LEVEL 4 LEVEL 3 LEVEL 2 1 of Functioning (4 points) (3 points) (2 points) (1 TREATMENT ADHERENCE (continued) Client has missed multiple History of 3 or more Client has missed no No history of missed scheduled appointments missed appointments in more than 1 appointment appointments in the last ADHERENCE TO in last 60 days. the last 120 days. with appropriate 12 months. APPOINTMENTS OR rescheduling and Client has never attended appointment kept. and HIV medical appointment Score: Client is experiencing Client is experiencing mild Client has a recent history No current report of side severe side effects with side effects with ARV of side effects with ARV effects with ARV ARV MEDICATION SIDE ARV medications; medication. medication. medications; EFFECTS OR OR Client has been newly ARV medication is not prescribed ARV indicated at this time. medication; OR Client is newly diagnosed and has not yet been prescribed ARV Score: medication.
of Functioning LEVEL 4 (4 points) LEVEL 3 (3 points) LEVEL 2 (2 points) 1 (1 TREATMENT ADHERENCE (continued) ADHERENCE TO APPOINTMENTS Score: Client has missed multiple scheduled appointments in last 60 days. OR Client has never attended and HIV medical appointment History of 3 or more missed appointments in the last 120 days. Client has missed no more than 1 appointment with appropriate rescheduling and appointment kept. No history of missed appointments in the last 12 months. ARV MEDICATION SIDE EFFECTS Score: Client is experiencing severe side effects with ARV medications; OR Client has been newly prescribed ARV medication; OR Client is newly diagnosed and has not yet been prescribed ARV medication. Client is experiencing mild side effects with ARV medication. Client has a recent history of side effects with ARV medication. No current report of side effects with ARV medications; OR ARV medication is not indicated at this time.
ELECTRONIC_Standardized_Michigan_HIV_MCM_Acuity_Pilot_Tool_2.2016_517969_7.docx