44. Your loved one threatened to physically attack a family member other than you 45. Your loved one actually physically attacked a family member other than you 46. Your loved one actually physically hurt a family member other than you 47. Another family member threatened to physically attack your one 48. Another family member actually physically attacked your one 49. Another family member actually physically hurt your loved one 50. Your loved one injured him/herself on purpose 51. Your loved one intentionally damaged or destroyed property or possessions PAST 30 DAYS HOW OFTEN HAVE YOU HOW BOTHERED WERE YOU BY – EXPERIENCED THE PROBLEM? THE PROBLEM? DEAL ALL AT GREAT LITTLE LOT OCCASIONALLY NEVER RARELY ALMOST NOT A SOMEWHAT A A FREQUENTLY 52. You dealt with legal problems related to your loved one List other legal problems below please print – 52a. 52b. 52c. 52d. 52e. HEALTH PAST 30 DAYS HOW OFTEN HAVE YOU HOW BOTHERED WERE YOU BY – EXPERIENCED THE PROBLEM? THE PROBLEM? DEAL LWAYS ALL AT GREAT LITTLE LOT NEVER RARELY OCCASIONALLY ALMOST NOT A A A FREQUENTLY SOMEWHAT 53. Experienced your own medical problems 54. Took prescribed medication for a physical condition
44. Your loved one threatened to physically attack a family member other than you 45. Your loved one actually physically attacked a family member other than you 46. Your loved one actually physically hurt a family member other than you 47. Another family member threatened to physically attack your one 48. Another family member actually physically attacked your one 49. Another family member actually physically hurt your loved one 50. Your loved one injured him/herself on purpose 51. Your loved one intentionally damaged or destroyed property or possessions – PAST 30 DAYS HOW OFTEN HAVE YOU EXPERIENCED THE PROBLEM? HOW BOTHERED WERE YOU BY THE PROBLEM? NEVER RARELY OCCASIONALLY FREQUENTLY ALMOST NOT AT ALL A LITTLE SOMEWHAT A LOT A GREAT DEAL 52. You dealt with legal problems related to your loved one List other legal problems below – please print 52a. 52b. 52c. 52d. 52e. HEALTH – PAST 30 DAYS HOW OFTEN HAVE YOU EXPERIENCED THE PROBLEM? HOW BOTHERED WERE YOU BY THE PROBLEM? NEVER RARELY OCCASIONALLY FREQUENTLY ALMOST LWAYS NOT AT ALL A LITTLE SOMEWHAT A LOT A GREAT DEAL 53. Experienced your own medical problems 54. Took prescribed medication for a physical condition
optional_module_11_-_impact_of_use_on_family_member.docx