Patient/Citizen Survey & Web Site Feedback

Thank you for sharing your opinions and feedback about health information exchange and the CORHIO Web site. Your opinions and suggestions will help us improve the site and our communications.

Questions marked with an asterisk (*) are required.

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1. What was your main reason for visiting CORHIO's web site today?

What was your main reason for visiting CORHIO's web site today? To learn more about health information exchange (HIE)

To learn more about CORHIO

To find out if my doctor(s) or other health care provider(s) is/are participating in HIE

To find out if my community/city/region is participating in HIE (and how)

To learn more about CORHIO's privacy and security safeguards

To submit a question or comment via email or a Web form

Other (please specify below)

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2. Would you like your doctor(s)/provider(s) to participate in HIE?

Would you like your doctor(s)/provider(s) to participate in HIE? Yes

I don't know

3. If you answered "yes" to the previous question, please tell us which doctor or provider you would most like to see participate. (List only one provider)
This question is optional.

If you answered "yes" to the previous question, please tell us which doctor or provider you would most like to see participate. (List only one provider) This question is optional. Provider Name:
Provider Type/Specialty:
Provider City:

4. Was there any information you were looking for that you did NOT find on the CORHIO site? If yes, please tell us what that is below.

Was there any information you were looking for that you did NOT find on the CORHIO site? If yes, please tell us what that is below.

5. Was there any information on the CORHIO Web site that was confusing to you? If yes, please tell us what that was.

Was there any information on the CORHIO Web site that was confusing to you? If yes, please tell us what that was.

Please tell us about yourself and your interactions with health care providers, which will help CORHIO better understand your needs.

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6. Are you a Colorado resident?

Are you a Colorado resident? Yes

7. How many times have you visited a physician, hospital or other health care provider in the past 90 days?
(for your own care or for your spouse or a child/dependent)

How many times have you visited a physician, hospital or other health care provider in the past 90 days?
(for your own care or for your spouse or a child/dependent) 0 (none)

1-2 times

3-4 times

5-6 times

7 or more times

I prefer not to answer

8. How often is/are your doctor(s) or health care provider(s) missing important information about your medical history, current medications, recent lab test results, x-ray or radiology films/reports, or notes from another provider regarding your care?

How often is/are your doctor(s) or health care provider(s) missing important information about your medical history, current medications, recent lab test results, x-ray or radiology films/reports, or notes from another provider regarding your care? Never - My providers are never missing information

Seldom - My providers are seldom missing information

Sometimes - My providers are sometimes missing information

Often - My providers are often missing information

I don't know / Unsure

9. How do you feel about the quality of communication and coordination that your doctors, pharmacists, or other health care providers have regarding your care?

How do you feel about the quality of communication and coordination that your doctors, pharmacists, or other health care providers have regarding your care? I only see 1 provider (or none), so this question does not apply to me

I am very happy with their communication/coordination

I am occasionally frustrated by their communication/coordination

I am often frustrated by their communication/coordination (or lack thereof)

I don't know or have no opinion

10. Are there any comments or questions you have that were not addressed in previous questions? If yes, please type them below.
Note: CORHIO is not a health care provider and cannot answer medical questions about your health care. Additionally, CORHIO staff do not have access to your medical records, therefore we cannot provide access to, nor copies of, any medical records. Please contact your health care provider for this type of information.

Are there any comments or questions you have that were not addressed in previous questions? If yes, please type them below.

Note: CORHIO is not a health care provider and cannot answer medical questions about your health care. Additionally, CORHIO staff do not have access to your medical records, therefore we cannot provide access to, nor copies of, any medical records. Please contact your health care provider for this type of information.

11. CORHIO often seeks input from patients (Colorado residents) about its policies and health information exchange practices. Are you interested in participating in future surveys, focus groups or workgroups?

CORHIO often seeks input from patients (Colorado residents) about its policies and health information exchange practices. Are you interested in participating in future surveys, focus groups or workgroups? Yes or Maybe

12. If you answered "Yes/Maybe" to the question above, please provide us with your contact information below.
This is optional.
Note: Due to the high level of interest, we cannot contact every person who submits their information. Online surveys (when conducted) will be emailed to all participants with valid email addresses. Focus groups and advisory committee space is limited and CORHIO will contact members of the list when space becomes available.

If you answered "Yes/Maybe" to the question above, please provide us with your contact information below. This is optional. Note: Due to the high level of interest, we cannot contact every person who submits their information. Online surveys (when conducted) will be emailed to all participants with valid email addresses. Focus groups and advisory committee space is limited and CORHIO will contact members of the list when space becomes available. First Name:
Last Name:
Email:
Phone (daytime):
City of Residence:

Thank you for your time completing this suvery, please click the "SUBMIT" button below to ensure your reponses are received.

Patient/Citizen Survey & Web Site Feedback

*1. What was your main reason for visiting CORHIO's web site today?

*2. Would you like your doctor(s)/provider(s) to participate in HIE?

3. If you answered "yes" to the previous question, please tell us which doctor or provider you would most like to see participate. (List only one provider) This question is optional.