Neighborhood Health Needs Assessment - Flushing Hospital Medical Center (Paper Data Entry)

Health of the People in Your Neighborhood

Flushing Hospital Medical Center is interested in your ideas about the health of the people in your neighborhood. Your answers are anonymous and confidential. Thank you for your participation.

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* 1. What is the zip code where you live?

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* 2. How would you rate the overall health of the residents of your neighborhood?

Poor

Fair

Good

Very Good

Excellent

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* 3. How important are the following issues to the health of the people in your neighborhood?

	Not at all Important	Somewhat Important	Important	Very Important	Extremely Important
Arthritis	Arthritis Not at all Important	Arthritis Somewhat Important	Arthritis Important	Arthritis Very Important	Arthritis Extremely Important
Asthma/breathing problems	Asthma/breathing problems Not at all Important	Asthma/breathing problems Somewhat Important	Asthma/breathing problems Important	Asthma/breathing problems Very Important	Asthma/breathing problems Extremely Important
Cancer	Cancer Not at all Important	Cancer Somewhat Important	Cancer Important	Cancer Very Important	Cancer Extremely Important
Dental care	Dental care Not at all Important	Dental care Somewhat Important	Dental care Important	Dental care Very Important	Dental care Extremely Important
Diabetes	Diabetes Not at all Important	Diabetes Somewhat Important	Diabetes Important	Diabetes Very Important	Diabetes Extremely Important
Falls prevention among elderly and small children	Falls prevention among elderly and small children Not at all Important	Falls prevention among elderly and small children Somewhat Important	Falls prevention among elderly and small children Important	Falls prevention among elderly and small children Very Important	Falls prevention among elderly and small children Extremely Important
Heart disease	Heart disease Not at all Important	Heart disease Somewhat Important	Heart disease Important	Heart disease Very Important	Heart disease Extremely Important
Hepatitis C	Hepatitis C Not at all Important	Hepatitis C Somewhat Important	Hepatitis C Important	Hepatitis C Very Important	Hepatitis C Extremely Important
High blood pressure	High blood pressure Not at all Important	High blood pressure Somewhat Important	High blood pressure Important	High blood pressure Very Important	High blood pressure Extremely Important
HIV/AIDS	HIV/AIDS Not at all Important	HIV/AIDS Somewhat Important	HIV/AIDS Important	HIV/AIDS Very Important	HIV/AIDS Extremely Important
Mental health/depression	Mental health/depression Not at all Important	Mental health/depression Somewhat Important	Mental health/depression Important	Mental health/depression Very Important	Mental health/depression Extremely Important
Obesity in children and adults	Obesity in children and adults Not at all Important	Obesity in children and adults Somewhat Important	Obesity in children and adults Important	Obesity in children and adults Very Important	Obesity in children and adults Extremely Important
Sexually Transmitted Infections (STIs)	Sexually Transmitted Infections (STIs) Not at all Important	Sexually Transmitted Infections (STIs) Somewhat Important	Sexually Transmitted Infections (STIs) Important	Sexually Transmitted Infections (STIs) Very Important	Sexually Transmitted Infections (STIs) Extremely Important
Smoking/tobacco use/vaping	Smoking/tobacco use/vaping Not at all Important	Smoking/tobacco use/vaping Somewhat Important	Smoking/tobacco use/vaping Important	Smoking/tobacco use/vaping Very Important	Smoking/tobacco use/vaping Extremely Important
Substance use problems (including alcohol and drugs)	Substance use problems (including alcohol and drugs) Not at all Important	Substance use problems (including alcohol and drugs) Somewhat Important	Substance use problems (including alcohol and drugs) Important	Substance use problems (including alcohol and drugs) Very Important	Substance use problems (including alcohol and drugs) Extremely Important
Women’s health and infant care	Women’s health and infant care Not at all Important	Women’s health and infant care Somewhat Important	Women’s health and infant care Important	Women’s health and infant care Very Important	Women’s health and infant care Extremely Important

Other, please specify:

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20% of survey complete.