Return to flip book view

STAR Screening Tool

Page 1

Adapted from "Six Core Elements of Health Transition 2.0," Sample Transition Readiness Assessment for Youth by Got Transition/Center for Health Care Transition Improvement, 2014, The National Alliance to Advance Adolescent Health. Retrieved from https://www.GotTransition.org. Copyright 2014 by Got Transition. How important is it to you to prepare for/transfer to an adult clinician before age 18?  0 (NOT Important) 1 2 3 4 5 6 7 8 9  10 (Very Important) How confident do you feel about your ability to prepare for/transfer to an adult clinician before age 18?  0 (NOT Confident) 1 2 3 4 5 6 7 8 9  10 (Very Confident) Scan here to learn about our Transition Policy! Health Things I need to know or do Will someone else have to do this for me? I will finish by (date) Scan this Code with a Smart Phone to Learn More! 1. I understand my healthcare needs.  YES, I know this  NO, I need to learn  YES  NO 2. I explain my medical needs to others.  YES, I know this  NO, I need to learn  YES  NO 3. I know my symptoms including ones that I quickly need to see a doctor for.  YES, I know this  NO, I need to learn  YES  NO 4. I know what to do in case I have a medical emergency.  YES, I know this  NO, I need to learn  YES  NO 5. I know my own medicines, what they are for, and when I need to take them.  YES, I know this  NO, I need to learn  YES  NO 6. I know my allergies to medicines and medicines I should not take.  YES, I know this  NO, I need to learn  YES  NO 7. I carry important health information with me every day (e.g. insurance card, allergies, medications, emergency contact information, medical summary).  YES, I know this  NO, I need to learn  YES  NO 8. I understand how healthcare privacy changes at age 18 when legally an adult.  YES, I know this  NO, I need to learn  YES  NO 9. I can explain to others how my customs and beliefs affect my health care decisions and medical treatment.  YES, I know this  NO, I need to learn  YES  NO

Page 2

Adapted from "Six Core Elements of Health Transition 2.0," Sample Transition Readiness Assessment for Youth by Got Transition/Center for Health Care Transition Improvement, 2014, The National Alliance to Advance Adolescent Health. Retrieved from https://www.GotTransition.org. Copyright 2014 by Got Transition. Independent Living Things I need to know or do Will someone else have to do this for me? I will finish by (date) Scan this Code with a Smart Phone to Learn More! 10. I know or I can find my doctor’s phone number.  YES, I know this  NO, I need to learn  YES  NO 11. I make my own doctor appointments.  YES, I know this  NO, I need to learn  YES  NO 12. Before a visit, I think about questions to ask.  YES, I know this  NO, I need to learn  YES  NO 13. I have a way to get to my doctor’s office.  YES, I know this  NO, I need to learn  YES  NO 14. I know to show up 15 minutes before the visit to check in.  YES, I know this  NO, I need to learn  YES  NO 15. I know where to go to get medical care when the doctor’s office is closed.  YES, I know this  NO, I need to learn  YES  NO 16. I have a file at home for my medical information  YES, I know this  NO, I need to learn  YES  NO 17. I have a copy of my current plan of care.  YES, I know this  NO, I need to learn  YES  NO 18. I know how to fill out medical forms.  YES, I know this  NO, I need to learn  YES  NO 19. I know to get referrals to other providers.  YES, I know this  NO, I need to learn  YES  NO 20. I know where my pharmacy is and how to refill my medicines.  YES, I know this  NO, I need to learn  YES  NO 21. I know where to get blood work or x-rays if my doctor orders them.  YES, I know this  NO, I need to learn  YES  NO 22. I have a plan so I can keep my health insurance after 18 or older.  YES, I know this  NO, I need to learn  YES  NO 23. My family and I have discussed my ability to make my own healthcare decisions at age 18.  YES, I know this  NO, I need to learn  YES  NO

Page 3

Health Care Providers: Please click here for reprint instructions.