Client Service Receipt Inventory (CSRI) Health Care Use

Intervention for Depressed People (3-months)

Subject Number Date

1. Have you sought help from any source for a health problem during the last 3 months?
(probe)
a) Physical Yes No
b) Psychological Yes No
If yes continue, note sources
If associated with pregnancy or childbirth please note
2. Have you been an in-patient?
a) Physical Number of days
b) Psychological Number of days
3. Have you consulted any doctors during the last 3 months? Yes No
If so how many times?
For physical illness For psychological problems
a) Out-patient clinic a) Out-patient clinic
b) GP b) GP
c) Any other doctor c) Any other doctor
4. Have you sought help from (non-medical healers), alternative treatment?
Physical Psychological
a) Immams / Maulvi (faith healers)
b) Pirs
c) Hakim (homeopathic)
d) Community leaders
e) Voluntary agencies
f) Other
5. Have you seen other members of Primary Care Team? i.e. Practice Nurse,
physiotherapist, psychologist, counselor ……….
Specify which & number of attendances Physical Psychological
…………………………..……………………………………………………………
6. Have you sought help for any health problem from a voluntary agency? (specify)
a) Physical ………………………………………………………………………
b) Psychological …………………………………………………………………
7. Any other source of help for problems of nature
a) Physical ………………………………………………………………………
b) Psychological …………………………………………………………………