Doesn’t Know Doesn’t Know Refused Refused HIV/AIDS Doesn’t Know Doesn’t Know Refused Refused Mental Health Problem Doesn’t Know Doesn’t Know Refused Refused Alcohol Abuse Doesn’t Know Doesn’t Know Refused Refused Drug Abuse Doesn’t Know Doesn’t Know Refused Refused Both Alcohol and Drug Abuse Doesn’t Know Doesn’t Know Refused Refused In permanent housing? Yes No If yes, date of move-in: _______/________/_____________
Doesn’t Know Refused Doesn’t Know Refused HIV/AIDS Doesn’t Know Refused Doesn’t Know Refused Mental Health Problem Doesn’t Know Refused Doesn’t Know Refused Alcohol Abuse Doesn’t Know Refused Doesn’t Know Refused Drug Abuse Doesn’t Know Refused Doesn’t Know Refused Both Alcohol and Drug Abuse Doesn’t Know Refused Doesn’t Know Refused In permanent housing? Yes No If yes, date of move-in: _______/________/_____________