REGULARLY ASSESS YOUR HAE MANAGEMENT

The following questions are intended to help you reflect on how HAE has recently impacted you, so that you and your healthcare team can assess your level of control and guide decisions to optimize your care.

Every person’s experience with HAE is different, so don't hesitate to share any concerns you have with your healthcare team. This will help them provide you with the care that best fits your needs.

You may enter your responses directly into this form or print a blank assessment to write on it.

NOTE: YOUR RESPONSES WILL NOT BE COLLECTED OR STORED.

myHAE Self-Assessment Questionnaire

1.

How often are you worried about your next unexpected attack? Move the slider to choose an option.

2.

Are you staying close to home in case you have an attack?

3.

Has the worry of an unexpected HAE attack held you back from making plans with family and friends?

4.

Does your experience with HAE hold you back from taking on educational or professional opportunities?

If yes, what opportunities would you pursue?

5.

What other ways does HAE currently impact the way you live your life between attacks?

6.

Now that HAE and its impact on your life are fresh in your mind, do you believe your quality of life could be better?

If yes, how so?

Take a PDF of your responses to share with your HAE healthcare team. Don’t be afraid to ask for resources and support that will help you deal with the concerns you have identified through this reflection exercise.

In order to save and/or share the summary PDF it is recommended to use the Safari browser.

Please complete the form.


myHAE CARE PLAN

HAE can affect each person differently. It’s important to work with your healthcare team to create a care plan that is right for you.

Takeda

Self-Assessment Questionnaire

1.

How often are you worried about your next unexpected attack? Please select one.

2.

Are you staying close to home in case you have an attack?

3.

Has the worry of an unexpected HAE attack held you back from making plans with family and friends?

4.

Does your experience with HAE hold you back from taking on educational or professional opportunities?

If yes, what opportunities would you pursue?

5.

What other ways does HAE currently impact the way you live your life between attacks?

6.

Now that HAE and its impact on your life are fresh in your mind, do you believe your quality of life could be better?

If yes, how so?