Considering your most recent visit at K’ima:w Medical Center, we would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses will be kept confidential and anonymous. Thank you for your time.

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* 1. Your Age

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* 2. Gender

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* 3. Nationality 

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* 4. Do you consider this center your regular source of care?

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* 5. When your given information from your provider and/or pharmacist how often do you need help understanding it?

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* 13. Confidentiality- Keeping my personal information private

i We adjusted the number you entered based on the slider’s scale.

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* 14. Primary Care Medical Home (PCMH) , is a model of care where services are provided to patients by a primary care practitioner and team that increases access to its services, tracks and coordinated a patient’s care delivered by other practitioners and facilities, uses evidence based treatment protocols and focuses more on patient and family education and self management. A “Medical home” focuses on the relationship between the patient, his/her family, and the people that work at the healthcare clinic.

Do you know your Primary Care Medical Home Team: (Acorn / River Ducks) :

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* 15. If you marked Yes, has this improved your access to care, treatment, services, and communication?

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* 16. Your suggestions for improvement, including patient Safety?

We appreciate your completion of our survey!

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