Survey Text

2021 2016 2011 2006
2020 2015 2010 2005
2019 2014 2009 2004
2018 2013 2008 2003
2017 2012 2007 2002
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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


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2018
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

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2017
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

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2016
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

top
2015
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

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2014
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

top
2013
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
AND
- RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR THIS PERSON IN ANY ROUND.
----------------------------------------------------

top
2012
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2011
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2010
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2009
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2008
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2007
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2006
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2005
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2004
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2003
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

top
2002
Survey form view entire document:  text  image
AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] (PROVIDER) speak the language they prefer or provide translator services for them?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------