Adherence Report
MRN:  110	Subject Number:  1	Date completed: 4/16/2008

Summary

Ways to help the patient

Patient took 92% of prescribed doses in past 3 days.   Patient 7 day estimate: 95%   Patient 30 day estimate: 95%

You can help by... Empathizing with difficulty of adherence (It's hard to remember your pills all the time.) Providing encouragement (I am confident that you can learn the skills to manage your medications.) Providing resources (Would you like to meet with someone who could give you some tips and hints about remembering your medications?) Reviewing reminder strategies and devices (How do you organize your pills? What do you do to remember to take them?)

Detail: Patient report and prescribed regimen

Pills per dose Doses per day Medication Patient report Prescribed Patient report Prescribed Combivir 300/150mg 1 1 2 2 Efavirenz 200mg 3 3 1 1

Adherence Over Past 3 Days

Yesterday 2 Days Ago 3 Days Ago

Medication Doses Taken/ Prescribed Pills Taken/ Prescribed Doses Taken/ Prescribed Pills Taken/ Prescribed Doses Taken/ Prescribed Pills Taken/ Prescribed Score Combivir 300/150mg 2/2 2/2 2/2 2/2 1/2 1/2 83% Efavirenz 200mg 1/1 3/3 1/1 3/3 1/1 3/3 100%

Adherence Calculation is based on adherence to prescribed regimen only.

Adherence History Patient 7-day estimate Patient 30-day estimate Assessment Date 95% 95% 04/16/2008 80% 90% 09/29/2007

CD4 Count CD4 Count Test date 1080 04/1/2008 950 12/13/2007 470 08/12/2007 310 05/10/2007

Viral Load Viral load Test date 50 04/1/2008 62 12/13/2007 380 08/12/2007 2400 05/10/2007

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