| Questions |
Placement and Other Instructions |
AC1. In the last 6 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 6
Note: Do not insert precodes to the left of check boxes
|
AC2. In the last 6 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 8
Note: Do not insert precodes to the left of check boxes
|
AC3. In the last 6 months, did you need care for yourself during evenings, weekends, or holidays?
1 __ Yes
2 __ No → If No, go to core question 9 |
After AC2
Note: If using AC3, change skip pattern for core question 7 to “If No, go to AC3”
|
AC4. In the last 6 months, how often were you able to get the care you needed from this provider’s office during evenings, weekends, or holidays?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC3
Note: Use with AC3
|
AC5. In the last 6 months, did you contact this provider’s office with a medical question after regular office hours?
1 __ Yes
2 __ No → If No, go to AC7 |
After core question 10
Note: If using AC5, change skip pattern for core question 9 to “If No, go to AC5”
|
AC6. In the last 6 months, when you contacted this provider’s office 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 AC5
Note: Use with AC5
|
AC7. In the last 6 months, did you need to visit this provider's office after regular office hours?
1 __ Yes
2 __ No → If No, go to AC9 |
After AC6 |
AC8. In the last 6 months, how often were you able to get the care you needed from this provider's office after regular office hours?
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 6 months, how often did you see this provider within 15 minutes of your appointment time?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always → If Always, go to core question 11 |
After AC8 |
AC10. In the last 6 months, after you checked in for your appointment at this provider'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
|
