HCSUS Baseline Questionnaire Table of Contents

Module 1: Introduction and Informed Consent

Module 2: Usual Source of Care and Access to Care

Section A: Usual Source of Medical Care
Section B: Usual Source of Dental Care
Section C: General Access to Care
Section D: Case Management

Module 3: HIV Tests and Staging

Section A: HIV Tests
Section B: Lab Stage
Section C: Clinical Stage

Module 4: Symptoms and Treatment

Section A: Symptoms Checklist
Section B: Headache
Section C: Cough or Breathing Difficulties
Section D: Weight Loss
Section E: Diarrhea
Section F: Kaposi's Sarcoma
Section G: Vaginal Discharge
Section H: Treatments

Module 5: Insurance Coverage

Section A: Public Coverage
Section B: Private Coverage
Section C: Characteristics of Primary Private Insurance Plan

Module 6: Utilization of Care

Section A: Services Used
Section B: Inpatient Hospital Stays
Section C: Nursing Home/Residential Care Stays
Section D: Visits to Emergency Rooms and Urgent Care Centers
Section E: Medical Visits
Section F: Visits During the Population Definition Period
Section G: Mental Health Providers
Section H: Other Health Care Providers
Section I: Home Health Services
Section J: Dental Services
Sectino K: Medications

Module 7: Residential History and Current Health

Section A: Residential History and Migration
Section B: Current Health

Module 8: Health-Related Quality of Life

Module 9: Social Support and Coping

Section A: Social Support
Section B: Coping
Section C: Patient Satisfaction
Section D: Discrimination and Domestic Violence

Module 10: Unmet Needs for Medical and Non-Medical Care

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

Module 11: Mental Health

Section A: Generalized Anxiety Disorder
Section B: Panic Attack
Section C: Depression
Section D: Dysthymia
Section E: Drug Dependence
Sectoin F: Alcohol Use

Module 12: Patient Description

Module 13: Knowledge

Section A: Knowledge for Early Stage Cases
Section B: Knowledge for Late Stage Cases
Section C: Perceptions About Therapies
Section D: Self-Perceived Knowledge, Trust, Self-Care
Section E: Knowledge and Decision Making
Section F: Preferences Reganding Health States and Treatment Approaches

Module 14: Contact and Tracking Information

Section A: Locating Information
Section B: Proxy Information

Module 15: Provider Consent, Thank You, and Payment