AnyQuest for Windows Questionnaire Definition File Version 2.36*;* -* 4aX\\  "Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l"Arial l8**,..Quality of Well-Being Scale, Self-AdministeredQWB-SAEnglish1.04 e 1@*/V^*r*j+uX*This survey asks about health problems that you have experienced in the last 3 days, not including today. Please answer all questions by ticking the appropriate answer field. Quality of Well-Being ScaleNeue Erklaerung Teil 2x*r0*r*j+uX* Acute and Chronic Symptoms Part INeue Erklaerung Teil 2*r*r*j+uX*4blindness or severely impaired vision in both eyes? Do you have...Neue Erklaerung Teil 2*( }*'dYes1*v(}*XdNo0*|D*3cdI cannot answer this question0*|D*3cd$I don't want to answer this question0*r,*r*j+uX*7blindness or severely impaired vision in only one eye? Do you have...Neue Erklaerung Teil 2H*( }L*'dYes1T*v(}X*XdNo0*|D*3cdI cannot answer this question0P*|Dx*3cd$I don't want to answer this question0t*r*r8*j +uX*Espeech problems such as stuttering or being unable to speak clearly? Do you have...Neue Erklaerung Teil 2*( }*'dYes1T*v(}X*XdNo0*|Dl*3cdI cannot answer this question0*|Dt*3cd$I don't want to answer this question0*rH*r\ *j +uX*1missing or paralyzed hands, feet, arms, or legs? Do you have...Neue Erklaerung Teil 2h*( }*'dYes1*v(}*XdNo0T *|Dt *3cdI cannot answer this question0 *|D| *3cd$I don't want to answer this question0*r*r*j+uX*&missing or paralyzed fingers or toes? Do you have...Neue Erklaerung Teil 2*( }`*'dYes1*v(}*XdNo0*|D*3cdI cannot answer this question0 *|D*3cd$I don't want to answer this question0d8r8r8j+uX*_any deformity of the face, fingers, hand or arm, foot or leg, or back (e.g. severe scoliosis)? Do you have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo08|D 83cdI cannot answer this question0,8|D 83cd$I don't want to answer this question08r8rT8j+uX*(general fatigue, tiredness, or weakness? Do you have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo08|D883cdI cannot answer this question08|D83cd$I don't want to answer this question08rX8r8j +uX*4a problem with unwanted weight gain or weight loss? Do you have...Neue Erklaerung Teil 208( }48'dYes18v(}8XdNo08|D 83cdI cannot answer this question0|8|D83cd$I don't want to answer this question0X 8r`8r8j!$+uX*+a problem with being under or over weight? Do you have...Neue Erklaerung Teil 2|8( }8'dYes18v(}8XdNo0D8|D83cdI cannot answer this question08|D83cd$I don't want to answer this question0D8r8r8j%(+uX*-a problem with chewing your food adequately? Do you have...Neue Erklaerung Teil 28 8( }< 8'dYes1H 8v(}L 8XdNo0 8|D 83cdI cannot answer this question08|DX 83cd$I don't want to answer this question08rD8rX8j),+uX*any hearing loss or deafness? Do you have...Neue Erklaerung Teil 2 8( }$8'dYes1t8v(}x8XdNo08|D83cdI cannot answer this question0h8|D83cd$I don't want to answer this question0*r*r*j-0+uX*dany noticeable skin problems, such as bad acne or large burns or scars on face, body, arms, or legs? Do you have...Neue Erklaerung Teil 2T*( }*'dYes1*v(}*XdNo0*|D*3cdI cannot answer this question0 *|D*3cd$I don't want to answer this question08r 8r 8j14+uX*!eczema or burning / itching rash? Do you have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo0P 8|Dp83cdI cannot answer this question08|D83cd$I don't want to answer this question0DG*rrG*j+uX*EThe following questions are about health aids that you use or have.Neue Erklaerung Teil 2G*rG*r4G*j58+uX* dentures? Do you use or have...Neue Erklaerung Teil 2G*( }G*'dYes1G*v(}G*XdNo0G*|DDG*3cdI cannot answer this question0,G*|DLG*3cd$I don't want to answer this question08r8r8j9<+uX* an O2-tank? Do you use or have...Neue Erklaerung Teil 28( }8'dYes1 8v(} 8XdNo0D8|Dd83cdI cannot answer this question08|D83cd$I don't want to answer this question08r8r8j=@+uX* a prosthesis? Do you use or have...Neue Erklaerung Teil 2|8( }@8'dYes18v(}8XdNo08|D83cdI cannot answer this question0P8|D83cd$I don't want to answer this question0,8r88rP8jAD+uX*glasses? Do you use or have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo0h8|D83cdI cannot answer this question08|D 83cd$I don't want to answer this question08r8r 8jEH+uX*a hearing-aid? Do you use or have...Neue Erklaerung Teil 28( }d8'dYes18v(}8XdNo08|D<83cdI cannot answer this question08|D83cd$I don't want to answer this question08r8r8jIL+uX* a magnifier? Do you use or have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo08|D83cdI cannot answer this question08|D 83cd$I don't want to answer this question0 8r8r08jMP+uX*a brace? Do you use or have...Neue Erklaerung Teil 28( }8'dYes18v(}8XdNo0L8|Dl83cdI cannot answer this question08|D83cd$I don't want to answer this question08rrX8j+uX*CThe following questions are about problems and physical symptoms.Neue Erklaerung Teil 2 8r8rL8jQV+uX*any problems with your vision not corrected with glasses or contact lenses (such as double vision, distorted vision, flashes, or floaters)?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2d8 %ox8dNo days0 8 %qx8d Yesterday1 8%ux88d 2 days ago2 8%vx 8d 3 days ago48|DP 83cdI cannot answer this question0D8|DX 83cd$I don't want to answer this question0 G*rlG*r$ G*jW\+uX*Hany eye pain, irritation, discharge, or excessive sensitivity to light?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2G* %oxG*dNo days0G* %qxG*d Yesterday1 G*%uxG*d 2 days ago2H G*%vxG*d 3 days ago4G*|DT G*3cdI cannot answer this question0lG*|D\ G*3cd$I don't want to answer this question0 8r\ 8r 8j]b+uX* a headache?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2 8 %ox 8dNo days0( 8 %qx| 8d Yesterday1D 8%ux 8d 2 days ago28%vxT 8d 3 days ago4@8|D 83cdI cannot answer this question0`8|D83cd$I don't want to answer this question008r8r`8jch+uX*-dizziness, earache, or ringing in your ears?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2x8 %ox8dNo days08 %qx8d Yesterday148%ux@8d 2 days ago2T8%vx`8d 3 days ago4P 8|D83cdI cannot answer this question0 8|D83cd$I don't want to answer this question0|w8rw8rw8jin+uX*;difficulty hearing, or discharge, or bleeding from an ear?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2 w8 %oxw8dNo days0w8 %qxw8d Yesterday1w8%uxw8d 2 days ago2Pw8%vx\w8d 3 days ago4w8|Dw83cdI cannot answer this question0Tw8|D|w83cd$I don't want to answer this question0w8rw8rw8jot+uX*3a stuffy or runny nose, or bleeding from the nose?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2(w8 %ox$w8dNo days08w8 %qxDw8d Yesterday1w8%uxw8d 2 days ago28w8%vxDw8d 3 days ago4w8|Dw83cdI cannot answer this question0<w8|Ddw83cd$I don't want to answer this question0|w8rw8rw8juz+uX*9a sore throat, difficulty swallowing, or a hoarse voice?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2Lw8 %oxTw8dNo days0w8 %qxw8d Yesterday1w8%uxw8d 2 days ago2hw8%vxtw8d 3 days ago4w8|Dw83cdI cannot answer this question0lw8|Dw83cd$I don't want to answer this question0`w8rw8rw8j{+uX*a tooth ache or jaw ache?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2w8 %oxw8dNo days0w8 %qxw8d Yesterday1 w8%uxw8d 2 days ago2w8%vxw8d 3 days ago4 w8|D@w83cdI cannot answer this question0w8|Dw83cd$I don't want to answer this question0 w8r0 w8rl w8j+uX*'sore or bleeding lips, tongue, or gums?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2tw8 %ox|w8dNo days0 w8 %qx w8d Yesterday1 w8%ux w8d 2 days ago2 w8%vx4 w8d 3 days ago4w8|D w83cdI cannot answer this question0Dw8|D\ w83cd$I don't want to answer this question0w8rw8r, w8j+uX*coughing or wheezing?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2 w8 %oxw8dNo days0xw8 %qx,w8d Yesterday1 w8%ux w8d 2 days ago2 w8%vxh w8d 3 days ago4\ w8|D w83cdI cannot answer this question0 w8|D w83cd$I don't want to answer this question0 8r8r8j+uX*-shortness of breath or difficulty breathing?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2d8 %ox8dNo days0 8 %qx 8d Yesterday18%ux 8d 2 days ago2p8%vx8d 3 days ago48|D83cdI cannot answer this question0_*|D_*3cd$I don't want to answer this question0|o8ro8ro8j+uX*]chest pain, pressure, palpitations, fast or skipped heart beat, or other discomfort in chest?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2 o8 %oxo8dNo days0o8 %qxo8d Yesterday1o8%ux o8d 2 days ago2to8%vxo8d 3 days ago4o8|Do83cdI cannot answer this question0xo8|Do83cd$I don't want to answer this question0(o8ro8r8o8j+uX*Ban upset stomach, abdominal pain, nausea, heartburn, or vomiting?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2Po8 %oxXo8dNo days0o8 %qxo8d Yesterday1 o8%uxo8d 2 days ago2lo8%vxxo8d 3 days ago4o8|Do83cdI cannot answer this question0po8|Do83cd$I don't want to answer this question0o8r@o8r o8j+uX*}difficulty with bowel movements, diarrhea, constipation, black tar-like stools, or any pain or discomfort in the rectal area?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2Do8 %oxLo8dNo days0 o8 %qx,o8d Yesterday1o8%uxo8d 2 days ago2o8%vxo8d 3 days ago4To8|Dto83cdI cannot answer this question0o8|D o83cd$I don't want to answer this question00o8rPo8r( o8j+uX*pain, burning, blood in urine?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2 o8 %ox o8dNo days0 o8 %qx o8d Yesterday1L o8%uxX o8d 2 days ago2 o8%vx o8d 3 days ago4 o8|D@o83cdI cannot answer this question0xo8|DHo83cd$I don't want to answer this question00 o8r o8r o8j+uX*Vloss of bladder control, frequent night-time urination, or difficulty with urination?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2o8 %oxo8dNo days0 o8 %qxo8d Yesterday1 o8%ux o8d 2 days ago2Xo8%vx o8d 3 days ago4o8|Do83cdI cannot answer this question0(o8|Do83cd$I don't want to answer this question0Po8zo8ro8j+uX*genital pain, itching, burning, or abnormal discharge, or pelvic cramping or abnormal bleeding? (does not include normal menstruation)SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2o8 %oxo8dNo days0o8 %qxo8d Yesterday1o8%uxo8d 2 days ago2@ o8%vxL o8d 3 days ago4 o8|D o83cdI cannot answer this question0xo8|D o83cd$I don't want to answer this question00w8rw8rw8j+uX*Sa broken arm, wrist, foot, leg, or any other broken bone? (other than in the back)SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2w8 %oxw8dNo days0w8 %qxw8d Yesterday1w8%uxw8d 2 days ago2\w8%vxhw8d 3 days ago4w8|D w83cdI cannot answer this question0w8|Dw83cd$I don't want to answer this question0g8rg8rg8j+uX*Dpain, stiffness, cramps, weakness, or numbness in the neck or back?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2g8 %oxg8dNo days0g8 %qxg8d Yesterday1 g8%uxg8d 2 days ago2`g8%vx g8d 3 days ago4g8|Dg83cdI cannot answer this question0`g8|Dg83cd$I don't want to answer this question0g8rg8rg8j+uX*Epain, stiffness, cramps, weakness, or numbness in the hips or sides?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 24g8 %ox<g8dNo days0g8 %qxDg8d Yesterday1g8%uxg8d 2 days ago2Xg8%vxdg8d 3 days ago4g8|Dg83cdI cannot answer this question0\g8|Dg83cd$I don't want to answer this question0g8r$g8r g8j+uX*qpain, stiffness, cramps, weakness, or numbness in any of the joints or muscles of the hand, feet, arms or legs?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 20g8 %ox8g8dNo days0g8 %qx@g8d Yesterday1`g8%uxlg8d 2 days ago2g8%vxg8d 3 days ago44g8|DTg83cdI cannot answer this question0g8|Dg83cd$I don't want to answer this question00g8r( g8rdg8j+uX*1swelling of the ankles, hands, feet, or abdomen?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2g8 %oxg8dNo days0g8 %qx g8d Yesterday1 g8%ux g8d 2 days ago2 g8%vx g8d 3 days ago44g8|DTg83cdI cannot answer this question0Xg8|D\g83cd$I don't want to answer this question0 g8rg8r<g8j+uX*fever, chills, or sweats?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2g8 %oxg8dNo days0g8 %qxg8d Yesterday1Dg8%uxPg8d 2 days ago2g8%vxg8d 3 days ago4 g8|D8 g83cdI cannot answer this question0 g8|D g83cd$I don't want to answer this question0w8rw8rw8j+uX*.loss of consciousness, fainting, or seizures?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2w8 %oxw8dNo days0$w8 %qx0w8d Yesterday1Tw8%uxDw8d 2 days ago2$ w8%vxpw8d 3 days ago4w8|D0 w83cdI cannot answer this question04w8|D w83cd$I don't want to answer this question0 g8r$ g8r g8j+uX*4difficulty with your balance, standing, or walking?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2g8 %oxg8dNo days0 g8 %qx g8d Yesterday1l g8%uxx g8d 2 days ago2Tg8%vx g8d 3 days ago4g8|D`g83cdI cannot answer this question0g8|D g83cd$I don't want to answer this question0|_8rr_8j+uX*LThe following questions are about your feelings, thoughts, and behaviours.Neue Erklaerung Teil 2@_8r_8rl_8j+uX**trouble falling asleep or staying asleep?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2_8 %ox,_8dNo days0d_8 %qx_8d Yesterday1_8%ux_8d 2 days ago2 _8%vx,_8d 3 days ago4_8|D_83cdI cannot answer this question0_8|D0_83cd$I don't want to answer this question0@_8rd_8r_8j+uX*#spells of feeling nervous or shaky?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2_8 %ox_8dNo days0\_8 %qxh_8d Yesterday1_8%ux_8d 2 days ago2_8%vx(_8d 3 days ago4_8|D_83cdI cannot answer this question0 _8|DH_83cd$I don't want to answer this question0P_8r_8r_8j+uX*/spells of feeling upset, downhearted, or blue?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2_8 %ox,_8dNo days0_8 %qx_8d Yesterday1_8%ux_8d 2 days ago2@_8%vxL_8d 3 days ago4_8|D_83cdI cannot answer this question0D_8|Dl_83cd$I don't want to answer this question0`_8r _8r _8j+uX*excessive worry or anxiety?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2_8 %ox_8dNo days0 _8 %qx _8d Yesterday1( _8%ux4 _8d 2 days ago2 _8%vx _8d 3 days ago4 _8|D _83cdI cannot answer this question0 _8|D _83cd$I don't want to answer this question0_8r_8rD_8j+uX*?feelings that you had little control over events in your life?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2l_8 %ox$_8dNo days0H_8 %qxt_8d Yesterday1`_8%ux_8d 2 days ago28 _8%vx\_8d 3 days ago4 _8|D _83cdI cannot answer this question0p_8|D _83cd$I don't want to answer this question00g8r@g8rxg8j +uX*%feelings of being lonely or isolated?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2g8 %oxg8dNo days0g8 %qxg8d Yesterday10g8%ux<g8d 2 days ago28%vx8d 3 days ago48|D483cdI cannot answer this question08|D83cd$I don't want to answer this question0,8r8rt8j +uX*Efeelings of frustration, irritation, or close to losing your temper?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 28 %ox8dNo days0t8 %qxp8d Yesterday1| 8%ux8d 2 days ago2 8%vx8d 3 days ago4@ 8|D83cdI cannot answer this question08|D 83cd$I don't want to answer this question0W8rW8rW8j+uX* a hangover?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2W8 %oxW8dNo days0W8 %qxW8d Yesterday1W8%uxW8d 2 days ago2$W8%vx W8d 3 days ago4W8|DW83cdI cannot answer this question0$W8|DLW83cd$I don't want to answer this question0LW8rW8rW8j+uX*0any decrease of sexual interest or performance?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2W8 %oxW8dNo days0W8 %qxW8d Yesterday1W8%uxW8d 2 days ago2W8%vxW8d 3 days ago4|W8|DW83cdI cannot answer this question0 W8|D4W83cd$I don't want to answer this question0LW8rW8rW8j"+uX*[confusion, difficulty understanding the written or spoken word, or significant memory loss?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2<W8 %oxDW8dNo days0W8 %qxW8d Yesterday1W8%uxW8d 2 days ago2XW8%vxdW8d 3 days ago4W8|DW83cdI cannot answer this question0\W8|DW83cd$I don't want to answer this question0`W8rL W8rW8j#(+uX*6thoughts or images you couldnt get out of your mind?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2W8 %oxW8dNo days0 W8 %qxtW8d Yesterday1 W8%ux W8d 2 days ago2 W8%vx W8d 3 days ago48W8|DXW83cdI cannot answer this question0W8|D`W83cd$I don't want to answer this question0 W8rW8rW8j).+uX*to take any medication including over-the-counter remedies (aspirin / tylenol, allergy medications, insulin, hormones, estrogen, thyroid, prednisone)?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2W8 %oxW8dNo days0W8 %qxW8d Yesterday1 W8%ux,W8d 2 days ago2W8%vxW8d 3 days ago4W8|DW83cdI cannot answer this question0W8|D\W83cd$I don't want to answer this question0DG*rG*rXG*j/4+uX*;to stay on a medically prescribed diet for health reasons?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2` G* %oxG*dNo days0G* %qxpG*d Yesterday1G*%uxG*d 2 days ago2 +%vx +d 3 days ago4h +|D +3cdI cannot answer this question0 +|D+3cd$I don't want to answer this question0 W8r0 W8r, W8j5:+uX*"a loss of appetite or over-eating?SIn which days (if any) over the past 3 days, not including today, did you have...Neue Erklaerung Teil 2W8 %oxW8dNo days0l W8 %qxx W8d Yesterday1 W8%ux W8d 2 days ago2 W8%vx W8d 3 days ago4XW8|D W83cdI cannot answer this question0W8|D W83cd$I don't want to answer this question00g8r|g8rg8j;<+uX*Hany symptoms, health complaints, or pains that have not been mentioned?& In the last 7 days, did you have...Neue Erklaerung Teil 2g8( }g8'dYes1g8v(}hg8XdNo0O8q(dO8rO8j=BuX*0What were they and which days did you have them?iSymptoms, health complaints or pains you had during the last 7 days that have not been mentioned yet...Neue Erklaerung Teil 2 O8?! O85r[d Symptoms:S1:lO8=*SxO83 Vrd Symptoms: S2:O8qO8rdDays: D1:4O8n*S<O8 rdDays: D2:O8w?O83cdI cannot answer this question0O8w?DO83cd$I don't want to answer this question0v65 0 = nottzigfhlung, berhaupt nicht gut gewesen. Auerdem den ganzen Tag lang rumgehangen. Dingdongdudeldei. d teeth, Kotzigfhlung, berhaupt nicht gut gewesen. Auerdem den ganzen Tag lang rumgehangen. Dingdongdudeldei. , ( $ O8rO8rxO8j+uX* Self Care Part IINeue Erklaerung Teil 2PO8r` O8rO8jCH+uX*hspend any part of the day or night as a patient in a hospital, nursing home, or rehabilitation center?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2TO8 %oxO8dNo days0O8 %qxO8d Yesterday1PO8%uxO8d 2 days ago2|O8%vx`O8d 3 days ago4O8|DO83cdI cannot answer this question0lO8|D O83cd$I don't want to answer this question0l O8r O8rO8jIN+uX*ineed help with your personal care needs such as eating, dressing, bathing, or getting around your home?|In which days (if any) over the past 3 days, not including today, because of any impairment or health problem, did you...Neue Erklaerung Teil 2xO8 %oxO8dNo days0D O8 %qx O8d Yesterday1 O8%ux O8d 2 days ago2 O8%vx O8d 3 days ago4O8|D O83cdI cannot answer this question0<O8|DL O83cd$I don't want to answer this question0W8rW8rW8jOT+uX*drive a motor vehicle?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 28W8 %ox@W8dNo days0`W8 %qxTW8d Yesterday1W8%uxtW8d 2 days ago2W8%vx| W8d 3 days ago4|W8|D W83cdI cannot answer this question08G*|D`G*3cd$I don't want to answer this question0o8r(o8rxo8jUZ+uX*Ouse public transportation such as a bus, subway, Medi-van, train, or airplane?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2$ o8 %ox, o8dNo days0o8 %qxo8d Yesterday1po8%ux|o8d 2 days ago2 8%vx 8d 3 days ago4x8|D 83cdI cannot answer this question08|D( 83cd$I don't want to answer this question0O8r O8r`O8j[`+uX*either not drive a motor vehicle or not use public transportation because of your health, or need help from another person to use?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2O8 %oxO8dNo days0O8 %qxO8d Yesterday1hO8%uxO8d 2 days ago2 O8%vxO8d 3 days ago4P O8|Dp O83cdI cannot answer this question0O8|Dx O83cd$I don't want to answer this question0`G8rtG8rG8j+uX* Physical Activity Part IVNeue Erklaerung Teil 2l G8rG8r G8jaf+uX*Bhave trouble climbing stairs or inclines or walking off the curb?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2d G8 %oxG8dNo days0TG8 %qxp G8d Yesterday1G8%uxG8d 2 days ago2 G8%vxG8d 3 days ago4lG8|DG83cdI cannot answer this question0G8|DG83cd$I don't want to answer this question0@G8rG8rG8jgl+uX*Uavoid walking, have trouble walking, or walk more slowly than other people your age?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2G8 %oxG8dNo days0tG8 %qxG8d Yesterday1G8%uxG8d 2 days ago24G8%vx@G8d 3 days ago4G8|DG83cdI cannot answer this question08G8|D`G83cd$I don't want to answer this question0<G8rG8rhG8jmr+uX*(limp or use a cane, crutches or walker?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2dG8 %oxlG8dNo days0G8 %qxG8d Yesterday1 G8%ux,G8d 2 days ago2G8%vxG8d 3 days ago4G8|DG83cdI cannot answer this question0G8|DG83cd$I don't want to answer this question0 G8r G8rG8jsx+uX*;avoid or have trouble bending over, stooping, or kneeling?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2G8 %oxG8dNo days00G8 %qxG8d Yesterday1G8%uxG8d 2 days ago2G8%vxG8d 3 days ago4LG8|DlG83cdI cannot answer this question0G8|DG83cd$I don't want to answer this question0 G8rTG8rG8jy~+uX*_have any trouble lifting or carrying everyday objects such as books, a briefcase, or groceries?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2@G8 %oxG8dNo days0XG8 %qxdG8d Yesterday1G8%uxlG8d 2 days ago2G8%vxG8d 3 days ago4(G8|DG83cdI cannot answer this question0G8|DG83cd$I don't want to answer this question0|O8rO8rO8j+uX*2have any other limitations in physical movements?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2O8 %oxO8dNo days0O8 %qxO8d Yesterday1(O8%ux O8d 2 days ago2O8%vxO8d 3 days ago4O8|DO83cdI cannot answer this question0O8|DO83cd$I don't want to answer this question0<_8r_8r|_8j+uX*Rspend all or most of the day in a bed, chair, or couch because of health reasons?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2<_8 %ox_8dNo days0_8 %qx_8d Yesterday1_8%ux$_8d 2 days ago2_8%vx@_8d 3 days ago4@_8|D _83cdI cannot answer this question0W8|D`W83cd$I don't want to answer this question00O8rO8r O8j+uX*/spend all or most of the day in a wheel chair?NIn which days (if any) over the past 3 days, not including today, did you...Neue Erklaerung Teil 2`O8 %oxhO8dNo days08 O8 %qxD O8d Yesterday1X O8%uxd O8d 2 days ago2 O8%vx O8d 3 days ago4O8|D O83cdI cannot answer this question0O8|D O83cd$I don't want to answer this question0|?8r?8r?8j+uX*6someone else control the movement of your wheelchair?JIn which days (if any) over the past 3 days, not including today, did...Neue Erklaerung Teil 2?8 %ox ?8dNo days0?8 %qx?8d Yesterday1?8%ux?8d 2 days ago2@?8%vxL?8d 3 days ago4?8|D?83cdI cannot answer this question0D?8|Dl?83cd$I don't want to answer this question0?8r?8r?8j+uX* Usual Activity Part VNeue Erklaerung Teil 2?8r|?8r?8j+uX*wavoid, need help with, or feel limited in doing some of your usual activities, such as work, school, or housekeeping?zOver the past 3 days, not including today, because of any physical or emotional health reasons, on which days did you...Neue Erklaerung Teil 2x?8 %ox?8dNo days0?8 %qx?8d Yesterday1(?8%ux4?8d 2 days ago2?8%vx?8d 3 days ago4?8|D?83cdI cannot answer this question0p?8|D?83cd$I don't want to answer this question0?8 z`?8r` ?8j+uX*avoid or feel limited in doing some of your usual activities, such as visiting family or friends, hobbies, shopping, recreational, or religious activities?zOver the past 3 days, not including today, because of any physical or emotional health reasons, on which days did you...Neue Erklaerung Teil 2 ?8 %ox ?8dNo days0 ?8 %qx ?8d Yesterday1P?8%ux\?8d 2 days ago2?8%vx?8d 3 days ago4?8|D?83cdI cannot answer this question0?8|D?83cd$I don't want to answer this question0?8rD?8r ?8j+uX*have to change any of your plans or activities because of your health (consider only activities that you did not report in the last 2 questions)zOver the past 3 days, not including today, because of any physical or emotional health reasons, on which days did you...Neue Erklaerung Teil 2$ ?8 %ox ?8dNo days0< ?8 %qxH ?8d Yesterday1 ?8%ux\ ?8d 2 days ago2?8%vx?8d 3 days ago4?8|D?83cdI cannot answer this question0?8|D?83cd$I don't want to answer this question0 ?8rrh ?8j+uX*"Would you say that your health is:Neue Erklaerung Teil 2h?8%&x( ?8Ad Excellent100,000 ?8%x< ?82d Very good75,00 ?8%x ?8qdGood50,00 ?8h%x?8NdFair25,00?8F%x?8)dPoor0?8|DP?83cdI cannot answer this question0`?8|D?83cd$I don't want to answer this question078rrd78j"uX*ICompared to one year ago, how would you rate your health in general now?Neue Erklaerung Teil 278 78 dMuch better now than 1 year ago100,00$78 9H78 Gd#Somewhat better now than 1 year ago75,0078r78d dAbout the same as 1 year ago50,0078<78  d"Somewhat worse now than 1 year ago25,00786^78( ldMuch worse now than 1 year ago078|D4783cdI cannot answer this question078|D783cd$I don't want to answer this question0X78qrT78j g"uX*Think of a scale of 0 to 100, with zero being the least desirable state of health that you could imagine and 100 being perfect health. What number, from 0 to 100 would you give to the state of your health, on average, over the past 3 days?Neue Erklaerung Teil 278!lr78$id00`78rd78d1010788r782d202078Nr78Td3030h78rl78d404078er78bd5050H78rL78d6060781r78-d707078Ir78Nd8080878r<78d909078`r78[d10010078|D783cdI cannot answer this question100`78|D783cd$I don't want to answer this question100x78qgrT78jg"uX*What is your sex?Neue Erklaerung Teil 2 78t78 dMale1 78" 78 -dFemale2t 78|D 783cdI cannot answer this question100 78|D 783cd$I don't want to answer this question10078qgrX78jY"uX*What is your ethnicity?Neue Erklaerung Teil 278j78NdAfrican American1 78j78P-dAsian / Pacific Islands2 78Mls$78P>dCaucasian - Non Hispanic3l78l78PdHispanic4 78l 78P-dNative American5, 78Jls 78P>dOther6 78|D 783cdI cannot answer this question100l 78|D 783cd$I don't want to answer this question100g8qrXlg8jT"uX*BWhich of the following best describes your educational background?Neue Erklaerung Teil 2g8g8d8th Grade Graduate1g8g8-dHigh School Graduate2g8Msg8>d Some College3g8ug8d&College Graduate (B.S. or B.A. degree)4$8<8-dSome Graduate School5p_8Ls _8>d+Completed Post-Graduate (M.A., M.D., Ph.D.)6_8|D_83cdI cannot answer this question100(_8|D_83cd$I don't want to answer this question100_8------CPX1?uX*v3 0.523 * v4 0.358 * v5 0.358 * v6 0.423 * v7 0.297 * v8 0.408 * v9 0.256 * v10 0.233 * v11 0.225 * v12 0.204 * v13 0.274 * v14 0.187 * v15 0.187 * v17 0.153 * v20 0.066 * v21 0.148 * 16 maxdO8------ CPX2YESTERDAY?uX*v25 1 and 0.293 * v26 1 and 0.389 * v27 1 and 0.189 * v28 1 and 0.299 * v29 1 and 0.350 * v30 1 and 0.178 * v31 1 and 0.204 * v32 1 and 0.298 * v33 1 and 0.271 * v34 1 and 0.386 * v35 1 and 0.208 * v36 1 and 0.343 * v37 1 and 0.260 * v38 1 and 0.278 * v39 1 and 0.424 * v40 1 and 0.259 * v41 1 and 0.369 * v42 1 and 0.365 * v43 1 and 0.318 * v44 1 and 0.365 * v45 1 and 0.318 * v46 1 and 0.306 * v47 1 and 0.320 * v48 1 and 0.517 * v49 1 and 0.377 * 25 maxG8------ CPX22DAYSAGO?uX*v25 2 and 0.293 * v26 2 and 0.389 * v27 2 and 0.189 * v28 2 and 0.299 * v29 2 and 0.350 * v30 2 and 0.178 * v31 2 and 0.204 * v32 2 and 0.298 * v33 2 and 0.271 * v34 2 and 0.386 * v35 2 and 0.208 * v36 2 and 0.343 * v37 2 and 0.260 * v38 2 and 0.278 * v39 2 and 0.424 * v40 2 and 0.259 * v41 2 and 0.369 * v42 2 and 0.365 * v43 2 and 0.318 * v44 2 and 0.365 * v45 2 and 0.318 * v46 2 and 0.306 * v47 2 and 0.320 * v48 2 and 0.517 * v49 2 and 0.377 * 25 max 2 / 8------ CPX23DAYSAGO?uX*v25 4 and 0.293 * v26 4 and 0.389 * v27 4 and 0.189 * v28 4 and 0.299 * v29 4 and 0.350 * v30 4 and 0.178 * v31 4 and 0.204 * v32 4 and 0.298 * v33 4 and 0.271 * v34 4 and 0.386 * v35 4 and 0.208 * v36 4 and 0.343 * v37 4 and 0.260 * v38 4 and 0.278 * v39 4 and 0.424 * v40 4 and 0.259 * v41 4 and 0.369 * v42 4 and 0.365 * v43 4 and 0.318 * v44 4 and 0.365 * v45 4 and 0.318 * v46 4 and 0.306 * v47 4 and 0.320 * v48 4 and 0.517 * v49 4 and 0.377 * 25 max 4 /8------ CPX3YESTERDAY?uX*v51 1 and 0.296 * v52 1 and 0.286 * v53 1 and 0.327 * v54 1 and 0.324 * v55 1 and 0.430 * v56 1 and 0.311 * v57 1 and 0.378 * v58 1 and 0.297 * v59 1 and 0.307 * v60 1 and 0.559 * v61 1 and 0.255 * v62 1 and 0.160 * v63 1 and 0.201 * v64 1 and 0.223 * 14 max8------ CPX32DAYSAGO?uX*v51 2 and 0.296 * v52 2 and 0.286 * v53 2 and 0.327 * v54 2 and 0.324 * v55 2 and 0.430 * v56 2 and 0.311 * v57 2 and 0.378 * v58 2 and 0.297 * v59 2 and 0.307 * v60 2 and 0.559 * v61 2 and 0.255 * v62 2 and 0.160 * v63 2 and 0.201 * v64 2 and 0.223 * 14 max 2 /8------ CPX33DAYSAGO?uX*v51 4 and 0.296 * v52 4 and 0.286 * v53 4 and 0.327 * v54 4 and 0.324 * v55 4 and 0.430 * v56 4 and 0.311 * v57 4 and 0.378 * v58 4 and 0.297 * v59 4 and 0.307 * v60 4 and 0.559 * v61 4 and 0.255 * v62 4 and 0.160 * v63 4 and 0.201 * v64 4 and 0.223 * 14 max 4 / 8------Q4A.Last 7 days: Symptoms not yet mentioned? (Q4A)uX*y65 8------Q4B Provided symptoms and days (Q4B)uX*a66 8------CPXYESTE?uX*1 fn 2 fn 5 fn 3 max 8------ CPX2DAYSAGO?uX*1 fn 3 fn 6 fn 3 maxD 8------ CPX3DAYSAGO?uX*1 fn 4 fn 7 fn 3 maxt 8------MOBYESTE?uX*)v68 1 and 0.089 * v72 1 and 0.031 * 2 max 8------ MOB2DAYSAGO?uX*-v68 2 and 0.089 * v72 2 and 0.031 * 2 max 2 /, 8------ MOB3DAYSAGO?uX*-v68 4 and 0.089 * v72 4 and 0.031 * 2 max 4 / 8------PACYESTE?uX*v74 1 and 0.072 * v75 1 and 0.072 * v76 1 and 0.072 * v77 1 and 0.072 * v78 1 and 0.072 * v79 1 and 0.072 * v80 1 and 0.163 * v81 1 and 0.102 * v82 1 and 0.163 * 9 max 8------ PAC2DAYSAGO?uX*v74 2 and 0.072 * v75 2 and 0.072 * v76 2 and 0.072 * v77 2 and 0.072 * v78 2 and 0.072 * v79 2 and 0.072 * v80 2 and 0.163 * v81 2 and 0.102 * v82 2 and 0.163 * 9 max 2 /48------ PAC3DAYSAGO?uX*v74 4 and 0.072 * v75 4 and 0.072 * v76 4 and 0.072 * v77 4 and 0.072 * v78 4 and 0.072 * v79 4 and 0.072 * v80 4 and 0.163 * v81 4 and 0.102 * v82 4 and 0.163 * 9 max 4 /8------SACYESTE?uX*Ov69 1 and 0.096 * v84 1 and 0.054 * v85 1 and 0.054 * v86 1 and 0.054 * 4 max,8------ SAC2DAYSAGO?uX*Sv69 2 and 0.096 * v84 2 and 0.054 * v85 2 and 0.054 * v86 2 and 0.054 * 4 max 2 /8------ SAC3DAYSAGO?uX*Sv69 4 and 0.096 * v84 4 and 0.054 * v85 4 and 0.054 * v86 4 and 0.054 * 4 max 4 /|8------CPX3DAY%CPX average for last 3 days (CPX3DAY)CPX3DAY?uX*10 fn 11 fn 12 fn 3 avg8------MOB3DAY%MOB average for last 3 days (MOB3DAY)MOB3DAY?uX*13 fn 14 fn 15 fn 3 avg8------PAC3DAY%PAC average for last 3 days (PAC3DAY)PAC3DAY?uX*16 fn 17 fn 18 fn 3 avg 8------SAC3DAY