Survey Text
2021
No questionnaire text is available for this sample.
No questionnaire text is available for this sample.
2019
No questionnaire text is available for this sample.
No questionnaire text is available for this sample.
2017
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2016
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2015
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
image
CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2014
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
view entire document:
text
image
CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2013
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2012
Survey form
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1. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else you would see for healthcare.
In the last 12 months, did you make any appointments with a doctor or other health provider for regular or routine health care?
Yes
No, Skip to Question 3
Survey form
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2011
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2010
Survey form
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4. In the last 12 months, when you needed care right away for an illness or injury, how often did you get care as soon as you wanted?
Never ......................................................
Sometimes ..............................................
Usually ....................................................
Always..............................................
I didn't need care right away for an illness or injury in the last 12 months.....
Survey form
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CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2009
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
view entire document:
text
image
CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2008
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
view entire document:
text
image
CS11A
=====
[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------
2007
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2006
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2005
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2004
Survey form
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text
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2003
Survey form
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Opinions about Health
For items 35-38, please check one of the boxes to indicate how strongly you agree or disagree for each statement.
If you are uncertain, check the box for uncertain.
Survey form
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text
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2002
Survey form
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3. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else you would see for health care.
In the last 12 months, not counting the times you needed health care right away, did you make any appointments with a doctor or other health provider for health care?
Yes
No, Skip to Question 5
Survey form
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2001
Survey form
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1. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else you would see for health care. In the last 12 months, did you make any appointments with a doctor or other health provider for regular or routine health care?
Yes .................................
No ..................................GO TO QUESTION 3
Survey form
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CS09
====
[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else (PERSON) would see for health care.
In the last 12 months, did you make any appointments for (PERSON) with a doctor or other health provider for regular or routine health care?
YES .................................... 1
NO ..................................... 2 [CS11]
REF ................................... -7 [CS11]
DK .................................... -8 [CS11]
2000
Survey form
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1. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else you would see for health care. In the last 12 months, did you make any appointments with a doctor or other health provider for regular or routine health care?
Yes .................................
No ..................................GO TO QUESTION 3
Survey form
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1.
A health provider could be a general doctor, a specialist
doctor, a nurse practitioner, a physician assistant, a
nurse, or anyone else your child would see for health
care.
In the last 12 months, did you make any appointments
for your child with a doctor or other health
provider for regular or routine health care?
Yes..........................................
No .........................................GO TO QUESTION 3