Platte Valley Healthcare Assessment
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How would you rate the general health of our community?
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In the following list what do you think are the three (3) most serious health concerns in our community?
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Select only three (3) items below that you believe are most important for a healthy community.
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Local Healthcare
How do you rate your knowledge of the healthcare services available in our valley?
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Which community health resources have you used in the last three years? (Select all that apply)
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In your opinion, what would improve our community's access to healthcare? (select ALL that apply)
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Which of the following preventative services have you used in the past year? (Select ALL that apply)
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What additional healthcare services would you use if available in our valley? (Select ALL that apply)
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How important are local healthcare providers and services (i.e. clinic, nursing home, public health, pharmacy) to the economic well-being of the valley?
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In the past three years, was there a time when you or a member of your household thought you needed healthcare services but did NOT get or delayed getting medical services because of local availability?
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No Service
If yes, what were the three (3) most important reasons why you did not receive healthcare services? (Select ONLY 3)
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Hospitalization
In the past three years, has anyone in your household received care in a hospital? (i.e. hospitalized overnight, day surgery, obstetrical care, rehabilitation, radiology or emergency care)
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Hospitalization - YES
Thinking about the hospitals you have visited, what were the three most important reasons for selecting that hospital? (Select up to 3 responses)
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Primary Provider
In the past three years, have you or a household member seen a primary healthcare provider, such as a family physician, physician's assistant or nurse practitioner for healthcare services?
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Primary Provider YES
Where was the most recent primary healthcare provider located? (Select only 1)
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Why did you select the primary care provider you are currently seeing? (Select up to 3 reasons)
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Specialist
In the past three years, have you or a household member seen a healthcare SPECIALIST (other than your primary care provider/family doctor) for healthcare services?
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Specialist YES
Where was the healthcare specialist seen? (Select ALL that apply)
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What type of healthcare specialist was seen? (Select ALL that apply)
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Clinic Assessment
The following services are available in the Platte Valley. Please rate the overall quality for each service by checking your answer (please choose N/A if you have not used the service).
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Insurance
Do you have Health Insurance?
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Insurance - YES
What type of medical insurance covers the MAJORITY of your household's medical expenses?
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How well do you feel your medical insurance covers your healthcare costs?
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Demographics
Where do you currently live, by zip code?
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What is your gender?
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What age range represents you?
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Estimated Household Annual Income
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What is your employment status?
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Additional Comments
Thoughtful and honest comments and suggestions are welcomed...
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Number of daily responses
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