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Medicaid: Forms An Analyst May Ask You To Complete (Supplemental Questionnaires)

How To Complete The Fatigue Questionnaire

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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.'

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