Exit this survey 2012 CSHCS SURVEY Question Title * 1. Did you know that the main number for the Children's Special Health Care Services (CSHCS) office at Tuscola County Health Department is (989) 673-1856? Yes No Question Title * 2. How many times did you call your local Children's Special Health Care Services office (at the Tuscola County Health Department) in the past year? None Once Twice Three Times Four or more times Question Title * 3. Please check one or more of the following reasons you have called to speak with a local CSHCS staff. To add a provider (doctor) to my child's list. To request assistance with billing problems. To request help finding a resource or referral for my child. To resolve problems with obtaining medicine. To resolve problems with obtaining supplies or equipment. For help with state forms, such as the application or income review form. Other (please specify) Question Title * 4. If you leave a message, how long does it usually take for someone to return your call? Within an hour The same day The same week My call(s) was not returned Question Title * 5. When you have called the CSHCS office, was the service you received: Usually very helpful Usually somewhat helpful Usually not helpful Question Title * 6. Were you aware that the CSHCS program offers the following services? Check all that apply. Assist in paying private insurance premium payments in the event that a parent loses their job; or assist with Cobra premium payments. Provide the toll-free "Family Phone Line" to help with scholarships for parents or youth to learn about their medical condition. Assist in obtaining CSHCS Special Needs Fund for purchasing a wheelchair ramp or van lift. Provide the assistance of a nurse to develop a Plan of Care for your child. Adjustment to payment agreement if financial situation changes. Question Title * 7. Our goal is to have a CSHCS staff member contact you shortly after enrolling in CSHCS to help you understand the program and assist with resources. Our nurses will work with you to create your child's Plan of Care (POC).Did one of our CSHCS nurses complete a Plan of Care (POC) with you? Yes No Question Title * 8. Was/Is the POC useful/helpful? Very Helpful Somewhat Helpful Not Helpful Question Title * 9. If you would like a POC, please list your child's name and phone number so we may call you. Child's Name: Phone: Question Title * 10. Are you familiar with the CSHCS Client Rights and Responsibilities? Yes No Question Title * 11. Are you familiar with the Family Center? Yes No Question Title * 12. Do you understand that at the age of 18 there is a process for transitioning off of the CSHCS program? Yes No Question Title * 13. What barriers, if any, have you experienced when receiving services from CSHCS at Tuscola County Health Department? None Understanding the Program in general Availabliity of CSHCS staff to assist you Payment agreements Medicaid Transportation Other (please specify) Question Title * 14. Comments regarding the above question? Question Title * 15. If we were to provide a presentation, what topic would you like to see addressed? Diabetes Nutrition Cerebral Palsy Cancer Other (please specify) Question Title * 16. What would make the local CSHCS office more useful to you and your family? Question Title * 17. We are seeking 5-7 people to participate in a Focus Group meeting. If you have any interest in participating in this activity or would like more details please provide your contact information below or call our office. Name: Address: City: State: Zip: Phone: Done