APPENDIX C
EUROQOL INSTRUMENT AND WEIGHTING SCHEME
Instructions: Responses to the form check boxes correspond to the values listed in the table provided. For subjects residing in the United States, the form is scored by subtracting the corresponding numbers from 1.0. For subjects in the United Kingdom, it's necessary to subtract 0.081 if any value is above 0. If any value is above 3, it is necessary to both subtract 0.081 and add 0.269.
By placing a check in one box in each group, please indicate which statements best describe your own health state today.
EXHIBIT 1. EuroQol 5D Health Domains
| Mobility | |
| I have no problems in walking about |  |
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