P-IM1. In the last 12 months, did you visit your personal doctor for care?
1__ Yes
2__ No → If No, go to core question 17 |
After core question 16
Note: Use P-IM1 if using P-IM2-IM9
|
P-IM2. In the last 12 months, when you visited your personal doctor's office, how often were you examined on the examination table?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM1
Note: Use with P-IM1
|
P-IM3. In the last 12 months, when you visited your personal doctor's office, how often did someone weigh you?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM2
Note: Use with P-IM1
|
P-IM4. In the last 12 months, when you visited your personal doctor's office, did you try to use the restroom?
1__ Yes
2__ No → If No, go to P-IM6 |
After P-IM3
Note: Use with P-IM1
|
P-IM5. In the last 12 months, how often was it easy to move around the restroom at your personal doctor's office?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM4
Note: Use with P-IM4
|
P-IM6. In the last 12 months, how often did pain limit your ability to do the things you needed to do?
1__ Never → If Never, go to P-IM8
2__ Sometimes
3__ Usually
4__ Always |
After P-IM5
Note: Use with P-IM1
|
P-IM7. In the last 12 months, did your personal doctor ask about the impact of pain on your life?
1__ Yes
2__ No |
After P-IM6
Note: Use with P-IM6
|
P-IM8. In the last 12 months, how often did fatigue limit your ability to do the things you needed to do?
1__ Never → If Never, go to core question 17
2__ Sometimes
3__ Usually
4__ Always |
After P-IM7
Note: Use with P-IM1
|
P-IM9. In the last 12 months, did your personal doctor ask about the impact of fatigue on your life?
1__ Yes
2__ No |
After P-IM8
Note: Use with P-IM8
|
P-IM10. In the last 12 months, did you need physical or occupational therapy?
1__ Yes
2__ No → If No, go to P-IM12 |
After core question 26 |
P-IM11. In the last 12 months, how often was it easy to get this kind of therapy?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM10
Note: Use with P-IM10
|
P-IM12. In the last 12 months, did you need speech therapy?
1__ Yes
2__ No → If No, go to P-IM14 |
After P-IM11 |
P-IM13. In the last 12 months, how often was it easy to get speech therapy?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM12
Note: Use with P-IM12
|
P-IM14. Mobility equipment includes things like a wheelchair, scooter, walker, or cane. In the last 12 months, have you used any mobility equipment?
1__ Yes
2__ No → If No, go to core question 27 |
After P-IM13 |
P-IM15. In the last 12 months, did you try to get your mobility equipment repaired?
1__ Yes
2__ No → If No, go to P-IM17 |
After P-IM14
Note: Use with P-IM14
|
P-IM16. In the last 12 months, how often was it easy to get your mobility equipment repaired?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM15
Note: Use with P-IM15
|
P-IM17. In the last 12 months, did you try to get or replace any mobility equipment?
1__ Yes
2__ No → If No, go to core question 27 |
After P-IM16
Note: Use with P-IM14
|
P-IM18. In the last 12 months, how often was it easy to get or replace the mobility equipment that you needed?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After P-IM15
Note: Use with P-IM17
|
P-IM19. A quarter mile is about 5 city blocks or 0.4 kilometers. In the last 12 months, were you able to walk that far?
1__ Yes
2__ No → If No, go to core question 33 |
After core question 32 |
P-IM20. In the last 12 months, did you have difficulty or need assistance walking that far?
1__ Yes
2__ No |
After P-IM19
Note: Use with P-IM19
|