Feb < mths mth- yr - yrs 3- yrs or > yrs How long have you been going to this provider 7 7 Yes Answer During your most recent visit, did you see your provider within minutes of your appointment time 9 3 seem to know the important information about your medical history 3 Yes Answer Did you talk to your provider about health questions or concern listen carefully to you 3 give you easy to understand information about your health questions or concerns 7 explain things in a way that was easy to understand 7 show respect for what you had to say 9 9 spend enough time with you 7 3 7 9 Using a number between (worst) and (best), what would you rate your provider 3 Would you recommend this provider's office to your family and friends 7 Yes answer N/A During your most recent visit, did your provider order a blood test, x-ray, or other test for you 7 Yes answer N/A 3 Did someone form the provider's office follow up to give you those results 3 During your most recent visit, were the clerks/receptionists as helpful as you thought they should be Did they treat you with courtesy and respect none 3-9 or > How many times in the last months did you see your provider 3 3 3 9 n/a 7 If you called for an appointment for illness/injury, how often did you get one as soon as you needed 3 7 7 3 n/a If you called to schedule a check-up, how often did you get an appointment as soon as you needed
Feb Yes answer N/A 9 Did you call your provider's office with a medical question during regular office hours 7 n/a If so, how often did you get an answer to your question that same day 37 3 3 3 Yes answer N/A Did you call your provider's office with a medical question after regular office hours 7 7 n/a If so, how often did you get an answer to your question as soon as you needed 3 3 n/a 3 How often in the last months did you see this provider within minutes of your appointment time 9 Excellent Very Good Good Fair Poor How would you rate your overall health 3 7 3 Excellent Very Good Good Fair Poor How would you rate your mental or emotional health 7 - -3 3- - - -7 7 or > What is your age 7 3 39 3 3 Male Female 7 Are you male or female 7 3 th grade or< some HS, no grad HS grad/ged college/ yr yr college > yr college What is the highest level of school that you completed 77 3 7 White Black/African Amer Asian Native HawaiianAmer Indian other 9 What is your race 9 Yes no 3 Are you of Hispanic or Latino origin or descent 9 yes no n/a 3 Did someone help you complete this survey 7 read questions wrote answers I gaveanswered for metranslated other ways n/a 3 How did the person help you 3
Feb or > yrs 3- yrs - yrs mth- yr < mths 7 7 How long have you been going to this provider 9 Yes Answer During your most recent visit, did you see your provider within minutes of your appointment time Answer Somewhat Definitely 3 seem to know the important information about your medical history Answer Yes 3 Did you talk to your provider about health questions or concern 3 listen carefully to you Answer Somewhat Definitely 3 give you easy to understand information about your health questions or concerns Answer 7 7 explain things in a way that was easy to understand Somewhat Definitely 9 show respect for what you had to say spend enough time with you 3
Feb 3 Using a number between (worst) and (best), what would you rate your provider 7 Would you recommend this provider's office to your family and friends N/A answer Yes 7 During your most recent visit, did your provider order a blood test, x-ray, or other test for you N/A answer Yes 3 3 Did someone form the provider's office follow up to give you those results During your most recent visit, were the clerks/receptionists as helpful as you thought they should be Definitely Somewhat Answer Did they treat you with courtesy and respect 7 3 3 3 3 9 How many times in the last months did you see your provider 3 3 7 7 7 If you called for an appointment for illness/injury, how often did you get one as soon as you needed If you called to schedule a check-up, how often did you get an appointment as soon as you needed
Feb 7 Yes answer N/A 9 Did you call your provider's office with a medical question during regular office hours n/a 3 3 3 37 If so, how often did you get an answer to your question that same day 7 7 Did you call your provider's office with a medical question after regular office hours n/a 3 3 If so, how often did you get an answer to your question as soon as you needed 9 3 How often in the last months did you see this provider within minutes of your appointment time Poor Fair Good Very Good Excellent 3 3 7 How would you rate your overall health How would you rate your mental or emotional health Excellent 7 Very Good Good Fair Poor 3 What is your age 39 3 7 3 3 7 3 7 Are you male or female Male Female
Feb > yr college yr college college/ yr HS grad/ged some HS, no grad 7 3 77 What is the highest level of school that you completed 9 9 What is your race th grade or< 3 Did someone help you complete this survey 3 How did the person help you 9 3 Are you of Hispanic or Latino origin or descent n/a other ways translated answered for me wrote answers I gave 7 yes no n/a read questions 3