SC-CII English
Authored by
Barbara Riegel, PhD, RN, FAAN, FAHA
Professor
University of Pennsylvania, School of Nursing
Claire M. Fagin Hall, 418 Curie Boulevard
Philadelphia, PA 19104-4217
briegel@nursing.upenn.edu
215-898-9927 Phone
240-282-7707 eFax
Co-Director, International Center for Self-Care Research www.selfcareresearch.org
<p class=MsoNormal align=center style='text-align:center;line-height:150%'><b><span<!-- [et_pb_line_break_holder] -->style='font-size:14.0pt;line-height:150%'>SELF-CARE OF CHRONIC ILLNESS<!-- [et_pb_line_break_holder] -->INVENTORY v.3a</span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal align=center style='text-align:center;line-height:150%'><i>All<!-- [et_pb_line_break_holder] -->answers are confidential.</i></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><b><span style='font-size:14.0pt'> </span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoHeading9 align=left style='text-align:left;line-height:normal'><span<!-- [et_pb_line_break_holder] -->style='font-weight:normal'>Think about how you have been feeling in the last<!-- [et_pb_line_break_holder] -->month as you complete this survey. </span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:150%'><b><span style='font-size:14.0pt;<!-- [et_pb_line_break_holder] -->line-height:150%'> </span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:150%'><b><span style='font-size:14.0pt;<!-- [et_pb_line_break_holder] -->line-height:150%'>SECTION A:</span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>Listed below are common self-help behaviors that people with<!-- [et_pb_line_break_holder] -->a chronic illness may do. How often or routinely do you do the following?</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:50%'><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] -->line-height:50%'> </span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse;border:none'><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt'> </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Never </span></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6> </h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6>Sometimes</h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'> </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>Always </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>1.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Make sure to get enough sleep?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2.<span style='font:7.0pt "Times New Roman"'> <!-- [et_pb_line_break_holder] --> </span></span><span style='font-size:13.0pt'>Try to avoid getting sick (e.g.,<!-- [et_pb_line_break_holder] --> flu shot, wash your hands)? </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>3.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Do physical activity (e.g., take a brisk walk, use<!-- [et_pb_line_break_holder] --> the stairs)?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt'> 1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>4.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Eat a special diet?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>5.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>See your healthcare provider for routine health care?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>6.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Take prescribed medicines without missing a dose?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>7.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Do something to relieve stress (e.g., medication,<!-- [et_pb_line_break_holder] --> yoga, music)?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='height:27.4pt'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>8.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Do you avoid tobacco smoke? </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:27.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b> </b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b>SECTION B:</b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>Listed below are common things that people with chronic<!-- [et_pb_line_break_holder] -->illness <u>monitor</u>. How often do you do the following?</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse;border:none'><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt'> </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Never </span></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6> </h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6>Sometimes</h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'> </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>Always </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>9.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Monitor your condition?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>10.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Monitor for medication side-effects?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>11.<span style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Pay attention to changes in how you feel?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>12.<span style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Monitor whether you tire more than usual doing<!-- [et_pb_line_break_holder] --> normal activities?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>13.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Monitor for symptoms?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5> </h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5 style='margin-left:.25in;text-indent:-.25in'>14.<span style='font:7.0pt "Times New Roman"'><!-- [et_pb_line_break_holder] --></span>Many patients have symptoms due to their illness or due to the treatment<!-- [et_pb_line_break_holder] -->they are receiving for their illness. The last time you had symptoms … </h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right'>(circle <b>one</b><!-- [et_pb_line_break_holder] -->number)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse;border:none'><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=222 valign=top style='width:166.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 1.45pt 0in 0in'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Have not had<!-- [et_pb_line_break_holder] --> symptoms</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 0in 0in 2.15pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>I did not</b> <b>recognize<!-- [et_pb_line_break_holder] --> the symptom</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 2.15pt 0in 2.15pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Not Quickly</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 0in'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Somewhat Quickly</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 0in'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Very Quickly</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=222 valign=top style='width:166.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 0in 0in 5.75pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt'>How quickly did you<!-- [et_pb_line_break_holder] --> recognize it as a symptom of your illness?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>N/A</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>0</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 style='width:27.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 style='width:49.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b> </b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b>SECTION C:</b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>Listed below are behaviors that people with chronic<!-- [et_pb_line_break_holder] -->illness use to control their symptoms. <b>When you have symptoms, how likely<!-- [et_pb_line_break_holder] -->are you to use one of these?</b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right;line-height:50%'> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right'>(circle <b>one</b><!-- [et_pb_line_break_holder] -->number for each behavior)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse'><!-- [et_pb_line_break_holder] --> <tr style='height:36.4pt'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoFooter style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'> </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Not Likely</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Somewhat Likely</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Very Likely</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>15.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Change what you eat or drink to make the symptom decrease or go away?<!-- [et_pb_line_break_holder] --> </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>16.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Change your activity level (e.g. slow down, rest)?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>17.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Take a medicine to make the symptom decrease or go away?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>18.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Tell your healthcare provider about the symptom at the next office visit?<!-- [et_pb_line_break_holder] --> </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>19.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Call your healthcare provider for guidance?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5> </h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5><b><span style='font-size:14.0pt'> </span></b></h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5><b><span style='font-size:14.0pt'>Think of a treatment you used the last<!-- [et_pb_line_break_holder] -->time you had symptoms… </span></b></h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoFooter style='line-height:25%'> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right'>(circle <b>one</b><!-- [et_pb_line_break_holder] -->number)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse;border:none'><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=270 valign=top style='width:202.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'> </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in .05in 0in 1.45pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>I did not do<!-- [et_pb_line_break_holder] --> anything</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Not Sure</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Somewhat Sure</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Very Sure</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=270 valign=top style='width:202.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>20.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'>Did the treatment you used make you feel better?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>0</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 style='width:40.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 style='width:67.5pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 style='width:.75in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:50%'> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b> </b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b> </b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b> </b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b>SECTION D</b>: <b>SELF-CARE<!-- [et_pb_line_break_holder] -->CONFIDENCE SCALE</b> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] -->line-height:150%'>In general, how confident are you that you can:</span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] -->line-height:150%'> </span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-left:4.0in'>(Circle <b>one</b> number for<!-- [et_pb_line_break_holder] -->each statement)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='margin-left:5.4pt;border-collapse:collapse'><!-- [et_pb_line_break_holder] --> <tr style='height:36.4pt'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoFooter style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'> </p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Not Confident</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Somewhat Confident</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b> </b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b>Very Confident</b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>21.<span style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Keep yourself <u>stable and free of symptoms?</u></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>22.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Follow the treatment plan</span></u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'> you have been given?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>23.<span style='font:7.0pt "Times New Roman"'> </span></span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'> <u>Persist</u> in following the treatment plan even<!-- [et_pb_line_break_holder] --> when difficult?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>24.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Monitor your condition</span></u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'> routinely?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>25.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Persist</span></u><span style='font-size:13.0pt'> in<!-- [et_pb_line_break_holder] --> routinely monitoring your condition even when difficult?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>26.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Recognize changes</span></u><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'> in your health if they occur?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>27.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Evaluate the importance</span></u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'> of your symptoms?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in'><span style='font-size:13.0pt'>28.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Do something</span></u><span style='font-size:13.0pt'><!-- [et_pb_line_break_holder] --> to relieve your symptoms?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>29.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Persist</span></u><span style='font-size:13.0pt'> in<!-- [et_pb_line_break_holder] --> finding a remedy for your symptoms even when difficult? </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>30.<span style='font:7.0pt "Times New Roman"'> </span></span><u><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Evaluate</span></u><span style='font-size:13.0pt'><!-- [et_pb_line_break_holder] --> how well a remedy works?</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='margin-top:6.0pt'> </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='margin-top:6.0pt'>THANK YOU FOR COMPLETING THIS<!-- [et_pb_line_break_holder] -->SURVEY! </p>