Harrison 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.  Please note that you will not be asked to supply your name to complete the survey.  Respondents of the survey will remain anonymous.

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* 1. Have you or someone in your household used the services of Harrison Community Hospital in the past 12 months?

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* 2. If not at Harrison Community Hospital, at which hospital were services rendered?

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* 3. Why did you or someone in your household receive care at a hospital other than Harrison Community Hospital?

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* 4. What services do you use at Harrison Community Hospital? (check all that apply)

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* 5. How satisfied were you or someone in your household with the services you received at Harrison Community Hospital?

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* 6. Please explain why you were satisfied or dissatisfied.

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* 7. What type of specialist have you or someone in your household been to in the past 12 months?

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* 8. In what city/cities did you consult with the specialist?

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* 9. How much of a barrier are the following to receiving assistance for your needs?

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

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* 10. Do you have children under age 18 living in your household?

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* 11. Do you care for an elderly parent/grandparent?

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

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* 13. If applicable, what barriers prevent you from seeing a dentist?

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* 14. Do you and/or your family have primary care physician?

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* 15. If yes, are you able to get an appointment with your primary care physician when needed?

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* 16. How satisfied were you or someone in your household with the quality of care received at your primary care physician's office?

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* 17. If no, then what kind of medical provider do you use for routine care?

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* 18. Have you or someone in your household delayed health care due to lack of money and/or insurance?

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* 19. Do you or someone in your household receive treatment for any of the following conditions? (select all that apply)

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* 20. Which service(s) would you like to see added or expanded in Harrison Community Hospital's service area? (select no more than 3)

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* 21. Please select your primary insurance carrier or provider.

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* 22. If you have Medicaid, did you obtain this coverage through the ACA Medicaid Expansion (i.e. HealthCare.gov)?

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* 23. Including yourself, how many people currently live in your household?

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* 24. Do you have any other thoughts on the level and variety of care provided in the community or by Harrison Community Hospital?

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