Do you provide some regular service or help for any sick, disabled or elderly person not living with you?
EXCLUDE HELP PROVIDED IN COURSE OF EMPLOYMENT

Is that one person or more than one?
IF MORE THAN ONE PROBE HOW MANY

Part 1:
Yes
No

Part 2:
ENTER NUMBER CARED FOR

Problems or disability connected with: arms, legs, hands,
feet back, or neck (including arthritis and rheumatism)
Difficulty in seeing (other than needing
glasses to read normal size print).
Difficulty in hearing
Skin conditions/allergies
Chest/breathing problems, asthma, bronchitis
Heart/high blood pressure or blood circulation problems
Stomach/liver/kidneys or digestive problems
Diabetes
Anxiety, depression or bad nerves, psychiatric problems
Alcohol or drug related problems Epilepsy.
Migraine or frequent headaches
Cancer
Stroke
Other health problems (PLEASE GIVE DETAILS).