HCSUS Second Follow-Up Questionnaire Table of Contents

Module 1: Introduction

Module 2: Usual Source of Care and Oral Health

Section A: Usual Source of Medical Care
Section B: Oral Health

Module 3: Tests and Staging

Section A: CD4 Tests
Section B: Viral Load Test
Section C: Clinical Stage

Module 4: Symptoms and Treatment

Section A: Symptoms Checklist
Section B: Treatments

Module 4.5: Antiretroviral and Opportunistic Infection Medication

Module 5: Insurance

Section A: Medicaid
Section B: Medicare
Section C: Other Public Insurance
Section D: Private Insurance
Section E: Clinical Trials

Module 6: Utilization

Section A: Services Used
Section B: Inpatient Hospital Stays
Section C: Nursing Home/Residential Care
Section D: Visits to Emergency Rooms and Urgent Care Centers
Section E: Medical Visits
Section F: Mental Health Providers
Section G: Other Health Care Visits
Section H: Home Health Services
Section I: Cost of Care and Services
Section J: Pharmacy

Module 7: Residential History

Module 8: Quality of Life

Section A: Current Health
Section B: Health-Related Quality of Life

Module 9: Social Support and Coping

Section A: Social Support
Section B: Coping
Section C: Patient Satisfaction

Module 10: Unmet Needs

Section A: Competing Needs
Section B: Unmet Non-Medical Needs

Module 11: Substance Use and Spirituality

Section A: Drug Dependence
Section B: Alcohol Use
Section C: Spirituality

Module 12: Patient Description

Section A: Employment and Household
Section B: Income and Assets

Module 13: Knowledge

Section A: Perceptions About Therapies

Module 14: Contact and Tracking Information

Module 15: Provider Consent, Thank You, and Payment