SH. FUNCIONALITY AND HELP

SH. FUNCIONALITY AND HELP for MHAS 2015 Exit

Start of SH. FUNCIONALITY AND HELP

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SH1
Due to health problems, did someone used to help (NAME) with at least one activity such as walking across a room, bathing or showering, eating, such as cutting his/her food, getting in or out of bed, using the toilet, including getting on and off the toil

DUE TO HEALTH PROBLEMS, DID SOMEONE USED TO HELP (NAME) WITH AT LEAST ONE ACTIVITY SUCH AS WALKING ACROSS A ROOM, BATHING OR SHOWERING, EATING, SUCH AS CUTTING HIS/HER FOOD, GETTING IN OR OUT OF BED, USING THE TOILET, INCLUDING GETTING ON AND OFF THE TOILET OR SQUATTING?

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1 Yes
2 No
3 Couldn't do those activities
4 Didn't do those activities
8 RF
9 DK

If Due to health problems, did someone used to help (NAME) with at least one activity such as walking across a room, bathing or showering, eating, such as cutting his/her food, getting in or out of bed, using the toilet, including getting on and off the toil (SH1) = 1 Yes or Due to health problems, did someone used to help (NAME) with at least one activity such as walking across a room, bathing or showering, eating, such as cutting his/her food, getting in or out of bed, using the toilet, including getting on and off the toil (SH1) = 3 Couldn't do those activities or Due to health problems, did someone used to help (NAME) with at least one activity such as walking across a room, bathing or showering, eating, such as cutting his/her food, getting in or out of bed, using the toilet, including getting on and off the toil (SH1) = 4 Didn't do those activities »

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SH2
Please tell me who helped (NAME) with these activities.

PLEASE TELL ME WHO HELPED (NAME) WITH THESE ACTIVITIES.
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1_____ Name

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SH3
If the person is included in any roster, note the corresponding registration number. If it's a child in law or a grandchild, note the registration number to whom he/she is related. If person is not in any roster, record 666

IF THE PERSON IS INCLUDED IN ANY ROSTER, NOTE THE CORRESPONDING REGISTRATION NUMBER. IF IT'S A CHILD IN LAW OR A GRANDCHILD, NOTE THE REGISTRATION NUMBER TO WHOM HE/SHE IS RELATED. IF PERSON IS NOT IN ANY ROSTER, RECORD 666
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1_____ REGISTRATION NUMBER

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SH4
What relationship did (NAME OF PERSON WHO HELPED) have to (NAME)?

WHAT RELATIONSHIP DID (NAME OF PERSON WHO HELPED) HAVE TO (NAME)?
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01 Spouse
02 Child
03 Child in law
04 Grandchild
05 Parent
06 Other relative
07 Other person
08 Paid person
88 RF
99 DK

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SH5
During the last month of his/her life, about how many days did he/she help (NAME)?

DURING THE LAST MONTH OF HIS/HER LIFE, ABOUT HOW MANY DAYS DID HE/SHE HELP (NAME)?
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1_____ Days
30 Everyday

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SH6
On those days that he/she helped (NAME), about how many hours per day did he/ she help?

ON THOSE DAYS THAT HE/SHE HELPED (NAME), ABOUT HOW MANY HOURS PER DAY DID HE/ SHE HELP?
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_____ Hours
01 Less than one hour

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SH7
Now I will mention other activities with which people may have problems due to a physical, mental, emotional or memory related problem. Please tell me about the help that (NAME) received in the LAST THREE MONTHS BEFORE HIS/HER DEATH. Due to a health probl

NOW I WILL MENTION OTHER ACTIVITIES WITH WHICH PEOPLE MAY HAVE PROBLEMS DUE TO A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY RELATED PROBLEM. PLEASE TELL ME ABOUT THE HELP THAT (NAME) RECEIVED IN THE LAST THREE MONTHS BEFORE HIS/HER DEATH. DUE TO A HEALTH PROBLEM, DID SOMEONE HELP (NAME) WITH AT LEAST ONE ACTIVITY SUCH AS PREPARING A HOT MEAL, MAKING PURCHASES/SHOPPING, TAKING HIS/HER MEDICATIONS (IF SOME ARE TAKEN), MANAGING HIS/HER MONEY
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1 Yes
2 No
3 Couldn't do those activities
4 Didn't do those activities
8 RF
9 DK

If Now I will mention other activities with which people may have problems due to a physical, mental, emotional or memory related problem. Please tell me about the help that (NAME) received in the LAST THREE MONTHS BEFORE HIS/HER DEATH. Due to a health probl (SH7) = 1 Yes or Now I will mention other activities with which people may have problems due to a physical, mental, emotional or memory related problem. Please tell me about the help that (NAME) received in the LAST THREE MONTHS BEFORE HIS/HER DEATH. Due to a health probl (SH7) = 3 Couldn't do those activities or Now I will mention other activities with which people may have problems due to a physical, mental, emotional or memory related problem. Please tell me about the help that (NAME) received in the LAST THREE MONTHS BEFORE HIS/HER DEATH. Due to a health probl (SH7) = 4 Didn't do those activities »

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SH8
Please tell me who helped (NAME) with these activities.

PLEASE TELL ME WHO HELPED (NAME) WITH THESE ACTIVITIES.

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SH9
If the person is included in any roster, note the registration number If it's a child in law or a grandchild, note the registration number to whom he/she is related. If person is not in any roster, record 666

IF THE PERSON IS INCLUDED IN ANY ROSTER, NOTE THE REGISTRATION NUMBER IF IT'S A CHILD IN LAW OR A GRANDCHILD, NOTE THE REGISTRATION NUMBER TO WHOM HE/SHE IS RELATED. IF PERSON IS NOT IN ANY ROSTER, RECORD 666

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1_____ REGISTRATION NUMBER

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SH10
What relationship did (NAME OF PERSON WHO HELPED) have to (NAME)?

WHAT RELATIONSHIP DID (NAME OF PERSON WHO HELPED) HAVE TO (NAME)?
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01 Spouse
02 Child
03 Child in law
04 Grandchild
05 Parent
06 Other relative
07 Other person
08 Paid person
88 RF
99 DK

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SH11
During the last month of his/her life, about how many days did he/she help (NAME)?

DURING THE LAST MONTH OF HIS/HER LIFE, ABOUT HOW MANY DAYS DID HE/SHE HELP (NAME)?
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_____ Days
30 Everyday

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SH12
On those days that he/she helped (NAME), about how many hours per day did he/ she help?

ON THOSE DAYS THAT HE/SHE HELPED (NAME), ABOUT HOW MANY HOURS PER DAY DID HE/ SHE HELP?
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_____ Hours
01 Less than one hour

End of SH. FUNCIONALITY AND HELP