Overall, how much difficulty would a person in this state have with selfcare, such as washing or dressing himself / herself?
Overall, how much difficulty would a person in this state have with moving around?
Overall, how much of bodily aches and pains would a person in this state have?
Overall, how much difficulty would a person in this state have with selfcare, such as washing or dressing himself / herself?
Overall, how much difficulty would a person in this state have with concentrating or remembering things?
Overall, how much of a problem would a person in this state have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?
Was it due to
Provide details of events that led to the injury. What was the mechanism or cause of injury?
Where did the injury occur?
Did the deceased report / experience chest pain lasting less than 24 hrs in the month preceding the death?
Did the deceased experience paralysis of any part of the body in the month preceding death?
If yes, was the paralysis accompanied or followed by sudden loss of consciousness?
Did the deceased have a cough that lasted more than 3 weeks?
If yes, was there blood in the sputum ?
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