| Always | Sometimes | Rarely | Never | |
| (a.) Primary Prevention of Stroke | 3 | 2 | 1 | 0 |
| (b.) Prevention of Recurrence of Stroke | 3 | 2 | 1 | 0 |
| (c.) History of Acute Chest Syndrome | 3 | 2 | 1 | 0 |
| (d.) Renal Failure | 3 | 2 | 1 | 0 |
| (e.) Congestive Heart Failure | 3 | 2 | 1 | 0 |
| (f.) Pulmonary Hypertension | 3 | 2 | 1 | 0 |
| (g.) Recurrent Debilitating Painful Episodes | 3 | 2 | 1 | 0 |
| (h.) Nonhealing Leg Ulcers | 3 | 2 | 1 | 0 |
| (i.) Prevention of Recurrence of Priapism | 3 | 2 | 1 | 0 |
| (j.) Uncomplicated Pregnancy | 3 | 2 | 1 | 0 |
| (k.) Other indications (please specify): | 3 | 2 | 1 | 0 |
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