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Family and Support System Survey

Please take this survey to see how well you are preparing your youth for health care transition

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* 1. Do you understand your youth’s medical condition?

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* 2. Can your youth describe their medical condition?

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* 3. Do you have a plan for your youth's following providers:

  Primary Care Specialty Care  Dental Care  Vision Care
I have a plan for my youth's

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* 4. Do you feel comfortable that your youth can: properly take medications, schedule an appointment, arrange transportation?

  Properly take medications Schedule an appointment Arrange transportation 
I feel comfortable that my youth can

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* 5. Is your youth able to care for self?

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* 6. If your youth is unable to care for self, are you preparing for shared decision making or Guardianship?

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* 7. Do you encourage alone time between your youth and his/her doctor?

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* 8. Do you encourage your youth to ask questions?

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* 9. Does your youth know about the change in privacy at age 18?

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* 10. Do you know how your youth’s medical needs will be paid when they reach adulthood?

0 of 10 answered
 

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