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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.


After completing the initial paperwork, an analyst who is determining whether you are "disabled" for purposes of Medicaid may send you supplemental questionnaires to be completed. These questionnaires are frequently called "Optional" forms, but that does not mean they are optional for you. It means they are optional for the Disability Analyst. If the Analyst decides he or she wants you to complete the forms, you have to complete them in order to keep your claim alive.

Some of the questionnaires you may encounter are the fatigue questionnaire, the pain questionnaire and the daily activities questionnaire.

The analyst may also ask for a statement from your doctor, and a daily activities questionnaire from you.

There are tips to know about before completing questionnaires relating to your medical condition. 

NOTE: There are other forms that may be used in the process that you should be aware of even though you are not expected to complete them. Each state develops its own forms, so while the forms are similar because they all need the same information, the specific form will vary from state to state.

For more information, see:

How To Complete The Fatigue Questionnaire

Medicaid has a separate questionnaire about fatigue because it is a common symptom of many conditions and a side effect of many medications. It is difficult if not impossible to measure fatigue on any kind of an objective scale.

The form asks questions about your daily activities and the effect that fatigue has on them.

  • Be as specific as you can.
  • Include the impact of fatigue on your work
  • Include the impact of fatigue on your daily life activities '" including all changes you've made to accommodate your condition. For example, examples of changes which can be caused by fatigue are:
    • Doing laundry more frequently so the loads are lighter to carry.
    • Buying fewer groceries so the bags are lighter.
    • Having friends help with household chores. (List the specific chores.)
    • Planning your meals so you spend as little energy as possible preparing them.
    • Looking at magazines because your reduced attention span won't let you focus long enough to read books.
    • Avoiding movies and long dramas on TV because you can't concentrate long enough to understand what is going on.
    • Having to take naps after going out to the doctor or on errands.

The form also asks for names and addresses of other people who are aware of your condition and have observed your fatigue.

When filling out the fatigue form, keep in mind your "bad days" and answer the form with them in mind. Don't forget to consult your SymptomsDiary or Work Journal if you've been keeping track of changes in your health.'

How To Complete The Pain Questionnaire

Pain, like fatigue, is a subjective symptom that cannot be measured in the lab and is not generally observable by a medical practitioner. So Medicaid has a special questionnaire to try to put some measurement to the severity of your pain. 

The Pain Questionnaire asks very specific questions about your pain such as the following:

  • Where is it located?
  • Is the pain a throb, an ache, sharp or stabbing?
  • How frequent is the pain?
  • Does the pain spread or move?
  • Does lying down or resting or medication relieve the pain? If so, how successfully and for how long?
  • How does the pain impact your activities and your ability to concentrate and think clearly?
  • Do you wear or use any device to relieve the pain or its effects?  Be specific. Describe everything you do to relieve pain, whether it's cool baths, warm baths, staying in a dark room, listening to music, loose clothing, sunglasses to cut down on glare or whatever.
  • Even if it's in the medical records, mention any treatment you've tried for pain such as acupuncture, chiropractic treatment, massage or meditation.

Be very specific in your answers. Describe how pain has affected your daily routine. For example, if you can no longer take walks or participate in sports because of pain, mention it.  

Tips For Completing Questionnaires Concerning Your Medical Condition

Don't delay.

Start working on the forms as soon as you receive them so you won't have to rush to get them returned.

Be very specific.

Be very specific in your answers and include as many anecdotes and details as possible that illustrate how your condition affects your daily activities. Your Work Journal and Symptoms List may be helpful with completing these questions.

Use bad days.

Complete the forms based on your bad days.

Complete the forms yourself.

Medicaid prefers that you complete all forms yourself, no matter how messy that would make a form.

If you cannot complete the form, ask the person who completes it for you to mention on the form that he or she completed it and to state why you were unable to complete the form yourself. For example, the person could write "I, Glenn Fleming, completed this form for Lenore. Lenore was unable to complete this form because of tremors caused by her medical condition."

Write legibly.

It is only important that your answers be legible -- not that they are neat. While you don't want to intentionally mess up the form, analysts say that they can tell a lot about a person's condition by the way the forms are completed.

If your form is professionally neat, explain why.

If your forms are especially neat or typed so they look almost professional, explain why and how long it took to get your forms that way. For Example: This is my fourth draft of this form and it took four and a half hours to do it.

Use additional sheets if necessary.

Add additional sheets if necessary to explain everything thoroughly.

Each additional sheet should be numbered, and should include your name and Social Security number in case the pages get separated.

It should also be clear what question is being answered. Even repeat the question if necessary so it's clear what you are answering.

Talk with friends, family and co-workers you list.

If you list anyone as a source to confirm any aspect of your medical condition and/or the impact on your work or daily life, make sure you tell the person to expect to hear from Medicaid.

Consider having a discussion with each of the people you name to remind them of your symptoms and how each symptom has impacted your work or daily life.

Ask all your medical providers to contact you should they receive an inquiry from Medicaid.

Some physicians will permit your input in the completion of the forms.

Provide your primary doctor and specialist with copies of all your Medicaid forms so they will know what you have said.

After completing a questionnaire, do not submit it right away.

  • Think about it for a day or two as you go about your routine. You may suddenly discover you're in the midst of accommodating a symptom and didn't realize it. Some of your symptoms may have been with you so long, and you have accommodated to them so well, that you forgot they are symptoms. These are the ones that will come to you as you set the form aside and continue with your regular activities for another day or two.
  • Ask a friend, housemate, former co-worker or counselor who is aware of your condition to review the form to see if there are things you may have overlooked.
  • After a few days, review the questionnaire. Re-reading it will probably trigger other issues to be included.

Make photocopies of everything you submit.

Or make sure the Medicaid worker or analyst makes a copy and gives you back the original.

How To Complete The Daily Activities Questionnaire

The Daily Activities Questionnaire asks you to describe in detail how you are able to manage the various functions of day-to-day living with your condition. It asks questions such as:

  • Q. Describe what you do on an average day. '
    • When you answer this question, describe how your condition affects your daily life, particularly the changes you have had to make in your daily life due to your condition. For example, did you have to abandon a hobby or favorite pastime?
  • Q. Do you need help completing your chores?
    • Again, as you answer this question, indicate how your health condition has affected your ability to complete your chores. For example: "I used to be able to change a bed, but now I get so dizzy when I bend over that I have to ask friends to make my bed for me."
  • Q. How often do you listen to the radio or watch TV or read magazines or books?
    • Have your reading or viewing habits changed due to your condition? The question relates to how your medical condition effects even your recreation or leisure time.

Be sure to list any changes you've made to accommodate your limited abilities. For examples, see the above discussion concerning the fatigue questionnaire.

The other questions are very specific. Using your Symptoms Diary and Work Journal, together with following the tips listed below, you should have no problem completing the form.

Other Forms Used By Analysts To Determine If You Are Disabled For Medicaid Purposes

Other forms that may bge used in the process that you are not expected to complete:

Physician Statement: In addition to obtaining your medical records, the state will sometimes send a questionnaire to one or more of your doctors to complete. The forms include questions about restrictions in your ability to perform work-related tasks, social functioning, and activities in daily living (transportation, household chores, personal hygiene) -- all information that you have provided yourself. (So be sure to tell your doctor about these affects on your daily living, and to note them in your medical record.)

To learn more about how to maximize your time with your doctor, see: How To Work Most Effectively With Your Doctor.

Daily Activities Questionnaire, Third Party. This questionnaire may be sent to friends or relatives you listed who have information about the effect of your health on your daily activities. It asks for third party observation of your condition and the impairments it causes.

If Medicaid does contact any of the people you suggested about your daily activities, consider getting similar statements from other people as well to bolster your case. It may be very helpful to include former co-workers, especially a supervisor who noticed your declining job performance.