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Your opinion is important! Please take a minute to complete the survey below. Your answers will be private and anonymous. The purpose of this survey is to get your opinions about access to your child's primary care physician or patient centered medical home*. The Department of Health will use the results of this survey and other information to identify challenges for families with children and youth with special health care needs that can be addressed through community action. Thank you for taking the time to provide us with your input. If you have any questions, please contact us at CMS.CSHCN@flhealth.gov or (850) 245-4200.

*A Patient Centered Medical Home is an approach to providing comprehensive and high quality primary care. A medical home should be the following: accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.

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* 1. Your age:

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* 2. Are you a parent or a guardian to a child or youth with special health care needs?

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* 4. Ethnic group you most identify with:

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* 5. How do you pay for your health care? (please check all that apply)

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* 6. In the past year, how satisfied were you with your ability to access care from your child's primary care physician or patient-centered medical home?

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* 7. Please explain your answer to the above question:

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* 8. Please provide any recommendations on how to improve access to care from your child's primary care physician or patient-centered medical home:

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