Princeton Community Hospital Community Health Needs Assessment

Princeton Community Hospital is conducting a Community Health Needs Assessment (CHNA) Survey. By answering these questions, you will help us identify the most important health needs in your community. The information obtained from the CHNA will be used in the development of an action plan to improve the health of local community members.

Question Title

* 1. What ZIP code is your home located? (enter 5-digit ZIP code; for example, 24740)

Question Title

* 2. Have you or someone in your household used the services of Princeton Community Hospital or Behavioral Health Pavilion of the Virginias in the past 24 months?

Yes

Question Title

* 3. If you answered "No" in question 2, at which hospital were services rendered?

Raleigh General Hospital

Bluefield Regional Medical Center

Wythe County Community Hospital

Giles Community Hospital

Welch Community Hospital

Not Applicable

Other (please specify)

Question Title

* 4. If you did not receive care at PCH, Please choose the reason or reasons why you did not go to PCH for your care:

Physician referral

Closer, more convenient

Services not available at Princeton Community Hospital

Insurance coverage

Quality of care/lack of confidence

Other (please specify)

Question Title

* 5. What keeps you from getting medical care that you need?

	Not a problem	A small problem	A major problem
Cost of assistance	Cost of assistance Not a problem	Cost of assistance A small problem	Cost of assistance A major problem
Not eligible/do not qualify for assistance	Not eligible/do not qualify for assistance Not a problem	Not eligible/do not qualify for assistance A small problem	Not eligible/do not qualify for assistance A major problem
Lack of transportation	Lack of transportation Not a problem	Lack of transportation A small problem	Lack of transportation A major problem
Lack of childcare	Lack of childcare Not a problem	Lack of childcare A small problem	Lack of childcare A major problem
Do not know where to go for assistance	Do not know where to go for assistance Not a problem	Do not know where to go for assistance A small problem	Do not know where to go for assistance A major problem
Do not want to ask for assistance	Do not want to ask for assistance Not a problem	Do not want to ask for assistance A small problem	Do not want to ask for assistance A major problem
Assistance is not available in my area	Assistance is not available in my area Not a problem	Assistance is not available in my area A small problem	Assistance is not available in my area A major problem
Prior bad experience with obtaining assistance	Prior bad experience with obtaining assistance Not a problem	Prior bad experience with obtaining assistance A small problem	Prior bad experience with obtaining assistance A major problem
Have to work during business hours of assistance provider	Have to work during business hours of assistance provider Not a problem	Have to work during business hours of assistance provider A small problem	Have to work during business hours of assistance provider A major problem
Health or disability prevents me from seeking assistance	Health or disability prevents me from seeking assistance Not a problem	Health or disability prevents me from seeking assistance A small problem	Health or disability prevents me from seeking assistance A major problem

Question Title

* 6. Do you have any of the following residents living in your household?

Children under the age of 18

Parents

Grandparents

Special needs Child/Adults

Not Applicable

Question Title

* 7. Did you receive dental care in the past 12 months?

Yes