In general, how would you rate your health today?
Overall in the last 30 days, how much difficulty did you have with work or household activities?
Overall in the last 30 days how much difficulty did you have with moving around?
In the last 30 days, how much difficulty did you have in vigorous activities, such as running 3km (or equivalent) or cycling?
Overall in the last 30 days, how much difficulty did you have with self-care, such as washing or dressing yourself?
In the last 30 days, how much difficulty did you have in taking care of and maintaining your general appearance (e.g. grooming, looking neat and tidy etc.)
Overall in the last 30 days, how much of bodily aches or pains did you have?
In the last 30 days, how much bodily discomfort did you have?
Overall in the last 30 days, how much difficulty did you have with concentrating or remembering things?
In the last 30 days, how much difficulty did you have in learning a new task (for example, learning how to get to a new place, learning a new game, learning a new recipe etc.)?
Overall in the last 30 days, how much difficulty did you have with personal relationship or participation in the community?
In the last 30 days, how much difficulty did you have in dealing with conflicts and tensions with others?
Do you wear glasses or contact lenses?
In the last 30 days, how much difficulty did you have in Seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters)?
In the last 30 days, how much difficulty did you have in seeing and recognizing an object at arm’s length or in reading?
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