Dietary Pattern Calculator

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What is your age?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Here are some questions about your ability to live on your own

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Here are some questions about your ability to live on your own

Has your ability to make decisions worsened over the last 90 days?

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Has your ability to make decisions worsened over the last 90 days?

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Has your ability to make decisions worsened over the last 90 days?

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Here are some questions about your ability to live on your own

Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Have you had any difficulty with the following tasks in the past week?

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Here are some questions about you

Please indicate sex:

What is your age?

Weight

Height

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Here are some questions about your ability to live on your own

Question Title Posed Here?

Question Title Posed Here?

Question Title Posed Here?

Question Title Posed Here?

Question Title Posed Here?

Question Title Posed Here?

Here are some questions about your ability to live on your own

Has your ability to make decisions worsened over the last 90 days?

Has your ability to make decisions worsened over the last 90 days?

Has your ability to make decisions worsened over the last 90 days?

Here are some questions about your ability to live on your own

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

Have you had any difficulty with the following tasks in the past week?

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