Survey Text

2001
2000
1999
1998
1997
1996
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2001
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

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2000
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

top
1999
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

top
1998
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

top
1997
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

top
1996
Survey form view entire document:  text  image
AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------