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Springhill Medical Center is conducting a Community Health Needs Assessment (CHNA) survey to better understand the health concerns and needs of the communities we serve. The information obtained from the CHNA will be used in the development of an action plan to help improve the health of community members.   

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* 1. How would you describe your overall health? 

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* 2. Please select the top three health challenges you face.

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* 3.
Where do you go for routine health care?

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* 4. Where would you go for emergency medical services if you were able to take yourself.

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* 5. Are there any issues that prevent you from accessing care? (Check all that apply)

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* 6. What is needed to improve the health of your family and neighbors? (Check three)

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* 7. What types of health screenings and/or services are needed to keep you and your family healthy? (Check up to five)

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* 8. What health issues do you need education about? (Please check up to five)

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* 9. Where do you get most of your health information (check all that apply)

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* 10. What additional health services need to be offered to meet your health challenges in your community.

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* 11. Please choose all the statements below that apply to you

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* 12. Which of the following preventative procedures have you had in the past 12 months?

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* 13. How can Springhill Medical Center better meet your health care needs? 

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* 14. Optional:  What is your gender?

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* 15. Optional: In what zip code is your home located?

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* 16. Optional: Which category below includes your age?

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* 17. Optional: What is your highest level of education? 

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* 18. Optional: What is your race?

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* 19. Optional: Do you have health insurance? 

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* 20. Optional: Would you like to receive information about Mental Health Services or Chronic Care Management?  If so please include your contact information at the end of this survey

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* 21. Optional: Do you need a Primary Care Provider?  If so, please include you contact information at the end of this survey. 

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* 22. Optional: Are you in need of a health specialist?  Please check all that apply and include your contact information at the end of this survey.

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* 23. Optional: Contact Information

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