Please complete this checklist during the client interview. Ask the client to rate each concern on a scale from 1-4.
1=no concern, 2=somewhat concerned, 3= concerned and 4=very concerned.
Feel free to fill this document out online and save it to your computer before printing or to print it and fill it out by hand.
Sections
- Language Access/Translation Services
- Enrolling in HIV Care and Treatment
- Childcare
- Disclosure
- Prevention
- Paying for Healthcare
- Medication Adherence
- Finding a Provider
- Housing Assistance
- Food Assistance
- Employment Assistance
- Substance Use/Treatment
- Mental Health Services
- Intimate Partner Violence Assistance
- Transportation
- Other Concerns
13 pages