| 41 | PFB12 | Are you able to make a bed, including spreading and tucking in bed sheets? |
| 42 | PFB13 | Are you able to carry a shopping bag or briefcase? |
| 43 | PFB14 | Are you able to take a tub bath? |
| 44 | PFB24 | Are you able to run a short distance, such as to catch a bus? |
| 45 | PFB32 | Are you able to stand unsupported for 10 minutes? |
| 46 | PFB40 | Are you able to stand up on tiptoes? |
| 47 | PFB42 | Are you able to stand unsupported for 30 minutes? |
| 48 | PFB43 | Does your health now limit you in taking care of your personal needs (dress, comb hair, toilet, eat, bathe)? |
| 49 | PFB44 | Does your health now limit you in doing moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? |
| 50 | PFB48 | Does your health now limit you in taking a shower? |
| 51 | PFB49 | Does your health now limit you in going for a short walk (less than 15 minutes)? |
| 52 | PFB50 | How much difficulty do you have doing your daily physical activities, because of your health? |
| 53 | PFB51 | Does your health now limit you in participating in active sports such as swimming, tennis, or basketball? |
| 54 | PFB54 | Does your health now limit you in going OUTSIDE the home, for example to shop or visit a doctor’s office? |
| 55 | PFC6 | Are you able to walk a block on flat ground? |
| 56 | PFC7 | Are you able to run five miles? |
| 57 | PFC10 | Does your health now limit you in climbing several flights of stairs? |
| 58 | PFC12 | Does your health now limit you in doing two hours of physical labor? |
| 59 | PFC13 | Are you able to run 100 yards? |
| 60 | PFC20 | Does your health now limit you in walking one hundred yards? |
| 61 | PFC29 | Are you able to walk up and down two steps? |
| 62 | PFC32 | Are you able to climb up 5 flights of stairs? |
| 63 | PFC33 | Are you able to run ten miles? |
| 64 | PFC34 | Does your health now limit you in walking several hundred yards? |
| 65 | PFC35 | Does your health now limit you in doing eight hours of physical labor? |
| 66 | PFC36 | Does your health now limit you in walking more than a mile? |
| 67 | PFC37 | Does your health now limit you in climbing one flight of stairs? |
| 68 | PFC38 | Are you able to walk at a normal speed? |
| 69 | PFC39 | Are you able to stand without losing your balance for several minutes? |
| 70 | PFC40 | Are you able to kneel on the floor? |
| 71 | PFC41 | Are you able to sit down in and stand up from a low, soft couch? |
| 72 | PFC45 | Are you able to get on and off the toilet? |
| 73 | PFC46 | Are you able to transfer from a bed to a chair and back? |
| 74 | PFC47 | Are you able to be out of bed most of the day? |
| 75 | PFC49 | Are you able to water a house plant? |
| 76 | PFC52 | Are you able to turn from side to side in bed? |
| 77 | PFC53 | Are you able to get in and out of bed? |
| 78 | PFC54 | Does your health now limit you in getting in and out of the bathtub? |
| 79 | PFC56 | Does your health now limit you in walking about the house? |