Please respond to the following questions about your physical health. Prefer not to Yes No answer a. Are you deaf or do you have serious difficulty hearing? .....................    b. Are you blind or do you have serious difficulty seeing, even when    wearing glasses?: measure 5529

Please respond to the following questions about your physical health. Prefer not to Yes No answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when    wearing glasses?

RequiredotherA4

Tier not determined

No rule matched this measure, so no tier is guessed.

Item text continues: ... c. Because of a physical, mental, or emotional condition, do you have Answer categories: serious difficulty concentrating, remembering, or making decisions? | d. Do you have serious difficulty walking or climbing stairs? ...    | e. Do you have difficulty dressing or bathing? ...    | f. Because of a physical, mental, or emotional condition, do you have | difficulty doing errands alone such as visiting a doctor’s office or    | shopping? ...

Instrument: SUPRT-C
Reporting: baseline
Target: No target rule stated

Source document, 5

Measure 5529

Please respond to the following questions about your physical health. Prefer not to Yes No answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when    wearing glasses?

Grantee precedent for this measure