[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get the care, tests, or treatments for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-4.
In the last 12 months, how much of a problem, if any, was it to get care for (PERSON) that you or a doctor believed necessary?

A BIG PROBLEM .......................... 1
A SMALL PROBLEM ........................ 2
NOT A PROBLEM .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

In the last 12 months, how much of a problem, if any,
was it to get care for your child that you or a doctor
believed necessary?

A big problem ....................................
A small problem ................................
Not a problem....................................
My child had no visits in the last 12 months. .........