3. In order to provide the best possible health and related services, we need to know what you think about how well you were able to deal with your everyday life during the past 30 days. Please indicate your disagreement/agreement with each of the following statements.
4. The following questions ask about how you have been feeling during the past 30 days. For each question, please indicate how often you had this feeling.
During the past 30 days, about how often did you feel...
5. The following questions ask about how you have been feeling during the past 4 weeks.
In the past 4 weeks...
6. The following questions relate to your experience with alcohol, cigarettes, and other drugs. Some of the substances we’ll talk about are prescribed by a doctor (like pain medications). But I will only record those if you have taken them for reasons or in doses other than prescribed.
In the past 30 days, how often have you used...
Total nights cannot exceed 30.
Please adjust responses to 1a. - 1d. so the sum total of days is 30 or less.
[IDENTIFY ALL OF THE SERVICES YOUR PROJECT PROVIDED TO THE CONSUMER SINCE HIS/HER LAST NOMS INTERVIEW; THIS INCLUDES CMHS-FUNDED AND NON-CMHS-FUNDED SERVICES.]