Dwelling 5 Income 6 Agreement to Share 7 Administration 7 Health Questions 8 General Health 8 Height/Weight 8 Preventive Health Practices 9 Two-Week Disability 11 Health Care Utilization 11 Restriction of Activities 14 Chronic Conditions 16May 9th, 2005
FiledMay 9th, 2005A-INT The first few questions will provide important basic information on the people in your household. A1 What are the names of all persons now living or staying here who have no usual place of