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WHODAS Disability Assessment 36 Item Self Report

Page One

This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.

Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please circle only one response.
 
UNDERSTANDING AND COMMUNICATING
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
GETTING AROUND
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
SELF-CARE
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
GETTING ALONG WITH PEOPLE
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
LIFE ACTIVITIES
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
In the past 30 days, how much difficulty did you have in:
Because of your health condition, in the past 30 days, how much difficulty did you have in:
Because of your health condition, in the past 30 days, how much difficulty did you have in:
Because of your health condition, in the past 30 days, how much difficulty did you have in:
Because of your health condition, in the past 30 days, how much difficulty did you have in:
PARTICIPATION IN SOCIETY
In the past 30 days:
In the past 30 days:
In the past 30 days:
In the past 30 days:
In the past 30 days:
In the past 30 days:
In the past 30 days:
In the past 30 days:
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid number format.