Screening Tool Topic A. Demographic Characteristics Patient Details Patient Name: Patient ID: DASHBOARD Quiz 🎯 Topic A. Demographic Characteristics A1. Gender Can you please tell me your gender? If you prefer not to answer, that's completely fine Male Female Non-Binary Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A2. Education Level What is the highest level of education you have completed (count the years)? Illiterate (less than 3 years of education) Primary school (3-6 years) Secondary school (7-12 years) Tertiary education (>12 years) Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A3. Income Level Could you tell me about your current income level? Would you say it is on the no/low, moderate, or high range? If you prefer not to answer, that's fine too. No/Low Moderate High Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A4. Age How old are you? 70 or less years old 71 or more years old Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A5. Area of Residence Can you tell me about the area where you live? Is it urban, suburban, or rural? Rural (Low population density, natural environment, limited amenities and infrastructure) Semi-rural (Moderate population density, balanced amenities, mixed residential-commercial areas) Urban (High density, extensive amenities, developed infrastructure) Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A6. Living Arrangement Who do you live with? Do you live alone, with family, or in a care facility? Alone With family / others In a care facility Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A7. Minority Status Are you a member of a group that is smaller in number or has less representation compared to the larger community (e.g., due to your ethnicity, religion, etc)? Yes No Not able to assess / Unwillingness to respond 🎯Topic A. Demographic Characteristics A8. Community disaster impact Has your community experienced any disasters recently, such as natural disasters like fires or floods, or unnatural disasters like wars or conflicts? Not particularly Natural disaster (e.g., fire, flood) Unnatural disaster (e.g., war, conflict) Not able to assess / Unwillingness to respond Next question ➜ ANSWERS