?| <*Answer_5707*>| D5.5
Your day-to-day work/school?| <*Answer_5708*>| D5.6 Doing your most important work/school tasks well?| <*Answer_5709*>| D5.7 Getting all the work done that you need to do?|
<*Answer_5710*>| D5.8 Getting your work done as quickly as needed?| <*Answer_5711*>| | Participation in society| | D6.1 How much of a problem did you have in joining in community activities
(for example, festivities, religious or other activities) in the same way as anyone else can?| <*Answer_5712*>| D6.2 How much of a problem did you have because of barriers or hindrances in the
world around you?| <*Answer_5713*>| D6.3 How much of a problem did you have living with dignity because of the attitudes and actions of others?| <*Answer_5714*>| D6.4 How much time did you
spend on your health condition, or its consequences?| <*Answer_5715*>| D6.5 How much have you been emotionally affected by your health condition?| <*Answer_5716*>| D6.6 How much has your
SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | <*Answer_999999999999*>| | | Questions and Answers| | Understanding and communication| | D1.1
health been a drain on the financial resources of you or your family?| <*Answer_5717*>| D6.7 How much of a problem did your family have because of your health problems?| <*Answer_5718*>|
D6.8 How much of a problem did you have in doing things by yourself for relaxation or pleasure?| <*Answer_5719*>| | H1. Overall, in the past 30 days, how many days were these difficulties
present?| <*Answer_5720*>| H2. In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition?| <*Answer_5721*>|
H3. In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition?|
<*Answer_5722*>| | | 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 conjunction with other diagnostic activities and procedures.| $~
Concentrating on doing something for ten minutes?| <*Answer_5683*>|
D1.2 Remembering to do important things?| <*Answer_5684*>| D1.3
Analyzing and finding solutions to problems in day-to-day
life?| <*Answer_5685*>| D1.4 Learning a new task, for example, learning how to get to a new place?| <*Answer_5686*>| D1.5 Generally understanding what people say?| <*Answer_5687*>|
D1.6 Starting and maintaining a conversation?| <*Answer_5688*>| |
Getting around| | D2.1 Standing for long periods such as 30 minutes?| <*Answer_5689*>| D2.2 Standing up from sitting
down?| <*Answer_5690*>| D2.3 Moving around inside your home?| <*Answer_5691*>| D2.4 Getting out of your home?| <*Answer_5692*>| D2.5 Walking a long distance such as a kilometer [or
|
