18a-18c. Mark the "Yes" or "No" box to indicate if the person has serious difficulty with any of the activities listed in parts a, b, and c because of a physical, mental, or emotional condition.

18a-18c. Mark the "Yes" or "No" box to indicate if the person has serious difficulty with any of the activities listed in parts a, b, and c because of a physical, mental, or emotional condition.

15. Does this person have any of the following long-lasting conditions:

b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying?

[ ] Yes [ ] No

15. Mark the "Yes" or "No" box for both parts a and b of question 15 to indicate whether the person has any of the conditions listed.

16. Does this person have any of the following long-lasting conditions: