This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.
Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please select only one response.
General Information
Understanding and Communicating
Getting Around
Self-Care
Getting Along with People
Life Activities
If you work or go to school, complete questions below. Otherwise, skip to Participation in Society section.
Participation in Society
