Community Health Needs Assessment 2020

All responses are CONFIDENTIAL and will be used for data purposes of the residents of Faulk County, SD and the surrounding communities.

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* 1. What is your Zip Code?

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* 2. Are you a smoker?

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* 3. Gender:

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* 4. Age:

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* 5. Marital Status:

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* 6. How many people live in your household (including yourself)?

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* 7. Race/Ethnic Origin:

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* 8. Highest level of education completed:

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* 9. Are you the primary care giver for any of the following?

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* 10. Do you:

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* 11. Do you have the following in your home?

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* 12. What are the biggest health issues or concerns in your community?

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* 13. Do you have insurance?

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* 14. No, why?

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* 15. What do you think is the most pressing health care related need for you, your family or our community?

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* 16. What keeps people in our community from seeking medical attention?

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* 17. Where do you and your family get most of your health information?

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* 18. What health screenings or education services are needed in our community?

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* 19. In the past 12 months, have you had a(n) (fill in all that apply):

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* 20. Have you been hospitalized in the last:

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* 21. In what ways do you think the hospital is serving the community well?

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* 22. In what ways could the hospital improve the way in which it serves the community?

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* 23. What services do you feel are needed in our community that currently do not exist?

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* 24. Do you see other community members working together in collaboration to address community health needs?

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* 25. Please explain:

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* 26. What is the number one thing the hospital could do to improve the health and quality of life of the community?

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* 27. Any other comments you think are important to address in this survey

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* 28. OPTIONAL: Enter your name and phone number for an entry into the $100 Amazon gift card drawing! (Your information will not be distributed or connected to this survey.)

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