MDEPX001X

Are you completing this questionnaire for someone else?

Completing Questionnaire 

1-digit numeric

e.g. 0 – No

Please refer to the technical specification for details

MDEPX002X

What is your relationship to the patient?

Relationship To Patient 

2-digit numeric

e.g. 02 - Relative or carer on behalf of the patient

Please refer to the technical specification for details

Why is your assistance needed?

Why Assistance Needed 

[Question header, no returned data]

MDEPX003A

Physical impairment

Physical impairment

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’

MDEPX003B

Mental impairment

Mental impairment

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’

MDEPX003C

Under 16

Under 16

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’

MDEPX003D

No Language

No Language

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’

MDEPX003E

Remote collection

Remote collection

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’

MDEPX003F

Other reason

Other reason

1-digit numeric

*Note that a value of ‘0 – no’ should only be recorded if there is an option for the patient to explicitly answer ‘no’ to the question, otherwise use ‘9 – unknown’