CDEs
Forms
I smoke more before going into a situation where smoking is not allowed.
In the past 7 days, How many days did you exercise so much that you breathed hard?
In the past 7 days, How many days did you exercise or play so hard that your muscles burned?
In the past 7 days, How many days was your child strong enough to go up and down stairs?
In the past 7 days, How many days was your child strong enough to reach above his/her head to get heavy things?
Considering your shortness of breath <u>over the past 7 days</u>, rate the amount of difficulty you had when doing the following activities: Walking (faster than your usual speed) for ½ mile (almost 1 km) without stopping
In the past 7 days I got tired easily.
In the past 7 days Being tired made it hard for me to keep up with my schoolwork.
In the past 7 days My child felt nervous.
In the past 7 days My child felt worried.
Are you able to step up and down curbs?
In the past 7 days I worried when I was at home.
In the past 7 days I had sudden feelings of panic
In the past 7 days My child had trouble starting things because he/she was too tired.
In the past 7 days I am satisfied with my ability to do things for my family
In the past 7 days I am satisfied with my ability to meet the needs of those who depend on me
In the past 7 days I had to limit my social activity because I was tired
In the past 7 days My child could open a jar by himself/herself.
In the past 7 days I missed school when I had pain
In the past 7 days, I felt great.
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