Most people use pip to install Python packages. It is one of the most popular programming languages in the world, and it's free! Pip does not fulfill all installation needs though. This blog post introduces you to Blank Pip Form, a tool that helps you create your own custom python distribution. You can then upload this distribution anywhere on the internet for other people to download and execute code with your custom package management system without needing any other tools or setup! The article also goes into detail about how you might want to use this tool in various situations like education, research labs, startups etc.
You will see info about the type of form you wish to fill out in the table. It can tell you how long it will take to fill out blank pip form, exactly what parts you will need to fill in, and so forth.
Question | Answer |
---|---|
Form Name | Blank Pip Form |
Form Length | 37 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 9 min 15 sec |
Other names | pip form, dwp pip application form download, pip application form pdf, pip application form download pdf 2020 |
Personal Independence Payment
How your disability affects you
Full name
National Insurance (NI) number
only
Please fill in this form and return it to us straightaway.
We’ve sent you an Information Booklet to help you complete the
form. In the Information Booklet we:
If you need to ask for more time to compl te this form please call suse on 0800 121 4433 (0800 121 4493 if using a t xtphon ).
• give advice on where you can get help to complete the f rm
• explain the questions we ask
• tell you how to answer the questions, and
• give you examples of other things you can tell us
If you don't return this form to us and we don't hear from you to ask for more time to complete t, we ay end your claim to PIP.
If you don't want to ont nue w th your claim and w n’t be etu ning this form, please call us on 0800 121 4433 (0800 121 4493 if using a textphone).
What you n d to do
Step 1 |
– Read through this form and the Inf |
rma ion Booklet. |
Step 2 |
– Fill in this form (in pen) to tell us h |
for |
w y ur health condition |
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or disability affects you. |
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tep 3 |
– Read and sign the declarati n n page 32. |
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tep 4 |
– Return the form to us with photocopies of any additional |
Specimeninformation. Not
PIP2 June 2018
1 of 33
Additional information to support your claim
As well as completing this form it is important that you help us to understand your needs by providing additional information. This should explain how your health condition or disability affects your daily life.
Do send information that shows how your health condition or disability affects you carrying out
Don’t send general information about your condition like fact sheets or information from the internet.
Only send us photocopies of information you already have available to you. We can’t return any documents to you.
There is more information, including examples of what to send us in the Information Booklet we sent you with this form.
only
Please put your name and National Insurance number |
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each document. |
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Specimen |
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Section 1 – About your health prof ssio |
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If we need additional information we may contact the h |
alth professionals that upport you. |
Q1 Tell us about the professional(s) best placed to advise s on how your health condition or d sab l ty affects you
For example, a GP, hospital doctor, spec alist nurse, community psychiatric nurse, occupational
therapist, physiotherapist, so |
al worker, counsell |
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PIP2 June 2018
2 of 33
Section 1 – About your health professionals continued
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If you need to add more please c |
ntinue at Q15 Additional information. |
PIP2 June 2018
3 of 33
Section 2 - About your health condition or disability
iUse page 7 of the Information Booklet to help you answer these questions.
Q2a - Tell us in the space below:
•what your health conditions or disabilities are, and
•approximately when each of these started
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Health condition or disability |
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Approximate start date |
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Example: Diabetes |
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May 2010 |
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We will ask you how your health ond t ons or disabilities affect h w useyou |
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If you need to add more pl ase ontinue at Q15 Additional inf rmation. |
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PIP2 June 2018
4 of 33
Section 2 - About your health condition or disability continued
Q2b - Tell us about:
•tablets or other medication you’re taking or will be taking and the dosage
•any treatments you’re having or will be having, such as chemotherapy, physiotherapy or dialysis
•any side effects these have on you
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Specimen |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
5 of 33
Section 3 - How your health condition or disability affects your
Tell us in the rest of this form how your health conditions or disabilities affect your
Q3 - Preparing Food
i Use page 7 of the Information Booklet to help answer these questions.
Tell us about whether you can prepare a simple one course meal for one from fresh ingredients.
This includes things like: |
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food preparation such as peeling, chopping or opening packagi g, a d |
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safely cooking or heating food on a cooker hob or in a microwave oven |
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Tick the boxes that apply to you, then provide more informati |
in the |
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Extra information box. |
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Q3a - Do you need to use an aid |
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or appliance to prepare or |
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cook a simple meal? |
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include things like: |
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• perching stools, |
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lightweight pots and |
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pans, easy grip handles |
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on utensils, single lever |
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arm taps and liqu d level |
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indicators |
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Q3b – Do you n |
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or cook a sim le m al? |
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motivate you to cook? |
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• do they plan the task f r |
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you? |
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• do they supervise you? |
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• do they physically help |
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you? |
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• do they prepare all your |
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food for you? |
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This includes help you |
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have, and help you need |
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but don’t get. |
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PIP2 June 2018
6 of 33
Q3c - Extra information - Preparing Food
Tell us more about any difficulties you have when preparing and cooking food:
• tell us how your condition affects you doing this activity |
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tell us how you manage at the moment and the problems you have when you can't |
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do this activity |
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tell us how long it takes to prepare and cook food |
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does whether you can do this vary throughout the day? Tell us about good and bad |
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days |
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can you cook using an oven safely? If not, tell us why not |
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tell us about the aids or appliances you need to use to help you prepare and cook |
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food |
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do you experience any other difficulties, either during or after the activity, ike pain, |
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breathlessness or tiredness? |
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tell us about the help you need from another person when prepari g f od. This |
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includes help you have and help you need but don't get |
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Specimen |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
7 of 33
Q4 - Eating and drinking
iUse page 7 of the Information Booklet to help answer these questions.
Tell us about whether you can eat and drink.
This means:
•remembering when to eat
•cutting food into pieces
•putting food and drink in your mouth, and
•chewing and swallowing food and drink
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Tick the boxes that apply to you, then provide more information in the |
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Extra information box. |
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Q4a – Do you need to use an aid |
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or appliance to eat and |
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drink? |
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Aids and appliances |
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Sometimes |
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include things like: |
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Specimen |
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• weighted cups, adapted |
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cutlery |
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Q4b – Do you use a feeding tube |
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or similar device to eat |
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or drink? |
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This means things l ke a |
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feeding tube with a rate |
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limiting devi e as a |
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delivery system or feed |
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pump. |
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Q4c – Do you n |
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anoth r |
rson to at and |
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drink? |
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By this we mean: |
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S metimes |
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• do they remind you to eat |
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and drink? |
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• do they supervise you? |
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• do they physically help |
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you to eat and drink? |
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• do they help you manage |
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a feeding tube? |
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This includes help you have and help you need but don't get.
PIP2 June 2018
8 of 33
Q4d - Extra information - Eating and drinking
Tell us more about any difficulties you have when eating and drinking:
• tell us how your condition affects you doing this activity |
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tell us how you manage at the moment and the problems you have when you can't |
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do this activity |
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tell us how long it takes you to complete this activity |
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does whether you can do this vary throughout the day? Tell us about good and bad |
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days |
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only |
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do you experience any other difficulties, either during or after the activity, ike pain, |
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breathlessness or tiredness? |
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tell us about the aids and appliances you need to use to help you eat and drink |
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tell us about the help you need from another person when eati g a d dri ki g. This |
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includes help you have and help you need but don't get |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
9 of 33
Q5 – Managing treatments
iUse page 8 of the Information Booklet to help answer these questions
Tell us about whether you can monitor changes in your health condition, take medication or manage any treatments carried out at home. Monitoring changes include things like:
• monitoring blood sugar level, changes in mental state and pain levels
A home treatment includes things like: |
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only |
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• physiotherapy and home dialysis |
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Tick the boxes that apply to you then provide more information in the Extra |
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information box. |
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Q5a – Do you need to use an aid |
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Yes |
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or appliance to monitor |
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No |
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your health conditions, |
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take medication or |
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Sometimes |
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Specimen |
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manage home |
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treatments? |
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For example, using a |
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Dosette Box for tablets. |
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Q5b – Do you need help from |
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another person to |
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No |
for |
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monitor your health |
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conditions, take |
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So eti es |
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medication or manage |
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home treatments? |
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By this we m an: |
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• do th y r mind you to |
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take m dications and |
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treatm nt? |
Not |
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• do th y su rvise you while you take your medication?
• do they physically help you take medication or manage treatments?
This includes help you have and help you need but don't get.
PIP2 June 2018
10 of 33
Q5c – Extra information - Managing treatments
Tell us more about any difficulties you have with managing your treatments:
• tell us how your condition affects you doing this activity |
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• |
tell us how you manage at the moment and the problems you have when you can't |
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do this activity |
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tell us how long it takes you to manage your treatments |
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does whether you can do this vary throughout the day? Tell us about good and bad |
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days |
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only |
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do you experience any other difficulties, either during or after the activity, ike pain, |
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breathlessness or tiredness? |
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tell us about the aids or appliances you need to use to help you monitor our |
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treatment |
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tell us about the help you need from another person when ma |
agi g your |
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treatments. This includes help you have and help you need but d |
't get |
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use |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
11 of 33
Q6 – Washing and bathing
iUse page 8 of the Information Booklet to help answer these questions.
Tell us about whether you can wash and bathe.
This means things like:
•washing your body, limbs, face, underarms and hair, and
•using a standard bath or shower
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only |
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This doesn't include any difficulties you have getting to the bathroom. |
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Tick the boxes that apply to you then provide more information in the Extra |
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information box. |
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Q6a – Do you need to use an aid |
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Yes |
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or appliance to wash and |
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No |
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bathe yourself, including |
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using a bath or shower? |
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Sometimes |
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Aids and appliances |
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Specimen |
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include things like: |
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• bath / shower seat, |
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grab rails |
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Q6b – Do you need help from |
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Y s |
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use |
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another person to wash |
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No |
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and bathe? |
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By this we mean: |
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So eti es |
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• do they physically help |
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for |
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you? |
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• do they tell you when to |
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wash and bath ? |
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• do th y wat h ov r you to |
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make sure you are saf ? |
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Not |
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This includ s help you have |
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and help you n d but |
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don't get. |
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PIP2 June 2018
12 of 33
Q6c – Extra information - Washing and bathing
Tell us more about any difficulties you have when washing and bathing:
• tell us how your condition affects you doing this activity |
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• |
tell us how you manage at the moment and the problems you have when you can't |
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do this activity |
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• |
tell us how long it takes you to wash and bathe |
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• |
does whether you can do this vary throughout the day? Tell us about good and bad |
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• |
days |
only |
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do you have difficulty washing particular parts of your body? Which parts? |
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• |
does it take you a long time to wash and bathe? |
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• |
do you experience any other difficulties, either during or after the activity, ike pain, |
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breathlessness or tiredness? |
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• |
tell us about the aids or appliances you need to help you wash a d bathe |
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• |
tell us about the help you need from another person when washi g a d bathing. |
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This includes help you have and help you need but don't get |
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
13 of 33
Q7 – Managing toilet needs
iUse page 8 of the Information Booklet to help answer these questions.
Tell us about whether you can use the toilet and manage incontinence.
Using the toilet means:
•being able to get on or off a standard toilet, and
•cleaning yourself after using the toilet
toilet or manage |
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No |
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only |
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Managing incontinence means: |
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• emptying your bowel and bladder, including if you need a collecting |
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device such as a bottle, bucket or catheter, and |
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• cleaning yourself after doing so |
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This doesn't include difficulties you have getting to the bathroom. |
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Tick the boxes that apply to you then provide more informati |
in the Extra |
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information box. |
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use |
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SpecimenThis includes help you have |
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Q7a – Do you need to use an aid |
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Yes |
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or appliance to use the |
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incontinence? |
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Som tim s |
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Aids and appliances |
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include things like: |
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• commodes, raised toilet |
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seats, bottom wipers, |
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for |
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bidets, incontinence pads |
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or a stoma bag |
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Q7b – Do you n |
d h lp from |
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Yes |
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anoth r p rson to use the |
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toilet or manage |
Not |
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No |
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incontinenc ? |
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S me imes |
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By this we mean: |
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• do they |
hysically help |
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you? |
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• do they tell you when to use the toilet?
• do they watch over you to make sure you are safe?
and help you need but don't get.
PIP2 June 2018
14 of 33
Q7c – Extra information - Managing toilet needs
Tell us more about any difficulties you have with your toilet needs or incontinence:
• tell us how your condition affects you doing this activity |
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• |
tell us how your manage at the moment and the problems you have when you can't |
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do this activity |
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• |
tell us how long it takes you to complete this activity |
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• |
does whether you can do this vary throughout the day? Tell us about good and bad |
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days |
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only |
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• |
are you incontinent? Tell us in what way and how you manage it |
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• |
do you experience any other difficulties, either during or after the activity, ike pain, |
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breathlessness or tiredness? |
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• |
tell us about the aids or appliances you need to use to help you ma |
age our toi et |
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needs |
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• |
tell us about the help you need from another person when ma agi |
g your toilet |
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needs. This includes help you have and help you need but d 't get |
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
15 of 33
Q8 – Dressing and undressing
iUse page 9 of the Information Booklet to help answer these questions.
Tell us about whether you can dress or undress yourself |
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This means: |
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• |
putting on and taking off clothes, including shoes and socks |
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• |
knowing when to put on or take off clothes, and |
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• |
being able to select clothes that are appropriate |
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only |
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Tick the boxes that apply to you then provide more information in the Extra |
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information box. |
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Q8a – Do you need to use an aid |
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Yes |
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or appliance to dress or |
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No |
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undress? |
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Aids and appliances |
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Sometimes |
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include things like: |
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• modified buttons, front |
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use |
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Specimen |
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fastening bras, velcro |
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fastening, shoe aids or an |
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audio colour detector |
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Q8b – Do you need help from |
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Y s |
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|
another person to dress |
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No |
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or undress? |
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for |
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||
|
By this we mean: |
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So eti es |
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• do they physi ally help |
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you? |
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• do they sele t your |
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cloth s? |
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• do th y tell you wh |
n to |
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dress and undr ss? |
Not |
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• do th y tell you wh |
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n to |
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change your cloth s?
This includes help you have and help you need but don't get.
PIP2 June 2018
16 of 33
Q8c – Extra Information - Dressing and undressing
Tell us more about any difficulties you have when dressing and undressing:
• tell us how your condition affects you doing this activity |
|
|
|
||
• |
tell us how you manage at the moment and the problems you have when you can't |
||||
|
do this activity |
|
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|
• |
tell us how long it takes you to dress and undress |
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• |
does whether you can dress or undress yourself vary throughout the day? Tell us |
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about good and bad |
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only |
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• |
do you only have difficulty dressing certain parts of your body? Which parts? |
||||
• |
do you experience any other difficulties, either during or after the activity, ike pain, |
||||
|
breathlessness or tiredness? |
|
|
|
|
• |
tell us about the aids or appliances you need to help with dressi g a d u dressing |
||||
• |
tell us about the help you need from another person when dressi |
g a d |
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|
undressing. This includes help you have and help you need but d |
't get |
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
17 of 33
Q9 – Communicating
iUse page 9 of the Information Booklet to help answer these questions.
Tell us about whether you have difficulties with your speech, your hearing or your understanding of what is being said to you.
This means in your native spoken language
Tick the boxes that apply to you then provide more information in the Extra
information box. |
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only |
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Q9a – Do you need to use an |
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Yes |
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|||
aid or appliance to |
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No |
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||
communicate with |
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others? |
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Sometimes |
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Aids and appliances |
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include things like: |
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• hearing and voice aids |
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use |
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• picture symbols, and |
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Specimen |
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• assistive computer |
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technology |
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Q9b – Do you need help from |
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Y s |
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another person to |
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No |
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communicate with |
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others? |
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So eti es |
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By this we mean: |
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for |
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• do they help you |
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||
understand what people |
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are saying? |
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• do you have som one |
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who helps you by |
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interpr ting sp ch into |
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sign languag ? |
Not |
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• do th y help you by |
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s eaking on your behalf? |
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|
This includes help you have and help you need but don't get.
PIP2 June 2018
18 of 33
Q9c – Extra information - Communicating
Tell us more about any difficulties you have with your speech, your hearing and your
understanding of what is said to you: |
|
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|
|
|
|
• tell us how your condition affects you doing this activity |
|
|
|
|
||
• |
tell us how you manage at the moment and the problems you have when you can't do |
|||||
|
this activity |
|
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|
• |
tell us how long it takes you to complete this activity |
only |
||||
• |
|
|
||||
does whether you can do this vary throughout the day? Tell us about good and bad |
||||||
|
days |
|
|
|
|
|
• |
do you experience any other difficulties either during or after the activity, ike anxiety |
|||||
|
and distress? |
|
|
|
|
|
• |
tell us about the aids or appliances you need to help you to commu |
icate |
||||
• |
tell us about the help you need from another person when commu |
icati g. This |
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|
includes help you have and help you need but don't get |
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
19 of 33
Q10 – Reading
iUse page 9 of the Information Booklet to help you answer these questions.
Tell us about whether you can read and understand signs, symbols and words in your native language. Also tell us about difficulties you have concentrating when doing so.
This means: |
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only |
||
• |
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||
signs, symbols and words written or printed in your native language, not braille |
||||||||
• |
understanding numbers, including dates |
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||||
• other instructions, such as timetables |
|
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||||
Tick the boxes that apply to you then provide more information in the Extra |
||||||||
information box. |
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|
Q10a – Do you need to use an |
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Yes |
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||
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aid or appliance other |
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No |
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than spectacles or |
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contact lenses to read |
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Specimen |
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signs, symbols and |
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Sometimes |
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words? |
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Aids and appliances |
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include things like |
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magnifiers. |
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|
Q10b – Do you need help from |
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Yes |
|
|
use |
||
|
another person to read |
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|
No |
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||
|
or understand signs, |
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|||
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symbols and words? |
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Sometimes |
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|||
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By this we mean do they |
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for |
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|
read or xplain signs and |
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symbols to you? |
Not |
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|
This includ s help you |
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have and help you n d |
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but don't get |
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|
PIP2 June 2018
20 of 33
Q10c – Extra information - Reading
Tell us more about any difficulties you have when reading and understanding signs,
symbols and written words: |
|
|
|
|
|
• tell us how your condition affects you doing this activity |
|
|
|
||
• |
tell us how you manage at the moment and the problems you have when you can't do |
||||
|
this activity |
|
|
|
|
• |
tell us how long it takes you to complete this activity |
|
|
|
|
• |
does whether you can do this vary throughout the day? Tell us about good and bad |
||||
|
days |
|
only |
||
|
|
|
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|
|
• |
do your difficulties depend on how complicated the signs, symbols and words are, or |
||||
|
how big they are? |
|
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|
|
• |
do you experience other difficulties, either during or after the activity, ike pain, |
||||
|
breathlessness or tiredness? |
|
|
|
|
• |
tell us about the aids or appliances you need to help y u read |
|
|
||
• |
tell us about the help you need from another person when readi g. This i cludes help |
||||
|
you have and help you need but don't get |
|
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
21 of 33
Q11 – Mixing with other people
iUse page 10 of the Information Booklet to help answer these questions.
Tell us about whether you have difficulties mixing with other people.
This means how well you are able to:
• get on with other people
|
group |
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|
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|
|
• |
understand how they're behaving towards you, and |
only |
|||||
• |
behave appropriately towards them |
|
|||||
|
|
|
|||||
It includes both people you know well and people you don't know. |
|
||||||
Tick the boxes that apply to you then provide more information in the Extra |
|||||||
information box. |
|
|
|
|
|
|
|
Q11a – Do you need another |
|
Yes |
|
|
|||
|
|
|
|||||
|
person to help you to |
|
No |
|
|
||
|
|
|
|
||||
|
mix with other people? |
|
|
use |
|||
|
Specimen |
|
|||||
|
By this we mean: |
|
|
|
Sometimes |
|
|
|
• do they encourage you |
|
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|
|||
|
to mix with other |
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|
|
people? |
|
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|
• do they help you |
|
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|
|
understand how people |
|
|
||||
|
are behaving and how |
|
|
||||
|
to behave yourself? |
|
|
||||
|
This includes help you |
|
|
||||
|
have and help you need |
|
|
||||
|
but don't get. |
|
|
|
|
|
|
Q11b – Do you find it diffi ult |
|
Yes |
|
|
|||
|
|
|
|||||
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to mix with oth r |
Not |
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eo le b cause of |
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No |
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severe anxiety or |
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S me imesfor |
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distress? |
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PIP2 June 2018
22 of 33
Q11c – Extra information - Mixing with other people
Tell us more about any difficulties you have when mixing with other people:
• |
tell us about how your condition affects you doing this activity |
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• |
tell us how you manage at the moment and the problems you have when you can't |
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do this activity |
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• |
do you have behaviours that could put yourself or others at risk? |
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• |
does whether you can do this vary throughout the day? Tell us about good and bad |
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• |
days |
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only |
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do you avoid mixing with other people, some more than others? |
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• |
does it take you a long time to mix with other people? |
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• |
do you experience any other difficulties, either during or after the activity, ike |
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anxiety or distress? |
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• |
tell us about help you need from another person when mixi g with other peop e. |
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This includes help you have and help you need but don't get |
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use |
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Specimen |
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for |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
23 of 33
Q12 – Making decisions about money
iUse page 10 of the Information Booklet to help answer these questions.
Tell us about whether you can make decisions about spending and
managing your money. This means: |
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• |
understanding how much things costs |
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• |
understanding how much change you should get |
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• |
managing budgets, paying bills and planning future purchases |
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By this we mean: |
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only |
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This activity looks at your decision making ability not things like getting to the |
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bank. |
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Tick the boxes that apply to you then provide more information in the Extra |
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information box. |
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Q12a – Do you need someone |
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Yes |
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else to help you to |
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No |
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understand how much |
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things cost when you |
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use |
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Specimen |
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buy them or how much |
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Sometimes |
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change you'll receive? |
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• do you need someone |
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to do it for you? |
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• do they need to remind |
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you to do it or how to do |
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it? |
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• do you need someone |
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to help you understand? |
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This includes help you |
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have and help you n d |
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but don't g |
t. |
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for |
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Not |
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Q12b – Do you n d som one |
Yes |
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else to help you manage |
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No |
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your household budgets, |
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ay bills or |
lan future |
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S metimes |
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purchases? |
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By this we mean: |
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• do you need someone |
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to do it for you? |
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• do they have to help you |
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manage your bills? |
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• do you need |
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encouraging to do it? |
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This includes help you have and help you need but don't get.
PIP2 June 2018
24 of 33
Q12c – Extra information - Making decisions about money
Tell us more about any difficulties you have when making budgeting decisions:
• tell us how your condition affects you doing this activity |
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• |
tell us how you manage at the moment and the problems you have when you can't |
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|
do this activity |
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• |
tell us how long it takes you to complete this activity |
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• |
does whether you can do this vary throughout the day? Tell us about good and bad |
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days |
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only |
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• |
do you experience any other difficulties, either during or after the activity, ike |
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anxiety and distress? |
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• |
tell us about the help you need from another person when making decisions about |
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money. This includes help you have and help you need but do 't get |
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use |
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Specimen |
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
25 of 33
Q13 – Going out
iUse page 10 of the Information Booklet to help answer these questions.
Tell us about whether you can plan and follow a route to another place. Also tell us if severe anxiety or stress prevents you from going out.
This includes planning and following a route to another place using public transport.
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only |
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This activity doesn't look at your ability to walk which is covered in Question 14, |
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Moving around. |
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Tick the boxes that apply to you then provide more information in the Extra |
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information box. |
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Q13a – Do you need help from |
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Yes |
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another person to plan |
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No |
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a route to somewhere |
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you know well? |
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Sometimes |
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use |
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lost? |
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By this we mean do you: |
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|||
Specimen |
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• need someone to help you plan a |
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route, or plan it for you? |
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• need to be encouraged to go out |
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or have someone with you wh n |
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going out to reassure you? |
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• need help from an assistance dog |
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or specialist aid, such as a white |
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stick? |
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• need someone to be w th you to |
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keep you safe or stop you gett ng |
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This includ |
s help you have and |
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help you n d but don't get. |
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for |
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Q13b – Do you n |
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Not |
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||||||
d h lp g tting |
Yes |
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|||||||
to somewhere you don't |
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No |
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|||||
know well? |
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By this we mean do you: |
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S metimes |
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• need to be encouraged |
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to go out or have someone |
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with you when going out to |
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reassure you? |
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• need help from an assistance |
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dog or specialist aid, such as a |
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white stick? |
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• need someone to be with you |
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to keep you safe or stop you |
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getting lost? |
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• need help using public |
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transport? |
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|
This includes help you have and help you need but don't get.
PIP2 June 2018
26 of 33
Q13 – Going out continued
Q13c – Are you unable to go out because of severe anxiety or distress?
Yes
No
Sometimes
|
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|
Q13d – Extra information - Going out |
|
only |
|||||
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|
||||
|
Tell us more about any difficulties you have when planning and following a route: |
|||||||
|
• tell us how your condition affects you doing this activity |
|
|
|
||||
|
• |
tell us how you manage at the moment and the problems you have when you can't do |
||||||
|
|
this activity |
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|
• |
tell us how long it takes you to complete this activity |
|
|
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|
||
|
• |
does whether you can do this vary throughout the day? Tell us ab ut g d a d bad |
||||||
Specimen |
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|
|||||
|
|
days |
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|
use |
||
|
• |
does whether you can do this depend on where you're g i g? |
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||||
|
• |
do you experience any other difficulties, either duri |
g or after the activity, like anxi ty |
|||||
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|
or distress? |
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|
• |
tell us about the help you need from anoth r p rso |
when planning and following a |
|||||
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|
journey. This includes help you have and help you |
d but don't get |
|||||
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for |
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Not |
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If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
27 of 33
Q14 – Moving around
iUse page 11 of the Information Booklet to help answer these questions.
Tell us about whether you can physically move around
This means how well you can walk and if you need to use aids and appliances to get around.
Tick the boxes that apply to you then provide more information in the Extra
information box. |
|
|
|
|
|
only |
|
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|
|
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|
|
|
|
Q14a – How far can you walk |
|
Less than 20 metres |
|
||||
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|
||||||
taking into account any |
|
Between 20 and 50 metres |
|
||||
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|
||||||
aids you use? |
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|
|||
To give you an idea of |
|
Between 50 and 200 metres |
|||||
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|||||||
distance, 50 metres is |
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||||||
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|||
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|
|||
approximately 5 buses |
|
200 metres or m re |
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|
|||
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|
|||||
parked end to end. |
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||||
|
It varies |
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use |
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|||
Specimen |
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|||||
Q14b – Do you use an aid or |
|
Y s |
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|
||
appliance to walk? |
|
No |
|
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|
||
Walking aids include: |
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|
|||
• walking sticks |
|
|
|
So ti s |
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|
• walking frames |
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|
• crutches, and |
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for |
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|
• prostheses |
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|
Q14c – Do you use a wheel ha r |
|
Yes |
|
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|
||
or similar d vi |
to move |
|
No |
|
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|
|
around saf ly, r |
liably |
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|
||
|
Not |
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|
|||
and r p at dly and in a |
|
Some imes |
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|
|||
reasonable time p riod? |
|
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|
|
|
PIP2 June 2018
28 of 33
Q14d – Extra information - Moving around
Tell us more about any difficulties when moving around: |
|
|
|
|
||
• tell us how your condition affects you doing this activity |
|
|
|
|
||
• |
tell us how you manage at the moment and the problems you have when you can't |
|||||
|
do this activity |
|
|
|
|
|
• |
tell us how long it takes you to complete this activity |
|
|
|
|
|
• |
does whether you can do this activity vary throughout the day? Tell us about good |
|||||
• |
and bad days |
|
only |
|||
|
|
|||||
do you regularly fall? Do you find it difficult to move around on certain ground |
||||||
|
surfaces? |
|
|
|
|
|
• |
do you use a wheelchair? Is it motorised or manual? |
|
|
|
|
|
• |
do you experience any other difficulties, either during or after the activity, ike pain, |
|||||
|
breathlessness, tiredness, dizziness or anxiety? |
|
|
|
|
|
• |
tell us about the aids or appliances you need to use when m vi |
g ar u |
d |
|||
• |
tell us about the help you need from another person when m |
vi g ar |
u d. This |
|||
|
includes help you have and help you need but don't get |
|
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use |
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Specimen |
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for |
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Not |
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|
If you need to add more please continue at Q15 Additional information.
PIP2 June 2018
29 of 33
Q15 – Additional information
Tell us anything else you think we should know about your health conditions or disabilities and how these affect you, that you haven't mentioned already.
• If any carers, friends or family want to provide further information they can do it here
• You don't have to complete this part if you've covered everything in
the form |
|
only |
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||
Specimen |
use |
||
|
Not |
for |
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|
Continue on separate pieces of paper, if needed. Remember to write your name and National Insurance number at the top of each page and tell us which questions your comments refer to.
PIP2 June 2018
30 of 33
Section 4 - What to do now
Also see page 11 of the Information Booklet.
•Check you've answered all the questions and sign the declaration in ink
•Place this form in the envelope provided so that the address on the back page shows through the window
After we've received your form we may contact you to arrange a
This will give you the chance to tell us more about how your health co |
dition |
||||
or disability affects your daily life. If you've given us enough informatio |
, we |
||||
might not need to see you. |
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|
|
If we ask you to go to a |
r we |
||||
can't decide if you're able to get PIP. |
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|
Specimen |
use |
||||
Coming to a |
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|
|
You'll be able to take someone with you. If you ca |
't atte d on the date |
||||
given, you can contact the health prof ssional to r |
arra |
ge. Theonlyconsultation |
|||
will last about an hour, it's not a full physical xami atio |
, but the health |
||||
professional will talk to you to understand how your h alth condition or |
|||||
disability affects your daily life. |
|
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|
Tell us about any help you (or so eone you bring with you) would need if you |
|||||
have to go for a |
for |
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Not |
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PIP2 June 2018
31 of 33
Declaration
We cannot pay any benefit until you’ve signed the declaration and returned the form to us. Please return the signed form straightaway.
I declare that the information I have given on this form is correct and complete.
I understand if I give wrong or incomplete information, my benefit may |
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only |
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be stopped and I may be prosecuted or may have to pay a penalty. |
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I understand I must promptly tell the office that pays my Personal |
|
|
||||||||
Independence Payment of anything that may affect my entitlement to, |
|
|
||||||||
or the amount of, that benefit. |
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|
||||
This is my claim for Personal Independence Payme |
t. |
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|||||||
Signature |
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Date |
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/ |
/ |
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|||||
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use |
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Specimen |
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||||||||
Print your name here |
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||||||
How the Department for Work and Pensions c llects and uses information |
||||||||||
When we coll ct information about you we may use it r any |
f ur |
|
|
|||||||
purposes. Th se include d aling with: |
for |
|
|
|||||||
• |
social security b n |
fits and allowances |
|
|
||||||
• |
child su |
ort |
|
Not |
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|
||||
|
|
|
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|
||||||
• |
employment and training |
|
|
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|
|||||
• |
financial |
lanning for retirement |
|
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|
|||||
• |
occu ational and |
ersonal pensi |
n schemes |
|
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|
|
We may get information about you from others for any of our purposes if the law allows us to do so. We may also share information with certain other organisations if the law allows us to.
To find out more about how we use information, visit our website
PIP2 June 2018
32 of 33
Please return the completed form to this address
Specimen |
use |
Put the completed form in the e velope provided, |
|
making sure the address shows through theonlyenvelope |
|
window. The envelope do sn’t d a stamp unle you |
live outside the United Kingdom. If you’ve access to the |
|
internet, you can get infor ation about Personal |
|
Independence Pay |
for |
ent by going to the Pe sonal |
|
Independence Pay |
ent website at www.gov.uk/pip |
Not |
33 of 33