It is hard for you to walk: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented It is hard for you to run: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented It is hard for you to play sports or exercise: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented It is hard for you to pick up big things: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented It is hard for you to take a bath or shower: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented It is hard for you to do chores (like pick up your toys): 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented Do you have or aches: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented If yes, where? __________ Do you ever feel too tired to play: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented EMOTIONAL FUNCTIONING (problems with…) Do you feel scared: 0 Not at all – 2 Sometimes – 4 A lot – Unknown or Not Documented
It is hard for you to walk: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented It is hard for you to run: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented It is hard for you to play sports or exercise: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented It is hard for you to pick up big things: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented It is hard for you to take a bath or shower: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented It is hard for you to do chores (like pick up your toys): 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented Do you have or aches: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented If yes, where? __________ Do you ever feel too tired to play: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented EMOTIONAL FUNCTIONING (problems with…) Do you feel scared: 0 – Not at all 2 – Sometimes 4 – A lot Unknown or Not Documented
Pedimacs_Users_Guide_v5_0_2018_03_26.docx