SVPAM Patient Centered Medical Home Survey 

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100% of survey complete.

Thank you for participating in our patient survey.
Your participation is voluntary.  You may choose to answer this survey or not.  If you choose not to, this will not affect the health care you receive in any way.  

Please know that your privacy is protected.  Your responses to this survey are completely confidential and unidentifiable unless you choose to share your contact information with us at the end of the survey.  We are proud to identify our practice as a Pediatric Patient Centered Medical Home (PCMH) and will use all responses gathered to enhance the quality of our services and your experience in our office each time you visit or interact with us.  Thank you for being part of our medical home!

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* 1. Which office is your child most often seen in ?

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* 2. Which provider does your child most often see when you come in for routine, well-child care?

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* 3. Is this the same provider you usually see if your child gets sick or hurt?

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* 4. How long has your child been a patient with SVPAM?

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* 5. In the last 12 months, how many times did your child visit SVPAM for care?

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* 6. In the last 12 months, were you present in the exam room with your child?

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* 7. Did the provider give you enough information about what was discussed during the visit when you were not present?

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* 8. Is your child able to talk with providers about his or her health care?

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* 9. In the last 12 months, how often did the provider explain things in a way that was easy for your child to understand?

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* 10. In the last 12 months, how often did the provider listen carefully to your child ?

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* 11. Did the provider tell you that you needed to do anything to follow up on the care your child received during the visit?

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* 12. Did the provider give you enough information about what you needed to do to follow-up on your child's care?

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* 13. In the last 12 months, did you phone our office to get an appointment for your child's illness, injury or condition that needed care right away?

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* 14. In the last 12 months, when you phoned our office to get an appointment for care your child needed right away, how often did you get an appointment as soon as your child needed?

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* 15. In the last 12 months, how long did you usually have to wait for an appointment when your child needed care right away?

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* 16. In the last 12 months, did you make any appointments for a check-up or routine care for your child?

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* 17. In the last 12 months, when you made an appointment for a check-up or routine care, how often did you get the appointment as soon as your child needed it?

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* 18. Did our office give you information or was information available to you about what to do if your child needed care during evenings, weekends, or holidays?

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* 19. In the last 12 months, did your child need care during evenings, weekends, or holidays?

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* 20. In the last 12 months, how often were you able to get the care your child needed from our office during evenings, weekends, or holidays?

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* 21. In the last 12 months, did you phone our office with a medical question about your child during regular office hours?

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* 22. In the last 12 months, when you phoned our office during regular office hours, how often did you get an answer to your medical question that same day?

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* 23. In the last 12 months, did you phone our office with a medical question about your child after regular office hours?

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* 24. In the last 12 months, when you phoned our office after regular office hours, how often did you get an answer to your medical question as soon as you needed it?

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* 25. Some offices remind patients between visits about tests, treatment or appointments.  In the last 12 months, did you get any reminders about your child's care from our office?

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* 26. Wait time includes time spent in the waiting room and exam room.  In the last 12 months, was your wait time to start the visit process with the nurse:

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* 27. In the last 12 months, how often did the provider explain things about your child's health in a way that was easy to understand?

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* 28. In the last 12 months, how often did the provider listen carefully to you?

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* 29. In the last 12 months, did you and the provider talk about any questions or concerns you had about your child's health?

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* 30. In the last 12 months, how often did your healthcare provider give you easy to understand information about these health questions or concerns?

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* 31. In the last 12 months, how often did the provider seem to know the important information about your child's medical history?

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* 32. In the last 12 months, how often did your healthcare provider show respect for what you had to say?

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* 33. In the last 12 months, how often did the provider spend enough time with your child?

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* 34. In the last 12 months, did the provider order a blood test, x-ray, or other test for your child?

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* 35. In the last 12 months, when this provider ordered a blood test, x-ray or other test for your child, how often did someone from the office follow up to give you those results?

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* 36. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your healthcare provider?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible
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* 37. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, & other doctors who specialize in one area of health care.  In the last 12 months, did your child see a specialist for a particular health provider?

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* 38. In the last 12 months, how often did the SVPAM provider seem informed and up to date about the care your child got from specialists?

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* 39. In the last 12 months, did you & anyone in the our office talk about your child's learning ability?

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* 40. In the last 12 months, did you & anyone in our office talk about the kinds of behaviors that are normal for your child at this age?

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* 41. In the last 12 months, did you & anyone in our office talk about how your child's body is growing?

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* 42. In the last 12 months, did you & anyone in our office talk about your child's moods & emotions?

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* 43. In the last 12 months, did you & anyone in our office talk about things that you can do to keep your child form getting injured?

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* 44. In the last 12 months, did anyone in our office give you information about how to keep your child form getting injured?

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* 45. In the last 12 months, did you & anyone in our office talk about how much time your child spends on a computer and in front of a TV?

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* 46. In the last 12 months, did you & anyone in our office talk about how much or what kind of food your child eats?

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* 47. In the last 12 months, did you & anyone in our office talk about how much or what kind of exercise your child gets?

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* 48. In the last 12 months, did you & anyone in our office talk about how your child gets along with others?

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* 49. In the last 12 months, did you & anyone in our office talk about whether there are any problems in your household that might affect your child?

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* 50. In the last 12 months, did anyone if our office talk with you about specific goals for your child's health?

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* 51. In the last 12 months, did anyone in our office ask you if there are things that make it hard for you to take care of your child's health?

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* 52. In the last 12 months, did your child take any prescription medicine?

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* 53. In the last 12 months, did you & anyone in our office talk at each visit about all the prescription medicines your child was taking?

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* 54. In the last 12 months, how often were the receptionists & nurses at our office as helpful as you thought they should be?

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* 55. In the last 12 months, how often did the receptionists & nurses at our office treat you with courtesy and respect?

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* 56. In general, how would you rate your child's overall health?

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* 57. In general, how would you rate your child's overall mental or emotional health?

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* 58. Rate SVPAM on how you feel we provide Whole-person care & Self Management Support for you & your child (children).  For example:  Do you feel supported by SVPAM with routine/urgent care needs & decisions, with SVPAM offering advice & assistance as needed, and by SVPAM supporting you & your child in making changes in health habits & with health care decisions?  Rate 5 as SVPAM supporting you in all areas down to Rate 1 if SVPAM doesn't support you in any area

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* 59. What is your child's age?

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* 60. Is your child:

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* 61. What is YOUR age?

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* 62. Are you:

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* 63. How are you related to the child?

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* 64. Optional Information if you would like us to contact you to discuss any items you feel need to be addressed:

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* 65. Date completed:

Date 

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* 66. Do you have any other comments, questions, or concerns?

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Thank you for your time from all of us at SVPAM.  We are honored to participate in your child's healthcare.

Thank you for your time from all of us at SVPAM.  We are honored to participate in your child's healthcare.

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