| Questions |
Placement and Other Instructions |
AC1. In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?
__ Same day
__ 1 day
__ 2 to 3 days
__ 4 to 7 days
__ More than 7 days |
After core question 4
Note: Do not insert precodes to the left of check boxes
|
AC2. In the last 12 months, how many days did you usually have to wait for an appointment for a check-up or routine care?
__ Same day
__ 1 day
__ 2 to 3 days
__ 4 to 7 days
__ 8 to 14 days
__ 15 to 30 days
__ More than 30 days |
After core question 6
Note: Do not insert precodes to the left of check boxes
|
AC3. In the last 12 months, did you need care for yourself during evenings, weekends, or holidays?
1 __ Yes
2 __ No 鈫 If No, go to core question 7 |
After AC2
Note: If using AC3, change skip pattern for core question 5 to 鈥If No, go to AC3鈥
|
AC4. In the last 12 months, how often were you able to get the care you needed from a doctor's office or clinic during evenings, weekends, or holidays?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC3
Note: Use with AC3
|
AC5. In the last 12 months, did you need to visit a doctor's office or clinic after regular office hours?
1 __ Yes
2 __ No 鈫 If No, go to core question 9 |
After core question 8 |
AC6. In the last 12 months, how often were you able to get the care you needed from a doctor's office or clinic after regular office hours?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC5
Note: Use with AC5
|
AC7. In the last 12 months, did you need care from your personal doctor during evenings, weekends, or holidays?
1 __ Yes
2 __ No 鈫 If No, go to AC9 |
After core question 11 |
AC8. In the last 12 months, how often were you able to get the care you needed from your personal doctor's office or clinic during evenings, weekends, or holidays?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC7
Note: Use with AC7
|
AC9. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see your personal doctor within 15 minutes of your appointment time?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always 鈫 If Always, go to core question 12 |
After AC8 |
AC10. In the last 12 months, after you checked in for your appointment at your personal doctor's office, how often were you kept informed about how long you would need to wait for your appointment to start?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC9
Note: Use with AC9
|
AC11. In the last 12 months, did you contact your personal doctor's office or clinic with a medical question during regular office hours?
1 __ Yes
2 __ No 鈫 If No, go to AC13 |
After core question 15 |
AC12. In the last 12 months, when you contacted your personal doctor's office or clinic during regular office hours, how often did you get an answer to your medical question that same day?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC11
Note: Use with AC11
|
AC13. In the last 12 months, did you contact your personal doctor's office or clinic with a medical question after regular office hours?
1 __ Yes
2 __ No 鈫 If No, go to core question 16 |
After AC12 |
AC14. In the last 12 months, when you contacted your personal doctor's office or clinic after regular office hours, how often did you get an answer to your medical question as soon as you needed?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC13
Note: Use with AC13
|
