| Questions |
Placement and Other Instructions |
|---|
AC1. In the last 12 months, how many days did you usually have to wait for an appointment when your child 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 for your child?
__ 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 your child need care during evenings, weekends, or holidays?
1__ Yes
2__ No → If No, go to core question 7 |
After AC2
Note: If using AC3, change skip pattern for core question 5 to “If No, go to AC3”
|
AC4. In the last 12 months, how often were you able to get the care your child 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 your child need to visit a doctor's office or clinic after regular office hours?
1__ Yes
2__ No → 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 your child 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 your child need care from his or her personal doctor during evenings, weekends, or holidays?
1__ Yes
2__ No → If No, go to AC9 |
After core question 11 |
AC8. In the last 12 months, how often were you able to get the care your child needed from his or her 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 your child see his or her personal doctor within 15 minutes of your child's appointment time?
1__ Never
2__ Sometimes
3__ Usually
4__ Always → If Always, go to core question 12 |
After AC8 |
AC10. In the last 12 months, after you checked in for an appointment at your child’s personal doctor’s office, how often were you kept informed about how long you would need to wait for your child's 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 child’s personal doctor's office or clinic with a medical question during regular office hours?
1__ Yes
2__ No → If No, go to AC13 |
After core question 18 |
AC12. In the last 12 months, when you contacted your child’s 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 child’s personal doctor's office or clinic with a medical question after regular office hours?
1__ Yes
2__ No → If No, go to core question 19 |
After AC12 |
AC14. In the last 12 months, when you contacted your child’s 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
|
