Are you evaluating a person living in the community?

Does the person have health insurance?

Number of months without health insurance

Is the person a recluse living alone (elderly, unable to travel, agoraphobia, etc)?

Does the person refuse to see a healthcare provider?

Does the person have no access to a healthcare provider (rural or other remote location)?

Is the person symptomatic with the symptoms ignored or thought to be insignificant?

Does the person have a hectic schedule with no time for a health checkup?

Is the person cared for by soomeone who is neglecting his or her care?


Please fill out required fields.