Survey Text

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2021

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2020

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2019

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2018
Survey form view entire document:  text  image
AC20 (AC1025)
BLAISE NAME: GoFirst
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
Would [you/[PERSON]] go to one of these places first or most often if [you/he/she] [are/is] sick?
Responses: 
YES 1 AC30 (AC1030)
NO 2 AC40 (AC1035)
REFUSED RF END_LP10 (AC1120)
DON'T KNOW DK END_LP10 (AC1120)
Display Instructions:
AC30 (AC1030)
BLAISE NAME: USCLoctn
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
Does the medical provider [you/[PERSON]] usually [see/sees] have his or her own practice that is not part of a group practice, health center, clinic, or other facility?
Responses: 
OWN PRACTICE, NOT PART OF GROUP/FACILITY 1 BOX_30 (AC1036)
PRACTICE IS ASSOCIATED WITH GROUP/FACILITY 2 BOX_30 (AC1036)
REFUSED RF BOX_30 (AC1036)
DON'T KNOW DK BOX_30 (AC1036)
Display Instructions: 
Display 'see' if asking about the respondent. Otherwise, display 'sees'
For response 1 "OWN PRACTICE, NOT PART OF GROUP/FACILITY", display the word "NOT" with an underline.