Questionnaire formview entire document:
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18.
a) Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?
[ ] Yes [ ] No
Questionnaire instructionsview entire document:
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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.