THIS IS HOW I USUALLY FEEL:
This is how I usually feel:
OK
Sad or Worried
Happy
OK
In Pain
No Pain
This is how I describe my health care needs and concern_ ____________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ My Medications
Name
Amount
Dosage
When Taken
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Taking Charge of My Health Care
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