Table of Contents
Advertisement
Appendix A
30
Are you having difficulty swallowing?
31
Have you had a fall in the last day?
32
Are you having difficulty taking care of your wound?
33
Have your hands or face been more swollen in the last day?
34
Has there been any protein in your urine in the last day?
35
Do you have severe heartburn today?
36
Have you noticed a decrease in your baby's movement today?
37
Have you had any blurred vision today?
38
Have there been any changes in the medication you are taking?
39
Are you having difficulty following your weight loss plan?
40
Are you having difficulty following your exercise plan?
41
Do you feel more anxious or upset today?
42
Has you been more depressed this week compared to a normal week?
43
Are you having difficulty managing stress this week compared to a normal week?
44
Are you having difficulty following your smoking cessation plan?
45
Are you having difficulty following your alcohol reduction plan?
46
Are you having difficulty understanding your diagnosis?
47
Have you had 2 plus or greater protein in your urine today?
48
Have you been to the emergency room this week?
49
Were you admitted to the hospital any time this week?
50
Has your doctor added, deleted, or changed any of your medications this week?
51
Did you have an unexpected visit to your physician this week?
A - 2
© 2014 Honeywell HomMed. All rights reserved.
P4820EN.04
4/16/14
Advertisement
Table of Contents
