quality_of_life

quality_of_life - HRSA SPNS US/Mexico Border Health...

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Quality of Life Quality of Life E How will this questionnaire be completed? self-administered self-administed with help face-to-face inteview phone interview SPNS Program: Project sub-site: CLIENT: Would you please provide the following information? 1. In general, would you say your health is: excellent very good good fair poor Please indicate the extent to which the following statements are true or false for you. How much, if at all, does your health limit you in each of the following activities? HRSA number (unique ID number): Date administered (MM/DD/YY): / / Staff Person: Form language: English Spanish Time: 1 2 3 4 5 HRSA SPNS US/Mexico Border Health Initiative Centro de Evaluacion: US/Mexico Border Health Evaluation Center San Ysidro Health Center, CA - El Rio Community Health Center, Tucson, AZ - Camino de Vida, Las Cruces, NM - La Fe Clinic, El Paso, TX - Valley AIDS Council, Harlingen, TX no yes, for some of the time yes, for all of the time 3. During the past 4 weeks , has your health kept you from working at a job, doing work around the house, or going to school? not at all
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quality_of_life - HRSA SPNS US/Mexico Border Health...

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