Survey Text

2021
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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
AC230 (AC1187)
BLAISE NAME: AffrdCare
Question Text:
In the last 12 months, was there any time when [[you/[PERSON]]/anyone in the household] needed medical care, but did not get it because [[you/he/she]/they] couldn?t afford it?
Responses: 
YES 1 AC240 (AC1188)
NO 2 AC250 (AC1189)
REFUSED RF AC250 (AC1189)
DON'T KNOW DK AC250 (AC1189)
Programmer Instructions: 
If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC240. If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC240, and go to AC250.
Display Instructions: 
Display ?[you/[PERSON]]? if SINGLE-PERSON RU. Otherwise, display ?anyone in the household?.
AC240 (AC1188)
BLAISE NAME: AffrdWho
Question Text:
Who was that?
PROBE: Did anyone else need medical care but did not get it because they couldn?t afford it?
ENTER ALL THAT APPLY.
Responses:

 

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5
Programmer Instructions: 
Go to AC250.
Display Instructions: 
Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.