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| 1. In the past week, did you take pills for diabetes? |
No Yes Don't know |
| Please specify the name(s) of the diabetes pills you took: | |
| 2. In the past week, did you get insulin injections? |
No Yes Don't know |
| 3. In the past week, did you take pills for high blood pressure? |
No Yes Don't know |
| Please specify the name(s) of the blood pressure pills you took: | |
| 4. In the past week, did you take pills for cholesterol? |
No Yes Don't know |
| Please specify the name(s) of the cholesterol pills you took: | |
These are single items only. Score No="0", Yes="1", Don't know=blank. You may code the names of the medications if you wish to track them, but they are mainly used to correct scoring, i.e., "hydrochlorothiazide" under cholesterol medications should be coded instead under hypertension medications.
We have not tested this scale in English.
This is the English translation of the Spanish scale. We have not tested this scale in English.
When conducting community-based studies, it is not always possible to do chart audits. This scale can be used to give some idea of the medication use of subjects in such studies.
Unpublished.
To download this scale and scoring instructions, right click the link below with your mouse and "Save as" to you hard disk or desktop (for Windows), or double click (Mac):