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We'd like to ask you a few more questions
This short survey will only take a minute to complete and will help us monitor how you are doing. If you are a caregiver, please answer the questions as they relate to the Fidelis Care member identified below.
Name
First
Last
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge
*
Not at all
Several days
More than half the days
Nearly every day
Not being able to stop or control worrying
*
Not at all
Several days
More than half the days
Nearly every day
Worrying too much about different things
*
Not at all
Several days
More than half the days
Nearly every day
Trouble relaxing
*
Not at all
Several days
More than half the days
Nearly every day
Being so restless that it's hard to sit still
*
Not at all
Several days
More than half the days
Nearly every day
Becoming easily annoyed or irritable
*
Not at all
Several days
More than half the days
Nearly every day
Feeling afraid as if something awful might happen
*
Not at all
Several days
More than half the days
Nearly every day
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GAD-7 Score
Hidden
Call Care Coordinator
Hidden
Call Helpline
Hidden
region
Hidden
mobile
Hidden
county
Hidden
status
Hidden
EscalationEmail
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