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|
For all |
For most |
For half |
For some |
For none |
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|
0 |
1 |
2 |
3 |
4 |
1 |
Do you know the reason for taking your medication? |
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|
|
|
|
2 |
Do you know the dosages of your medication? |
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3 |
Are you familiar with the timing for taking the medication? |
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|
|
|
|
|
|
All |
Most |
Half |
Some |
None |
|
|
0 |
1 |
2 |
3 |
4 |
4 |
Do you take your medication regularly? |
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|
|
|
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5 |
Do you know the names of medications you are taking? |
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|
|
|
|
|
|
Never |
Rare |
Sometimes |
Often |
Mostly |
|
|
0 |
1 |
2 |
3 |
4 |
6 |
Do you forget to take your medication? |
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|
|
|
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7 |
Are you untroubled about taking the medication? |
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8 |
Do you stop taking your medication when you feel better? |
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9 |
Do you stop taking your medication if you sometimes feel worse after taking the medication? |
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10 |
Do you take any wrong or other/unprescribed medications (such as those of your partner)? |
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If you think you have side effects due to of the medications (such as tremors, nausea, etc) |
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11 |
Do you reduce the dose without consulting a doctor? |
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12 |
Do you not take the medication for a while, ie, take a break? |
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|
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13 |
If you feel you have to take too many, do you stop taking those medications you consider to be less important than the others without consulting your doctor? |
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If you forget or omit your medication, do you forget it… |
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|
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14 |
in the morning? |
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|
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15 |
at noon? |
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16 |
in the evening? |
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17 |
Do you deliberately not take medications you do not consider important, but take the rest? |
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18 |
If you take medication as a syringe or a weekly tablet, have you ever forgotten it? |
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