Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

Annual Wellness Health Risk Assessment Questionnaire, Exams of Health sciences

Kent State University (KSU) - Stark CampusHealth sciences

A health risk assessment questionnaire for patients in preparation for their Annual Wellness Visit. It includes questions about their overall health, quality of life, mental health, pain, daily activities, and specific health conditions. The questionnaire aims to help healthcare providers address areas important to the patient's overall well-being.

Typology: Exams

2021/2022

Uploaded on 03/31/2022

maraiah
maraiah 🇺🇸

3.3

(3)

253 documents

1 / 5

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Place patient sticker here
Annua
l
We
llne
ss Health Risk
Assessment
1
Rev 9/5/17
To our patients:
This Medicare health assessment questionnaire is part of your upcoming Annual
Wellness Visit. Please answer the following questions about your health and day to
day activities.
This questionnaire will help your clinical team address the areas important to your
overall well- being.
This questionnaire should take about 5 minutes to complete.
If you need help, please contact the medical staff, or ask for help during your visit.
Thank you.
pf3
pf4
pf5

Partial preview of the text

Download Annual Wellness Health Risk Assessment Questionnaire and more Exams Health sciences in PDF only on Docsity!

To our patients:

This Medicare health assessment questionnaire is part of your upcoming Annual

Wellness Visit. Please answer the following questions about your health and day to

day activities.

This questionnaire will help your clinical team address the areas important to your

overall well- being.

This questionnaire should take about 5 minutes to complete.

If you need help, please contact the medical staff, or ask for help during your visit.

Thank you.

Please answer the following questions to the best of your ability.

  1. In general, how would you rate your overall health:

 Excellent  Very Good  Good  Fair  Poor

  1. In general, how would you rate your quality of life:

 Excellent  Very Good  Good  Fair  Poor

  1. In general, how would you rate your mental health, including your mood and your ability to think?

 Excellent  Very Good  Good  Fair  Poor

  1. In the past 7 days , how much did pain interfere with your day to day activities?

 Not at all  A little bit  Somewhat  Quite a bit  Very Much

  1. Over the last 2 weeks , how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day Little interest or pleasure in doing things

Feeling down, depressed or hopeless

  1. Do you think you have a hearing problem, or do others think you have a hearing problem?

 No  Yes

  1. Do you have difficulty driving, watching TV, reading, or doing any of your daily activities because of your eyesight?

 No  Yes

  1. How many servings of fruits and vegetables do you eat in a typical day?

 More than 5

servings

 3 - 5 servings  1 - 2 servings  I do not eat

fruits and vegetables

  1. Does the place where you live have the following safety concerns addressed? Yes No

Loose rugs secured  

Carbon Monoxide detector  

Working smoke alarm  

Good lighting in walkways  

Solid hand rails on stairs  

Non-slip flooring in tub or shower, or grab bars

  1. What is your usual form of transportation?

 Drive self  Driven by others  Bus/taxi/para-transit

  1. Do^ you^ have^ an^ Advance^ Healthcare^ Directive^?

 Yes  No

16. Is your Advance Healthcare Directive on file with us?

 Yes  No

17. To ensure optimal care coordination, please list below all providers you see

on a regular basis.

Please wait for your provider to

complete this portion