Are you evaluating a patient who needs to complete a long-term therapeutic regimen?

Does/Is the patient?

• have difficulty affording transportation to the clinic?

• have small children?

• work or have little free time during the week?

• fluent in English?

• unable leave home?

• tend to forget appointments?

• have a problem with substance abuse?

• have problems with adequate housing or other social needs?

• have other medical conditions?

• have problems getting enough food to eat?

• need clothing or personal care products?

• like to read?

• need money?


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