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n.>\r\n| \r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| \r\n| MRC Grade <-Total->\r\n| \r\n| \r\n|Questions and
Answers:\r\n| \r\n| 1. Are you ever troubled by breathlessness except on strenuous \r\n| exertion?\r\n| <*Answer_8974*>\r\n| 2. Are you short of breath when hurrying on the level or walking up\r\n| a slight hill?\r\
n| <*Answer_8975*>\r\n| 3. Do you have to walk slower than most people on the level? -or-\r\n| Do you have to stop after a mile or so (or after 1\/4 hour) on the \r\n| level at your own pace?\r\n| <*Answer_8976*>\
r\n| 4. Do you have to stop for breath after walking about 100 yds. (or \r\n| after a few minutes) on the level?\r\n| <*Answer_8977*>\r\n| 5. Are you too breathless to leave the house, or breathless after \r\n| undre
ssing?\r\n| <*Answer_8978*>\r\n| \r\n|Information contained in this note is based on a self-report assessment \r\n|and is not sufficient to use alone for diagnostic purposes. Assessment \r\n|results should be verified for accuracy an
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