The questionnaire provided above is intended to be a helpful representation of whether a consumer could qualify for self directed program. There are several factors that could affect a consumer's ability to qualify for the program that are not included in this assessment. The questionnaire is not meant to be used, nor should it be used as any final indication of whether a consumer qualifies for self direction in any state. Burd Home Health is not responsible or liable for any damages or negative consequences that may result from taking this assessment.