Case ID
Municipality
Settlement type
Who has completed the questionnaire
PwD's sex
PwD's age
Caregiver's sex
Caregiver's age
Does the person with the disability (Do you) have a physical disability?
Does the person with the disability (Do you) have a mental disability?
Does the person with the disability (Do you) have a hearing disability?
Does the person with the disability (Do you) have a vision disability?
Does the person with the disability (Do you) have an intellectual disability?
Need of service: Professional orientation and career planning
Need of service: Support with finding/participating in preparatory courses
Need of service: Help with finding work and the job search process
Need of service: Foreign language and computer skill courses
Need of service: Help in identifying and taking part in preparatory courses
Do you need or not need - In home care services
Do you need In home care 24 hours, several times a day,or on an on-demand basis?
Do you need or not need - Personal assistant
Do you need PA 24 hours, several times a day, or on an on-demand basis?
Need of service: Day centers
Need of service: Psychological consultations
Need of service: Delivery of therapeutic services
Need of service: Recreational services
Need of service: Funding for Transportation
Need of service: Adapted transportation services
Need of service: Transport card
Need of service: Identification or diagnosis of developmental disorders
Need of service: Development of functional skills
Need of service: Psychological consultation
Need of service: Development of motor skills
Need of service: Development of cognitive skills
Need of service: Behavioral regulation
Need of service: Sensory therapy
Need of service: Language and speech development
Need of service: Parental consultations
Need of service: Identification or diagnosis of disorders
Need of service: Cognitive skill rehabilitation
Need of service: Rehabilitation of functional skills
Need of service: Language and speech rehabilitation
Need of service: Motor skill rehabilitation
Need of service: Consultations for caregivers
Need of service: Personal alarm system
Need of service: Personal digital assistant and internet connection
Need of service: Handles/ handrails
Need of service: Removal of barriers to entrance to the home
Need of service: Landscaping (flattening/correction of surfaces in the yard)
Need of service: Railing installation
Need of service: Medication organizer
Need of service: Active mechanical wheelchair
Need of service: Passive mechanical wheelchair
Need of service: Mechanical wheelchair with posture control
Need of service: Electric wheelchair
Need of service: Electric wheelchair with posture control
Need of service: Walker on wheels
Need of service: Walker without wheels
Need of service: Standing supports
Need of service: Cane
Need of service: Crutches
Need of service: Tricycle/ Scooter
Need of service: Therapeutic shoes
Need of service:  Lower limb orthosis
Need of service: Upper limb orthosis
Need of service: Lower limb prosthesis
Need of service: Spine orthosis (Corset)
Need of service: Pressure relief cushion (for bed rest)
Need of service: Pressure relief mattress (for bed rest)
Need of service: Transfer board (For transfer from one surface to another)
Need of service: Crane (For transfer from wheelchair to bed and vice versa)
Need of service: Bathroom, shower, toilet chair
Need of service: Portable ramp
Need of service: Pelvic abductor (in case of pelvic dysplasia in children)
Need of service: Diapers
Need of service: Excrement receiving container
Need of service: One time use care products
Need of service: Keyboard and mouse control software
Need of service: Installation of a ramp at the entrance of one’s residence
Need of service: Adapted  bathroom
Need of service: White cane
Need of service: Glasses
Need of service: Magnifying glass, magnifying glass with light
Need of service: Portable (tablet) maginifier
Need of service: Stationary magnifier
Need of service: Screen sound software- JOWS, NVDA
Need of service: Audio player with DAISY function
Need of service: Braille display (for bookmarks)
Need of service: Braille type-writer
Need of service: Audio watch
Need of service: Screen reader
Need of service: Audio warning or vibration signal
Need of service: Accompanying services for blind or visually impaired people
Need of service: Mobility/orientation courses for people with limited vision
Need of service:Everyday skills courses for people with blindness/limited vision
Need of service: Braille courses for people with blindness or limited vision
Need of service: Courses on how to use support programs
Need of service: From gesture to voice technology
Need of service: Video communication device
Need of service: Hearing aids (digital) and batteries for the hearing impaired
Need of service: Sound amplifier (Audio (induction) loop / FM systems)
Need of service: Sound amplifier
Need of service: Subtitles/captions
Need of service: Communication board, book, cards
Need of service: Deaf-blind communicator
Need of service: Cochlear implants and hearing/speech therapy
Need of service: Provision of sign language translation services
Need of service: Sign language study courses for deaf people, interested parties
Need of service: Home visit of a multidisciplinary team to monitor situation.
Need of service:Out patient visit of multidisciplinary team to monitor situation
Need of service: Rehabilitation services: Self-care skill improvement
Need of service: Rehabilitation services:Everyday HH & living skills improvement
Need of service: Rehabilitation services: Communication skills improvement
Need of service: Rehabilitation services: Work skill development
Need of service: Rehabilitation services: Time and money management improvement
Need of service: Rehabilitation services: Psychological consultations
Need of service: Rehabilitation services: Consultations on treatment /medication
Need of service: Self-help groups or patient clubs
Need of service: Crisis services  - Removal from a dangerous family situation
3 most important services: In home care services
3 most important services: Personal assistant services
3 most important services: Day center services
3 most important services: Pshychological consultations/ support
3 most important services: Skill development or recovery  services
3 most important services: Provision of skill development services at home
3 most important services: Adaption of the home
3 most important services: Transfer devices such as a crane or transfer board
3 most important services: Bath room, toilet chair
3 most important services: Entertainment services
3 most important services: Employment services
3 most important services: Transportation services
3 most important services: Mobility devices (Wheelchairs, canes) and cushions
3 most important services: Orthosis and prosthesis
3 most important services: Portable ramps
3 most important services: Personal alarm system
3 most important services: Personal digital assistant
3 most important services: Medication organizer
3 most important services: Excrement receiving container
3 most important services: Care products
3 most important services: Mouse and keyboard management programs
3 most important services: Other
3 most important services: Home visit of a multidisciplinary team
3 most important services: Out patient visit of a multidisciplinary team
3 most important services: Rehabilitation services: Self-care skill improvement
3 most important services: Every day household and living skills improvement
3 most important services: Communication skills improvement
3 most important services: Work skill development/ training during working
3 most important services: Time and money management improvement
3 most important services: Psychological consultations/ psychotherapy
3 most important services: Self-help groups or patient clubs
3 most important services: Psychological consultation/ psychotherapy
3 most important services: Home care service
3 most important services: Personal assistant
3 most important services:Crisis service-Removal from dangerous family situation
3 most important services: Medicine organizer
3 most important services: Cochlear implant, hearing, speech therapy
3 most important services: Sign language translation services
3 most important services: Sign language study courses
3 most important services: Employment support services
3 most important services: Hearing aids (digital) and batteries
3 most important services: Communication board/ book/ cards
3 most important services: From gesture to voice technology
3 most important services: Video communication device
3 most important services: Sound amplifier  (Hearing (induction) / FM Systems)
3 most important services: Subtitles / Captions
3 most important services: Accompaniment service
3 most important services: Mobility/Everyday skills/Braille/software courses
3 most important services: White cane
3 most important services: Glasses
3 most important services: Magnifiers- glass,portable,stationary magnifier
3 most important services: Screen reading and description programs - JOWS, NVDA
3 most important services: Audio player with DAISY functions
3 most important services: Braille displayer
3 most important services: Braille type writer
3 most important services: Audio watch
3 most important services: Home adaptation
3 most important services: Audio warning signal
3 most important services: Employment related services
3 most important services: Psychological consultation/ support
3 most important services: Transportation related services
3 most important services: Screen reader
Which ethnic group do you consider yourself a part of?
PwD's level of education
Caregiver's level of education
How many adults aged 65 or older including you live in the household?
How many adults aged 18 -64 including you live in the household in total?
How many children 17 or younger live in the household in total?
Household owns/does not own - Fridge
Household owns/does not own - Color TV
Household owns/does not own - A smartphone
Household owns/does not own - Tablet computer
Household owns/does not own - Automobile
Household owns/does not own - AC
Household owns/does not own - Automatic washing machine
Household owns/does not own - Computer
Household owns/does not own - Hot water
Household owns/does not own - Central heating