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(53) Any restriction in mobility due to ill health      
Key
       
- Yes
- No
0
1
     
(54) Degree of activity      
Key
       
- Nil
- Often
- Frequent
0
1
2
     
(55) Assessment of social integration      
Key
       
- Well integrated
- Moderately integrated
- Somewhat integrated
- Not integrated
- Socially isolated
1
2
3
4
5
     
(56) Total social integration score
CLINICAL DETAILS
     
(57-58) Psychiatric Diagnosis      
(59) Clinical Diagnosis of patient      
Key
       
- No disease
- Only psychiatric diagnosis
- Only physical diagnosis
- Both physical and psychiatric diagnoses
1
2
3
4
     
(60) Number of diagnosis      
Key
       
- One
- Two
- Three
- Four
- Five
- More than five
1
2
3
4
5
6
     
(61) (On Followup only)
Hospital vIsit
     
Key
       
- No visit
- Visited psychiatric OPD
- Visited Medical OPD
- Psychiatric inpatient admission
- Physical inpatient admission
1
2
3
4
5
     
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