What Matters To You Community Survey

Hello,
Health departments, hospitals, county health plans and the Northern Michigan Health Network are working together to find out what the most important health issues are in Northern Michigan. One important part of the project is this Community Survey. Your input is very important! Your opinions will help us decide what to work on across the region for the next 3 years.
Thank you!

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* 1. Please check the THREE most important factors needed for a healthy community.

Access to affordable healthy foods

Access to health care, including primary care, specialty care, behavioral health services and dental care

Affordable housing

Clean environment

Community involvement

Good jobs and healthy economy

Good schools/high value on education

Healthy lifestyles

Low levels of child abuse

Opportunities for social and/or emotional support

Parks and recreation/access to physical activity

Safe neighborhoods

Strong family life

Other (please specify)

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* 2. Please check the THREE most important community health problems in your county.

Aging problems (arthritis, hearing loss/vision loss)

Chronic diseases (heart disease, cancer, diabetes, COPD, stroke)

Chronic pain

Homelessness

Infectious disease

Injury/trauma

Lack of access to affordable, healthy food

Lack of access to primary care, specialty care, behavioral health services or dental care

Lack of affordable housing

Lack of physical activity

Mental health issues

Overweight and obesity

Rape/sexual assault

Sexually transmitted diseases

Substance abuse (alcohol, illegal drugs, prescription drugs)

Suicide

Teenage pregnancy

Tobacco and e-cigarette use

Unsafe home environment (child abuse and neglect and domestic violence)

Other (please specify)

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* 3. Please check all the problems adults, older adults, and children in your family are having in getting health care services.

	Adults	Older adults	Children
Cannot afford visits to doctor,clinic, and/or hospital	Cannot afford visits to doctor,clinic, and/or hospital Adults	Cannot afford visits to doctor,clinic, and/or hospital Older adults	Cannot afford visits to doctor,clinic, and/or hospital Children
Cannot find doctor to take me as a patient	Cannot find doctor to take me as a patient Adults	Cannot find doctor to take me as a patient Older adults	Cannot find doctor to take me as a patient Children
Difficult to set appointments	Difficult to set appointments Adults	Difficult to set appointments Older adults	Difficult to set appointments Children
Do not know where to go for health care	Do not know where to go for health care Adults	Do not know where to go for health care Older adults	Do not know where to go for health care Children
ER waiting time	ER waiting time Adults	ER waiting time Older adults	ER waiting time Children
Finding a behavioral health provider	Finding a behavioral health provider Adults	Finding a behavioral health provider Older adults	Finding a behavioral health provider Children
Finding a dentist	Finding a dentist Adults	Finding a dentist Older adults	Finding a dentist Children
Finding a doctor	Finding a doctor Adults	Finding a doctor Older adults	Finding a doctor Children
Getting pregnancy care	Getting pregnancy care Adults	Getting pregnancy care Older adults	Getting pregnancy care Children
Getting specialist care	Getting specialist care Adults	Getting specialist care Older adults	Getting specialist care Children
Health insurance coverage is limited	Health insurance coverage is limited Adults	Health insurance coverage is limited Older adults	Health insurance coverage is limited Children
Health insurance does not cover behavioral health services	Health insurance does not cover behavioral health services Adults	Health insurance does not cover behavioral health services Older adults	Health insurance does not cover behavioral health services Children
Health insurance does not cover dental services	Health insurance does not cover dental services Adults	Health insurance does not cover dental services Older adults	Health insurance does not cover dental services Children
Health insurance does not cover medications	Health insurance does not cover medications Adults	Health insurance does not cover medications Older adults	Health insurance does not cover medications Children
Health insurance has high deductibles and/or copays	Health insurance has high deductibles and/or copays Adults	Health insurance has high deductibles and/or copays Older adults	Health insurance has high deductibles and/or copays Children
Lack of health insurance	Lack of health insurance Adults	Lack of health insurance Older adults	Lack of health insurance Children
Physician dropped me as a patient for missing appointments	Physician dropped me as a patient for missing appointments Adults	Physician dropped me as a patient for missing appointments Older adults	Physician dropped me as a patient for missing appointments Children
Too busy to get to doctor	Too busy to get to doctor Adults	Too busy to get to doctor Older adults	Too busy to get to doctor Children
Transportation issues	Transportation issues Adults	Transportation issues Older adults	Transportation issues Children

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* 4. Have you or any member of your immediate family ever been told by a doctor or other health professional that you have any of the following? Check all that apply.

	You	Member of your immediate family
Alcoholism or other addiction	Alcoholism or other addiction You	Alcoholism or other addiction Member of your immediate family
Arthritis	Arthritis You	Arthritis Member of your immediate family
Asthma	Asthma You	Asthma Member of your immediate family
Cancer	Cancer You	Cancer Member of your immediate family
Chronic pain	Chronic pain You	Chronic pain Member of your immediate family
Dental health problems	Dental health problems You	Dental health problems Member of your immediate family
Diabetes/prediabetes	Diabetes/prediabetes You	Diabetes/prediabetes Member of your immediate family
Hearing problems	Hearing problems You	Hearing problems Member of your immediate family
Heart disease/heart attack	Heart disease/heart attack You	Heart disease/heart attack Member of your immediate family
High blood pressure	High blood pressure You	High blood pressure Member of your immediate family
High cholesterol	High cholesterol You	High cholesterol Member of your immediate family
Kidney disease	Kidney disease You	Kidney disease Member of your immediate family
Lung disease/COPD	Lung disease/COPD You	Lung disease/COPD Member of your immediate family
Overweight/Obese	Overweight/Obese You	Overweight/Obese Member of your immediate family
Stroke	Stroke You	Stroke Member of your immediate family

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* 5. How long has it been since your most recent visit /care experience?

Less than 1 month

At least 1 month but less than 3 months

At least 3 months but less than 6 months

At least 6 months but less than 12 months

12 months or more

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* 6. Where was your most recent visit/care experience?

General/Family Physician

Specialist

Health Department

Other (please specify)

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* 7. How many visits have you had with this provider?

This was the first visit

2-4 visits

5 or more visits

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* 8. Do you have a primary care/family physician?

Yes

Uncertain

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* 9. Following is a series of characteristics which may describe your health care visit. Please indicate how important the characteristic is to you.

	Very important	Somewhat important	Neither Important nor Unimportant	Somewhat Unimportant	Very Unimportant
Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Very important	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Somewhat important	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Neither Important nor Unimportant	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Somewhat Unimportant	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Very Unimportant
Health Care Provider/Physician shows respect for my opinions	Health Care Provider/Physician shows respect for my opinions Very important	Health Care Provider/Physician shows respect for my opinions Somewhat important	Health Care Provider/Physician shows respect for my opinions Neither Important nor Unimportant	Health Care Provider/Physician shows respect for my opinions Somewhat Unimportant	Health Care Provider/Physician shows respect for my opinions Very Unimportant
Health Care Provider/Physician helps me to understand options available for treatment	Health Care Provider/Physician helps me to understand options available for treatment Very important	Health Care Provider/Physician helps me to understand options available for treatment Somewhat important	Health Care Provider/Physician helps me to understand options available for treatment Neither Important nor Unimportant	Health Care Provider/Physician helps me to understand options available for treatment Somewhat Unimportant	Health Care Provider/Physician helps me to understand options available for treatment Very Unimportant
Health Care Provider/Physician involves me in decision-making about my care	Health Care Provider/Physician involves me in decision-making about my care Very important	Health Care Provider/Physician involves me in decision-making about my care Somewhat important	Health Care Provider/Physician involves me in decision-making about my care Neither Important nor Unimportant	Health Care Provider/Physician involves me in decision-making about my care Somewhat Unimportant	Health Care Provider/Physician involves me in decision-making about my care Very Unimportant
Health Care Provider/Physician spends enough time with me to discuss options and questions	Health Care Provider/Physician spends enough time with me to discuss options and questions Very important	Health Care Provider/Physician spends enough time with me to discuss options and questions Somewhat important	Health Care Provider/Physician spends enough time with me to discuss options and questions Neither Important nor Unimportant	Health Care Provider/Physician spends enough time with me to discuss options and questions Somewhat Unimportant	Health Care Provider/Physician spends enough time with me to discuss options and questions Very Unimportant

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* 10. How would you rate your most recent visit/care experience with regard to each characteristic?

	Excellent	Above Average	Average	Below Average	Poor
Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Excellent	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Above Average	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Average	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Below Average	Health Care Provider/Physician expresses understanding of my personal values when considering my care decisions Poor
Health Care Provider/Physician shows respect for my opinions	Health Care Provider/Physician shows respect for my opinions Excellent	Health Care Provider/Physician shows respect for my opinions Above Average	Health Care Provider/Physician shows respect for my opinions Average	Health Care Provider/Physician shows respect for my opinions Below Average	Health Care Provider/Physician shows respect for my opinions Poor
Health Care Provider/Physician helps me to understand options available for treatment	Health Care Provider/Physician helps me to understand options available for treatment Excellent	Health Care Provider/Physician helps me to understand options available for treatment Above Average	Health Care Provider/Physician helps me to understand options available for treatment Average	Health Care Provider/Physician helps me to understand options available for treatment Below Average	Health Care Provider/Physician helps me to understand options available for treatment Poor
Health Care Provider/Physician involves me in decision-making about my care	Health Care Provider/Physician involves me in decision-making about my care Excellent	Health Care Provider/Physician involves me in decision-making about my care Above Average	Health Care Provider/Physician involves me in decision-making about my care Average	Health Care Provider/Physician involves me in decision-making about my care Below Average	Health Care Provider/Physician involves me in decision-making about my care Poor
Health Care Provider/Physician spends enough time with me to discuss options and questions	Health Care Provider/Physician spends enough time with me to discuss options and questions Excellent	Health Care Provider/Physician spends enough time with me to discuss options and questions Above Average	Health Care Provider/Physician spends enough time with me to discuss options and questions Average	Health Care Provider/Physician spends enough time with me to discuss options and questions Below Average	Health Care Provider/Physician spends enough time with me to discuss options and questions Poor

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* 11. Please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of agreement with how each statement reflects that most recent experience with the Health Care Provider/Physician.

	Strongly Agree	Somewhat Agree	Neither Agree nor Disagree	Somewhat Disagree	Strongly Disagree	N/A
Health Care Provider/Physician demonstrated knowledge of my medical history	Health Care Provider/Physician demonstrated knowledge of my medical history Strongly Agree	Health Care Provider/Physician demonstrated knowledge of my medical history Somewhat Agree	Health Care Provider/Physician demonstrated knowledge of my medical history Neither Agree nor Disagree	Health Care Provider/Physician demonstrated knowledge of my medical history Somewhat Disagree	Health Care Provider/Physician demonstrated knowledge of my medical history Strongly Disagree	Health Care Provider/Physician demonstrated knowledge of my medical history N/A
Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions Strongly Agree	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions Somewhat Agree	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions Neither Agree nor Disagree	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions Somewhat Disagree	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions Strongly Disagree	Health Care Provider/Physician expressed understanding of my personal situation when considering my care decisions N/A
Health Care Provider/Physician asked questions of me regarding my preferences	Health Care Provider/Physician asked questions of me regarding my preferences Strongly Agree	Health Care Provider/Physician asked questions of me regarding my preferences Somewhat Agree	Health Care Provider/Physician asked questions of me regarding my preferences Neither Agree nor Disagree	Health Care Provider/Physician asked questions of me regarding my preferences Somewhat Disagree	Health Care Provider/Physician asked questions of me regarding my preferences Strongly Disagree	Health Care Provider/Physician asked questions of me regarding my preferences N/A
Health Care Provider/Physician listened to me carefully	Health Care Provider/Physician listened to me carefully Strongly Agree	Health Care Provider/Physician listened to me carefully Somewhat Agree	Health Care Provider/Physician listened to me carefully Neither Agree nor Disagree	Health Care Provider/Physician listened to me carefully Somewhat Disagree	Health Care Provider/Physician listened to me carefully Strongly Disagree	Health Care Provider/Physician listened to me carefully N/A
Health Care Provider/Physician explained things in a way that was easy to understand	Health Care Provider/Physician explained things in a way that was easy to understand Strongly Agree	Health Care Provider/Physician explained things in a way that was easy to understand Somewhat Agree	Health Care Provider/Physician explained things in a way that was easy to understand Neither Agree nor Disagree	Health Care Provider/Physician explained things in a way that was easy to understand Somewhat Disagree	Health Care Provider/Physician explained things in a way that was easy to understand Strongly Disagree	Health Care Provider/Physician explained things in a way that was easy to understand N/A

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* 12. Again, please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of agreement with how each statement reflects that most recent experience with the Staff/Care Team.

	Strongly Agree	Somewhat Agree	Neither Agree nor Disagree	Somewhat Disagree	Strongly Disagree	N/A
Staff at the provider's office treated me with courtesy and respect	Staff at the provider's office treated me with courtesy and respect Strongly Agree	Staff at the provider's office treated me with courtesy and respect Somewhat Agree	Staff at the provider's office treated me with courtesy and respect Neither Agree nor Disagree	Staff at the provider's office treated me with courtesy and respect Somewhat Disagree	Staff at the provider's office treated me with courtesy and respect Strongly Disagree	Staff at the provider's office treated me with courtesy and respect N/A
Staff explained things in a way that was easy to understand	Staff explained things in a way that was easy to understand Strongly Agree	Staff explained things in a way that was easy to understand Somewhat Agree	Staff explained things in a way that was easy to understand Neither Agree nor Disagree	Staff explained things in a way that was easy to understand Somewhat Disagree	Staff explained things in a way that was easy to understand Strongly Disagree	Staff explained things in a way that was easy to understand N/A
Staff kept me informed of any delays to my scheduled appointment.	Staff kept me informed of any delays to my scheduled appointment. Strongly Agree	Staff kept me informed of any delays to my scheduled appointment. Somewhat Agree	Staff kept me informed of any delays to my scheduled appointment. Neither Agree nor Disagree	Staff kept me informed of any delays to my scheduled appointment. Somewhat Disagree	Staff kept me informed of any delays to my scheduled appointment. Strongly Disagree	Staff kept me informed of any delays to my scheduled appointment. N/A
Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns Strongly Agree	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns Somewhat Agree	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns Neither Agree nor Disagree	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns Somewhat Disagree	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns Strongly Disagree	Staff followed up with me in a timely manner when I contacted the provider's office with questions and/or concerns N/A
Staff are accessible during the standard lunch hour (12pm-1pm)	Staff are accessible during the standard lunch hour (12pm-1pm) Strongly Agree	Staff are accessible during the standard lunch hour (12pm-1pm) Somewhat Agree	Staff are accessible during the standard lunch hour (12pm-1pm) Neither Agree nor Disagree	Staff are accessible during the standard lunch hour (12pm-1pm) Somewhat Disagree	Staff are accessible during the standard lunch hour (12pm-1pm) Strongly Disagree	Staff are accessible during the standard lunch hour (12pm-1pm) N/A
The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team Strongly Agree	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team Somewhat Agree	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team Neither Agree nor Disagree	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team Somewhat Disagree	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team Strongly Disagree	The care team (Physician, Nurse, Physician's Assistant) demonstrated that my health information was shared among members of the team N/A

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* 13. Please indicate how much you feel each of the following is a barrier to getting the health care that you need, or makes it more difficult.

	Major Barrier	Minor Barrier	Not a Barrier	NA
Availability of information on area health care resources	Availability of information on area health care resources Major Barrier	Availability of information on area health care resources Minor Barrier	Availability of information on area health care resources Not a Barrier	Availability of information on area health care resources NA
Availability of information on cost of health care services	Availability of information on cost of health care services Major Barrier	Availability of information on cost of health care services Minor Barrier	Availability of information on cost of health care services Not a Barrier	Availability of information on cost of health care services NA
Coordination of resources among services and providers	Coordination of resources among services and providers Major Barrier	Coordination of resources among services and providers Minor Barrier	Coordination of resources among services and providers Not a Barrier	Coordination of resources among services and providers NA
Access to affordable health care	Access to affordable health care Major Barrier	Access to affordable health care Minor Barrier	Access to affordable health care Not a Barrier	Access to affordable health care NA
Access to holistic treatment options	Access to holistic treatment options Major Barrier	Access to holistic treatment options Minor Barrier	Access to holistic treatment options Not a Barrier	Access to holistic treatment options NA
Availability of transportation	Availability of transportation Major Barrier	Availability of transportation Minor Barrier	Availability of transportation Not a Barrier	Availability of transportation NA
Availability of child care	Availability of child care Major Barrier	Availability of child care Minor Barrier	Availability of child care Not a Barrier	Availability of child care NA
Ability to contact (no telephone)	Ability to contact (no telephone) Major Barrier	Ability to contact (no telephone) Minor Barrier	Ability to contact (no telephone) Not a Barrier	Ability to contact (no telephone) NA
Ability to take time off work for appointment/care	Ability to take time off work for appointment/care Major Barrier	Ability to take time off work for appointment/care Minor Barrier	Ability to take time off work for appointment/care Not a Barrier	Ability to take time off work for appointment/care NA

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* 14. Where do you get health information?

	Yes	Sometimes	No
Doctor or health clinic	Doctor or health clinic Yes	Doctor or health clinic Sometimes	Doctor or health clinic No
Family or friends	Family or friends Yes	Family or friends Sometimes	Family or friends No
Health Department	Health Department Yes	Health Department Sometimes	Health Department No
Internet	Internet Yes	Internet Sometimes	Internet No
Newspapers or magazines	Newspapers or magazines Yes	Newspapers or magazines Sometimes	Newspapers or magazines No
Radio	Radio Yes	Radio Sometimes	Radio No
Television	Television Yes	Television Sometimes	Television No

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* 15. Please tell us about yourself. This anonymous personal health information helps us to plan programs and services where they are needed.

In which of the following counties do you live?

Alcona

Alpena

Antrim

Benzie

Charlevoix

Cheboygan

Crawford

Emmet

Grand Traverse

Iosco

Kalkaska

Lake

Leelanau

Manistee

Mason

Mecosta

Missaukee

Montmorency

Newaygo

Oceana

Ogemaw

Oscoda

Otsego

Presque Isle

Roscommon

Wexford

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* 16. What is your age?

18-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

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* 17. What is your highest level of education?

8th grade or less

Some high school

High school graduate/vocational-technical/GED

Some college

College graduate

Post college/secondary school

Refused (VOLUNTEERED)

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* 18. What is your annual household income?

Less than $15,000

$15,000 - $34,999

$35,000 - $74,999

$75,000 - $99,999

$100,000 or more

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* 19. Do you have health insurance?

Yes

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* 20. What is your race/ethnicity?

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Pacific Islander

Hispanic or Latino

Two or more races

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* 21. Gender

Male

Female

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* 22. Comments:

Thank you!

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* 1. Please check the THREE most important factors needed for a healthy community.

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* 2. Please check the THREE most important community health problems in your county.

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* 3. Please check all the problems adults, older adults, and children in your family are having in getting health care services.

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* 4. Have you or any member of your immediate family ever been told by a doctor or other health professional that you have any of the following? Check all that apply.

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* 5. How long has it been since your most recent visit /care experience?

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* 6. Where was your most recent visit/care experience?

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* 7. How many visits have you had with this provider?

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* 8. Do you have a primary care/family physician?

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* 9. Following is a series of characteristics which may describe your health care visit. Please indicate how important the characteristic is to you.

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* 10. How would you rate your most recent visit/care experience with regard to each characteristic?

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* 11. Please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of agreement with how each statement reflects that most recent experience with the Health Care Provider/Physician.

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* 12. Again, please consider your most recent health care visit/experience. Then, for each of the following statements, rate your level of agreement with how each statement reflects that most recent experience with the Staff/Care Team.

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* 13. Please indicate how much you feel each of the following is a barrier to getting the health care that you need, or makes it more difficult.

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* 14. Where do you get health information?

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* 15. Please tell us about yourself. This anonymous personal health information helps us to plan programs and services where they are needed. In which of the following counties do you live?

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* 16. What is your age?

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* 17. What is your highest level of education?

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* 18. What is your annual household income?

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* 19. Do you have health insurance?

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* 20. What is your race/ethnicity?

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* 21. Gender

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* 22. Comments:

* 15. Please tell us about yourself. This anonymous personal health information helps us to plan programs and services where they are needed.

In which of the following counties do you live?