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qs7_s Mobility & Physical Support
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1) How independently can you move?
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2) How important is it physical assistance?
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3) How comfortable are you with mobility help?
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4) How strong is your physical endurance?
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5) Do you use mobility aids?
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6) Do you walk outdoors?
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balance? for physical
7) How much assistance is needed for daily tasks?
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8) How physically active are you?
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9) Can you lift or support someone?
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10) How stable is your balance?
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