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Blue Mountain Hospital District is asking for your help to identify important health care needs in our county.

We would appreciate it if you would take the time to complete a short survey.  The survey should take less than ten (10) minutes to complete and is confidential.

We will use your feedback to help identify potential programs, services and initiatives that may be of benefit in our county.  

If you have questions please feel free to contact Jena Knowles, Public Relations Director, at 541-575-1311 extension 2213.

Thank you for taking the time to complete the survey and to help improve the health in our community.

Thank you again,

Derek Daly
Chief Executive Officer

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* 1. Tell us about your physical health. Please choose only one.

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* 2. Tell us about your mental health. Please choose only one.

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* 3. How many people, including yourself, live in the same house? Please choose only one.

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* 4. What is your housing situation today? Please choose only one.

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* 5. Think about the place you live. Do you have problems with any of the following? (Check all that apply)

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* 6. Tell us if you are providing care for someone else in your family.

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* 7. What is your work situation? Please choose only one.

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* 8. What is your main insurance? Please choose only one.

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* 9. In the past year, have you or the people that you live with been unable to get any of the following when “really needed?” Choose all that apply.

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* 10. Within the past 12 months, you worried that your food would run out before you got money to buy more?

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* 11. Within the past 12 months, the food you bought just didn’t last and you don’t have money to get more.

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* 12. In the past 12 months, has lack of transportation kept you from medical appointments, meetings, work or from getting things you needed for daily living? Choose all that apply.

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* 13. In the past 12 months has the electric, gas, oil, or water company threatened to shut off services to your home?

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* 14. In the past 12 months have you had trouble getting child care services?

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* 15. What do you think would help you and your family improve your health? Please choose all that apply.

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* 16. What behaviors put adults over age 18 at risk in Grant County?

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* 17. What behaviors put youth and teens under age 18 at risk in Grant County?

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* 18. In your opinion, what is the biggest mental health or addiction issue that you see in this community?

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* 19. What stressors do you see in the community that contribute to problems with mental health or addiction? Check all that apply.

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* 20. What are the reasons you or your family don’t use available healthcare services in Grant County? Please choose all that apply.

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* 21. The following doctors or providers are available in Grant County. Please tell us if you have any trouble getting an appointment or accessing care. Please choose all that apply.

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* 22. What doctors or providers do you or your family travel outside of Grant County to see? Please choose all that apply.

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* 23. In the past six months, have you used a Smart application on your phone, computer or tablet to do any of the following? Check all that apply.

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* 24. At your house, apartment or mobile home – do you or any member of your household own or use any of the following types of computers? Check all that apply

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* 25. At your house, apartment or mobile home – do you or any member of your household have access to the internet? Check all that apply

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* 26. Do you or any member of your household have access to the internet using a – (Check all that apply)

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* 27. Individual health statements. Check all that apply to you.

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* 28. What would you like to see Blue Mountain Hospital District, in cooperation with community partners, focus on over the next three years? Please choose up to three (3).

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* 29. If you think one of the priorities should be chronic disease, what chronic diseases would you recommend the Hospital and community partners focus on?

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* 30. If you think one of the priorities should be Supporting Caregivers, what would you recommend the Hospital and community partners focus on?

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* 31. If you think one of the priorities should be Drugs, Alcohol or Tobacco should be a priority, what would you recommend the Hospital and community partners focus on?

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* 32. If you think Domestic Violence, Abuse, or Neglect should be a priority, what would you recommend the Hospital and community partners focus on?

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* 34. Tell us about yourself.
What community do you live in? Please choose only one.

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* 35. What is your race or ethnicity? Please choose only one.

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* 36. What is your age?

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* 37. What language do you speak?

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* 38. What is the highest level of school you attended? Please choose only one.

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* 39. Any other comments are welcome and appreciated.

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* 40. (OPTIONAL DRAWING ENTRY) Thank you for your time! To be entered into a drawing to win $100 Grant County Greenbacks (which can be used at numerous participating local businesses) please enter your name, email address, and/or a phone number where we can reach you.

Your survey responses will remain completely confidential, and contact information will only be used for the drawing.

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