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This is UN World Health Organization form required under Obamacare aka Affordable Care Act to be filled out by all American Medical Patients using uninformed consent Consent Tactic. This document is then sent to the United Nations. I had to ask questions for 10 minutes before the Doctors office admitted it was voluntary. Something else Progressive Democrat Nancy Pelosi had to pass, before we could know what was in it.
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0% found this document useful (0 votes)
163 viewsWhodas 2.0
This is UN World Health Organization form required under Obamacare aka Affordable Care Act to be filled out by all American Medical Patients using uninformed consent Consent Tactic. This document is then sent to the United Nations. I had to ask questions for 10 minutes before the Doctors office admitted it was voluntary. Something else Progressive Democrat Nancy Pelosi had to pass, before we could know what was in it.
Uploaded by
Don MashakCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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Name:
é y WHODAS 2.0
WoaLD HEALTH ORGANIZATION
DISASIITY ASSESSMENT SCHEDULE 2.0 Date of Birth: -
12-item version, self-administered
This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or
illnesses, other health problems that may be shart or long lasting, injuries, mental or emotional problems,
and problems wiih 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.
Ifthe past 30 days, how much difficulty did you have in:
St ‘Standing for long periods suchas 30. | None | Mild Moderate | Severe | Extreme
minutes? orcannot
do
32 Taking care of your houschald. None | Mid | Moderate | Severe | Exireme
responsibilities? oreannot
do
83 ‘Learning a new task, for example, None | Mid | Moderate | Severe | Extreme
Jeaming how to get fo a new place? er cannot
do
s4 How much of problem did you have | None | Mild | Moderate | Severe | Extreme
joining in community activities (tor or cannot
example, festivities, religious or other do
activities) in the same way as anyone
| else can?
$8 ‘How much have you been emotionally | None | Mild | Moderate | Severe | Extreme
affected by your health problems? or cannot
| se
Cyne
Page 1 of 2 (12-item, selfac WHODAS 2.0 a
WORLD HEALTH ORGANIZATION
SE" pisapiusry ASSESSMENT SCHEDULE2.0 Self
in the past 20 days, how much difficulty did you have in
86 | Concentrating on doing something for | None | Mid | Moderate | Severe | Extreme
lenminutes? corcannot
do
87° | Walking alonadistance such asa’ | None | Mid | Moderate | Severe | Exreme
Kdomette [or equivaient}? orcanriot
&
se Washing your whole body? None = | Mild Moderate | Severe Extreme
corcannot
do
so | Getting dressed? None | wid | Moderate | Severe | Exreme
orcannet
&
S10 | Dealing with people you do not know? | None | Mid | Moderate | Severe | Extreme
orcannot
do
S11 | Mainiainine a fiendshin? None | Wid | Moderate | Severe | Extreme
orcanrit
do
S12 | Your day-to-day work? None | Mid | Moderale | Severe | Extreme
oreannot
do
Ht | Overall inthe past 30 days, how many davs were these
dificulies present? Record number of days
12 _| Inthe past 20 days, for how many days were you fotally unable
to carry out your usual acivties or work because of any health | Record number of days
condition?
8 _| inthe past 20 days, not counting the days that you were fotaly
Unable, for how many days did you cut back or reduce your | Record number of days
usual activities or work because of any health condition?
l
This completes the questionnaire. Thank you.
Page 2 of 2 (12-item, seif-admiristered)