Questionnaire - Page 8(k) of 9
(1014 maximum possible questions)		 Last updated: May 05, 2008

THE ANALYST TM
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This sections deals with various medications that have not been covered elsewhere. You may list further medications in the notes box below.
936.  Are you currently using a prescription anticoagulant? Warfarin is the generic name for Coumadin.
Don't know
No
Heparin
Warfarin
937.  Caffeine in powder, tablet or injection form (used to restore mental alertness or overcome drowsiness/weakness).
Never / don't know
Some use (under 1000mg per day) in the past only
Heavy use (over 1000mg per day) in the past only
Currently using some (under 1000mg per day)
Currently using high doses (over 1000mg per day)

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GLOSSARY

Anticoagulant:  A substance that prevents or delays blood clots (coagulation).



 


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