This Community Health Needs Assessment (CHNA) is being conducted by Methodist Le Bonheur Healthcare to gather input on the health and health needs of the community. Your input to this process is VITAL.  
This survey will take approximately 15 to 20 minutes to complete. Your individual responses will remain completely anonymous.  

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* 1. What is your age range?

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* 2. What is your gender?

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* 3. Which one of these groups would you say best represents your race?

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* 4. What is the highest level of school you have completed or the highest degree you have received?

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* 5. Which of the following categories best describes your employment status?

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* 6. Please enter your home ZIP code:

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* 7. What is your marital status?

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* 8. What is your annual household income?

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* 9. What is your primary health insurance plan? This is the plan which pays the medical bills first or pays most of the medical bills.

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* 10. For those of you who selected no health insurance, why do you not have health insurance?

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* 11. Do you have a primary care physician?

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* 12. Have you delayed getting needed medical care for any of the following reasons in the past 12 months? Select the most important reason

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* 13. How would you rate your overall physical health?

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* 14. In the past 30 days, how many days were you not able to work or do daily activities because of poor physical health?

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* 15. How would you rate your overall mental health?

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* 16. In the past 30 days, how many days were you not able to work or do daily activities because of poor mental health?

Section 2. Community Health

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* 17. What do you think are the top 3 most pressing health conditions affecting people in the community? (choose 3)

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* 18. Of the issues listed above, which do you think is the most important to address? (choose 1)

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* 19. What do you think are the top 3 most pressing community issues affecting people's health? (choose 3)

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* 20. Of the issues listed above, which do you think is the most important to address? (choose 1)

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* 21. In your opinion, what are the most significant barriers that keep people in the community from accessing health care when they need it (check all that apply)?

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* 22. Of the barriers mentioned above, which barrier is the most significant in keeping people in the community from accessing health care? (choose 1)

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* 23. On a scale of 1 (strongly disagree) through 5 (strongly agree), please rate each of the following statements about Health Care Access in your community.

  Strongly Disagree Disagree Neutral Agree Strongly Agree Unsure/Don't Know
People in the community are able to access a primary care provider when needed. (Family Doctor, Pediatrician, General Practitioner)
People in the community are able to access a medical specialist when needed. (Cardiologist, Dermatologist, Neurologist, etc.)
People in the community are able to access a dentist when needed.
There is a sufficient number of providers accepting Medicaid or other medical assistance in the area.
There is a sufficient number of bilingual providers in the area.
There is a sufficient number of mental/behavioral health providers in the area.
Transportation for medical appointments is available to residents when needed. 

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* 24. Are there specific populations in the community who you think are not being adequately served by local health services?

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* 25. If yes, which populations are underserved? (select all that apply)

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* 26. Related to health and quality of life, what resources or services do you think are missing in the community? (select all that apply)

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* 27. How would you rate your community’s overall health? 

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* 28. In the past three years, do you think access to health care in the community has…

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* 29. In your opinion, what is being done well in the community in terms of health and quality of life? (Community Assets/Strengths/Successes)

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* 30. What can Methodist Le Bonheur Healthcare do to improve health and quality of life in the community?

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* 31. Thank you for your time and contribution to Methodist Le Bonheur's Community Health Needs Assessment. Would you like to receive the final CHNA document when it is completed?

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