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Self Assessment End


    YesNo


    YesNo


    YesNo


    YesNo

    Are you an intravenous drug user?
    YesNo

    Do you have signs of a urinary tract infection?
    YesNo

    Is your pain increased or not relieved by rest?
    YesNo

    Do you have a fever?
    YesNo

    Have you experienced trauma or had an accident?
    YesNo

    Have you experienced bladder or bowel incontinence?
    YesNo

    Do you have numbness or feel clumsy in both feet?
    YesNo