Adult WHO Disability Assessment (WHODAS 2.0) - Self Rated

Assessment 1 of 39

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. In the last 30 days, how much difficulty did you have in concentrating on doing something for ten minutes?
2. In the last 30 days, how much difficulty did you have in remembering to do important things?
3. In the last 30 days, how much difficulty did you have in analyzing and finding solutions to problems in day-to-day life?
4. In the last 30 days, how much difficulty did you have in learning a new task, for example, learning how to get to a new place?
5. In the last 30 days, how much difficulty did you have in generally understanding what people say?
6. In the last 30 days, how much difficulty did you have in starting and maintaining a conversation?
7. In the last 30 days, how much difficulty did you have in standing for long periods, such as 30 minutes?
8. In the last 30 days, how much difficulty did you have in standing up from sitting down?
9. In the last 30 days, how much difficulty did you have in moving around inside your home?
10. In the last 30 days, how much difficulty did you have in getting out of your home?
11. In the last 30 days, how much difficulty did you have in walking a long distance, such as a kilometer (or equivalent)?
12. In the last 30 days, how much difficulty did you have in washing your whole body?
13. In the last 30 days, how much difficulty did you have in getting dressed?
14. In the last 30 days, how much difficulty did you have in eating?
15. In the last 30 days, how much difficulty did you have in staying by yourself for a few days?
16. In the last 30 days, how much difficulty did you have in dealing with people you do not know?
17. In the last 30 days, how much difficulty did you have in maintaining a friendship?
18. In the last 30 days, how much difficulty did you have in getting along with people who are close to you?
19. In the last 30 days, how much difficulty did you have in making new friends?
20. In the last 30 days, how much difficulty did you have in sexual activities?
21. In the last 30 days, how much difficulty did you taking care of your household responsibilities?
22. In the last 30 days, how much difficulty did you have in doing most important household tasks well?
23. In the last 30 days, how much difficulty did you have in getting all of the household work done that you needed to do?
24. In the last 30 days, how much difficulty did you have in getting your household work done as quickly as needed?
25. Because of your health condition, in the past 30 days, how much difficulty did you have in your day-to-day work/school?
26. Because of your health condition, in the past 30 days, how much difficulty did you have in doing your most important work/school tasks well?
27. Because of your health condition, in the past 30 days, how much difficulty did you have in getting all of the work done that you need to do?
28. Because of your health condition, in the past 30 days, how much difficulty did you have in getting your work done as quickly as needed?
29. In the past 30 days how much of a problem did you have in joining in community activities (for example, festivities, religious, or other activities) in the same way as anyone else can?
30. In the past 30 days how much of a problem did you have because of barriers or hindrances around you?
31. In the past 30 days how much of a problem did you have living with dignity because of the attitudes and actions of others?
32. In the past 30 days how much time did you spend on your health condition or its consequences?
33. In the past 30 days how much have you been emotionally affected by your health condition?
34. In the past 30 days how much has your health been a drain on the financial resources of you or your family?
35. In the past 30 days how much of a problem did your family have because of your health problems?
36. In the past 30 days how much of a problem did you have in doing things by yourself for relaxation or pleasure?