Question

1. has the pain limited or restricted your activities? yes no

if yes, explain and provide examples.

Explanation:

Analyze the image content

The image shows a question from a medical intake form or health questionnaire:
"6) Has the pain limited or restricted your activities? [Checked Box] Yes [ ] No
If yes, explain and provide examples. _____________________________________"

Identify the checked option

The checkbox next to "Yes" is checked with a pen mark.

Formulate the transcription

Transcribe the question text and represent the checked "Yes" option and the blank line for explanation.

Answer:

1. Has the pain limited or restricted your activities? <blank>Yes</blank> No

If yes, explain and provide examples. <blank>_____________________________________</blank>