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Medicaid: Forms An Analyst May Ask You To Complete (Supplemental Questionnaires)
How To Complete The Daily Activities Questionnaire
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The Daily Activities Questionnaire asks you to describe in detail how you are able to manage the various functions of day-to-day living with your condition. It asks questions such as:
- Q. Describe what you do on an average day. '
- When you answer this question, describe how your condition affects your daily life, particularly the changes you have had to make in your daily life due to your condition. For example, did you have to abandon a hobby or favorite pastime?
- Q. Do you need help completing your chores?
- Again, as you answer this question, indicate how your health condition has affected your ability to complete your chores. For example: "I used to be able to change a bed, but now I get so dizzy when I bend over that I have to ask friends to make my bed for me."
- Q. How often do you listen to the radio or watch TV or read magazines or books?
- Have your reading or viewing habits changed due to your condition? The question relates to how your medical condition effects even your recreation or leisure time.
Be sure to list any changes you've made to accommodate your limited abilities. For examples, see the above discussion concerning the fatigue questionnaire.
The other questions are very specific. Using your Symptoms Diary and Work Journal, together with following the tips listed below, you should have no problem completing the form.
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