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| How important is it to you to prepare for health care with an adult doctor before age 21 years? |
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| How confident do you feel about your ability to prepare for health care with an adult provider? |
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| I can explain my diagnosis and medical needs to other people |
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| I know my symptoms including the ones for which I would need to see a doctor quickly |
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| I know what I need to do in case of a medical emergency |
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| I know the names of my own medicines, what they are for, and when I need to take them |
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| I know my allergies to medicines and which medicines I should not take |
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| I carry important health information with me everyday (e.g. insurance care, allergies, medications, emergency contact information, and medical summary) |
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| I understand how health care privacy changes at age 18 years when I am legally an adult |
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| I know or I can find my doctor's phone number |
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