Take the test
YES NO Have you lost 10% or more of your body weight in the last 6 months?
YES NO have you been to the hospital more than 2 times in the last 6 months?
YES NO Have you had pneumonia in the last 3 months?
YES NO Have you had a urinary tract infection (UTI) in the last 3 months?
YES NO Have you lost the will to live?
YES NO Do you use oxygen all the time or have increased the frequency of use?
YES NO Are your nebulizer treatments not as effective as they used to be?
YES NO Do you have Stage III or IV wounds (deep into the tissues or bone)?
YES NO Are you unable to do work or hobbies?
YES NO Do you mainly sit or lie?
YES NO Do you require assistance in at least 3 of the following areas?
Bathing
Dressing
Eating
Transferring
Walking (confined to a wheelchair or using a walker)
Control of your bladder or bowel
If you answered at least YES to six or more of the above questions, please contact us immediately.