| 105472-5 | Instructions abt cond 12Mo | |
| 105473-3 | Instr ease understand 12Mo | |
| 105474-1 | How oft desc foll instr 12Mo | |
| 105475-8 | Fill sign form 12Mo | |
| 105476-6 | How oft help fill form 12Mo | |
| 105477-4 | How oft explain underst 12Mo | |
| 105478-2 | How oft listen 12Mo | |
| 105479-0 | How oft respect say 12Mo | |
| 105480-8 | How oft spend enough time 12Mo | |
| 105481-6 | Appnt see specialist 12Mo | |
| 105482-4 | How oft appoint as need 12Mo | |
| 30947-6 | Date form completed | |
| 105483-2 | Who comp form | |
| 105484-0 | Rship person on form | |
| 105485-7 | Healthcare comms proto 281101 | |