Over the past 6 months, when I received care for my chronic conditions, I was: None of A Little of Some of Most of Always the Time the Time the Time the Time Asked for my ideas when we 1 2 3 4 5 made a treatment plan. choices about treatment to 1 2 3 4 5 think about. Asked to talk about any problems 1 2 3 4 5 with my medicines or their effects. Given a written list of things I 1 2 3 4 5 should do to improve my health. Satisfied that my care was well 1 2 3 4 5 organized. how what I did to take care 1 2 3 4 5 of myself influenced my condition. Asked to talk about my goals in 1 2 3 4 5 caring for my condition. Helped to set specific to 1 2 3 4 5 improve my eating or exercise. a copy of my treatment plan. 1 2 3 4 5 Encouraged to go to a specific group or class to help me cope 1 2 3 4 5 with my chronic condition. Asked questions, either directly or on a survey, about my health 1 2 3 4 5 habits. Sure that my doctor or nurse thought about my values, beliefs, 1 2 3 4 5 and traditions when they recommended treatments to me. Helped to make a treatment plan that I could carry out in my daily 1 2 3 4 5 life. Helped to plan ahead so I could take care of my condition even in 1 2 3 4 5 hard times. Cont’d Patients Over the past 6 months, when I received care for my chronic conditions, I was: None of A Little of Some of Most of Always the Time the Time the Time the Time
Over the past 6 months, when I received care for my chronic conditions, I was: None of the Time A Little of the Time Some of the Time Most of the Time Always Asked for my ideas when we made a treatment plan. 1 2 3 4 5 choices about treatment to think about. 1 2 3 4 5 Asked to talk about any problems with my medicines or their effects. 1 2 3 4 5 Given a written list of things I should do to improve my health. 1 2 3 4 5 Satisfied that my care was well organized. 1 2 3 4 5 how what I did to take care of myself influenced my condition. 1 2 3 4 5 Asked to talk about my goals in caring for my condition. 1 2 3 4 5 Helped to set specific to improve my eating or exercise. 1 2 3 4 5 a copy of my treatment plan. 1 2 3 4 5 Encouraged to go to a specific group or class to help me cope with my chronic condition. 1 2 3 4 5 Asked questions, either directly or on a survey, about my health habits. 1 2 3 4 5 Sure that my doctor or nurse thought about my values, beliefs, and traditions when they recommended treatments to me. 1 2 3 4 5 Helped to make a treatment plan that I could carry out in my daily life. 1 2 3 4 5 Helped to plan ahead so I could take care of my condition even in hard times. Cont’d 1 2 3 4 5 Patients Over the past 6 months, when I received care for my chronic conditions, I was: None of the Time A Little of the Time Some of the Time Most of the Time Always