From: CONECT-6: a case-finding tool to identify patients with complex health needs
Questions | Answers | |
---|---|---|
1. In general, would you say your health is fair or even poor? | Yes | No |
2. Do you have pain or discomfort preventing most of your activities? | Yes | No |
3. In the past 12 months, do you consider your health needs were met less than half of the time? | Yes | No |
4. Do your interactions with the health system and health professionals ever make you feel like you have complex health problems? | Yes | No |
5. Is your household income from all sources before taxes and other deductions less than $20,000? | Yes | No |
6. In the past 12 months, have you rarely or even never received support from friends or relatives when you needed it? | Yes | No |
Number of yes and no answers | ____ | ____ |