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| Question | Scoring |
|---|---|
| 1. Do you ever forget to take your (name of health condition) medicine? | 1, Yes; 0, no |
| 2. Do you ever have problems remembering to take your (name of health condition) medication? | |
| 3. When you feel better, do you sometimes stop taking your (name of health condition) medicine? | |
| 4. Sometimes if you feel worse when you take your (name of health condition) medicine, do you stop taking it? |
