Medical Needs Assessment

1. Medical Needs

1. Are you able to afford all the medication you need?
2. If no, do you receive assistance from any of the following? (choose all that apply).
3. Do you have transportation to and from medical appointments?
4. Who provides your transportation?
5. Are you currently the primary caregiver for someone with illness or disability?
6. Do you have access to services that assist you with caregiving?
7. What caregiving services would you access if they were available? (choose all that apply)
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