Screening Tool Topic B. Health & Comorbidities Patient Details Patient Name: Patient ID: DASHBOARD Quiz 🎯Topic B. Health & Comorbidities B1. Number of Chronic Illnesses Can you please let me know of any chronic illnesses you have been diagnosed with (e.g., diabetes, cardiovascular diseases, pulmonary diseases, neurological disorders)?*Count the number of the diseases reported 1-3 diseases 4 or more No diseases Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B2. Number of Medications Taken How many medications do you currently take? No medications 1-2 medications 3-5 medications > 5 medications Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B3. Mobility How would you describe your mobility? Are you able to drive, do you use mobility aids, or are you unable to drive? Able to drive Unable to drive (no aids) Using mobility aids Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B4. Mental Disorder Diagnosis Have you ever been diagnosed with any mental health conditions such as depression, anxiety, or other? Yes No Maybe Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B5. Family History of Mental Health Disorders Has anyone in your family (incl. mom or dad) ever experienced symptoms like feeling very sad for a long period of time, irrational behaviours, or other signs that could indicate mental health issues?" Yes No Maybe Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B6. Mental Health Professionals Do you currently have a psychiatrist, neurologist, or psychologist? Yes No Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B7. Pain Intensity and Frequency Can you describe the intensity and frequency of any pain you experience? Would you say it is none, mild, moderate, or severe? No Mild Moderate Severe Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B8. Hearing Impairment Do you experience difficulty with your hearing, such as trouble hearing conversations or sounds? Yes No Maybe Not able to assess / Unwillingness to respond 🎯Topic B. Health & Comorbidities B9. Visual Impairment Do you experience vision problems, such as difficulty seeing objects or reading? Yes No Maybe Not able to assess / Unwillingness to respond Next question ➜ ANSWERS