CONTINUOUS WEIGHT LOSS A
INVOLUNTARY URINATION B
INVOLUNTARY BOWEL MOVEMENTS C
BOTH INVOLUNTARY URINATION AND BOWEL MOVEMENTS D
CONSTANTLY WET E
NAUSEATING ODORS F
DIFFICULTY MOVING G

CONTINUOUS WEIGHT LOSS A
INVOLUNTARY URINATION B
INVOLUNTARY BOWL MOVEMENTS C
BOTH INVOLUNTARY URINATION AND BOWEL MOVEMENTS D
CONSTANTLY WET E
NAUSEATING ODORS F
LOCOMOTIVE DISABILITY G
OTHERS (SPECIFY) _____ X
DON'T KNOW Y

A CONTINUOUS WEIGHT LOSS
B INVOLUNTARY URINE LEAKAGE
C INVOLUNTARY STOOL LEAKAGE
D INVOLUNTARY URINE AND STOOL LEAKAGE
E CONSTANT WETNESS
F FOUL-SMELLING ODORS
G RELATED LOCOMOTIVE DISABILITY
X OTHERS (SPECIFY)
Y DON'T KNOW