cannot do  
D5.8 Getting your work done as quickly as needed?  None Mild Moderate Severe Extreme or 
cannot do  
Participation in society   
In the past 30 days:  
D6.1 How much of a problem did you have in joining in 
community activities (for example, festivities, 
religious, or other activities) in the same way as 
anyone else can?  None Mild Moderate Severe Extreme or 
cannot do  
 
____ 
40 
  
____ 
5 
 D6.2 How much of a problem did you have because of 
barriers or hindrances around you?   
None  
Mild  
Moderate  
Severe Extreme or 
cannot do  
D6.3 How much of a problem did you have living with 
dignity because of the attitudes and actions of 
others?  None Mild Moderate Severe Extreme or 
cannot do  
D6.4 How much time did you spend on your health 
condition or its consequences?  None Some Moderate A Lot Extreme or 
cannot do  
D6.5 How much have you been emotionally affected by 
your health condition?  None Mild Moderate Severe Extreme or 
cannot do  
D6.6 How much has your health been a drain on the 
financial resources of you or your family?  None Mild Moderate Severe Extreme or 
cannot do  
D6.7 How much of a problem did your family have 
because of your health problems?  None Mild Moderate Severe Extreme or 
cannot do  
D6.8 How much of a problem did you have in doing 
things by yourself for relaxation or pleasure?  None Mild Moderate Severe Extreme or 
cannot do  
General Disability Score (Total): ____