Goshen Medical Center CAHPS® Visit Survey (English) Question Title 1. Our records show that you received care from a Goshen Medical Center provider. Is that correct? Yes No Question Title 2. What site did you visit to receive care from the Goshen Medical Center provider? Beulaville Bolton Clinton OB/GYN - Sampson Clinton Medical Clinton Dental Fairview Faison Medical Faison Pediatrics Faison OB/GYN Faison Dental Fayetteville - Cape Fear Fremont Garland Goldsboro Medical Goldsboro Eastpointe Jacksonville - New River Kenansville OB/GYN - Women's Health Mt. Olive Community Mt. Olive Lamberts New Bern Plainview Health Services Rosewood Medical Rosewood Dental Trenton Medical Wallace Medical Wallace OB/GYN Warsaw OB/GYN Warsaw Wellness Whiteville Question Title 3. Is your Goshen Medical Center provider the provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt? Yes No Question Title 4. How long have you been going to your Goshen Medical Center provider? Less than 6 months At least 6 months but less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more Question Title 5. In the last 12 months, how many times did you visit your Goshen Medical Center provider? None 1 time 2 3 4 5 to 9 10 or more times Question Title 6. In the last 12 months, did you phone your Goshen Medical Center provider’s site to get an appointment for an illness, injury, or condition that needed care right away? Yes No Question Title 7. In the last 12 months, when you phoned your Goshen Medical Center provider’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title 8. In the last 12 months, did you make any appointments for a check-up or routine care with your Goshen Medical Center provider? Yes No Question Title 9. In the last 12 months, when you made an appointment for a check-up or routine care with your Goshen Medical Center provider, how often did you get an appointment as soon as you needed? Never Sometimes Usually Always Question Title 10. In the last 12 months, did you phone your Goshen Medical Center provider’s office with a medical question during regular office hours? Yes No Question Title 11. In the last 12 months, when you phoned your Goshen Medical Center provider’s office during regular office hours, how often did you get an answer to your medical question that same day? Never Sometimes Usually Always Question Title 12. In the last 12 months, did you phone your Goshen Medical Center provider’s office with a medical question after regular office hours? Yes No Question Title 13. In the last 12 months, when you phoned your Goshen Medical Center provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? Never Sometimes Usually Always Question Title 14. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did you see your Goshen Medical Center provider within 15 minutes of your appointment time? Never Sometimes Usually Always Question Title 15. How long has it been since your most recent visit with your Goshen Medical Center provider? Less than 1 month At least 1 month but less than 3 months At least 3 months but less than 6 months At least 6 months but less than 12 months 12 months or more Question Title 16. Wait time includes time spent in the waiting room and exam room. During your most recent visit, did you see your Goshen Medical Center provider within 15 minutes of your appointment time? Yes No Question Title 17. During your most recent visit, did your Goshen Medical Center provider explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No Question Title 18. During your most recent visit, did your Goshen Medical Center provider listen carefully to you? Yes, definitely Yes, somewhat No Question Title 19. During your most recent visit, did you talk with your Goshen Medical Center provider about any health questions or concerns? Yes No Question Title 20. During your most recent visit, did your Goshen Medical Center provider give you easy to understand information about these health questions or concerns? Yes, definitely Yes, somewhat No Question Title 21. During your most recent visit, did your Goshen Medical Center provider seem to know the important information about your medical history? Yes, definitely Yes, somewhat No Question Title 22. During your most recent visit, did your Goshen Medical Center provider show respect for what you had to say? Yes, definitely Yes, somewhat No Question Title 23. During your most recent visit, did your Goshen Medical Center provider spend enough time with you? Yes, definitely Yes, somewhat No Question Title 24. During your most recent visit, did your Goshen Medical Center provider order a blood test, x-ray, or other test for you? Yes No Question Title 25. Did someone from your Goshen Medical Center provider’s site follow up to give you those results? Yes No Question Title 26. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your Goshen Medical Center provider? 10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible . . 10 Best provider possible . 9 . 8 . 7 . 6 . 5 . 4 . 3 . 2 . 1 . 0 Worst provider possible Question Title 27. Would you recommend your Goshen Medical Center provider’s office to your family and friends? Yes, definitely Yes, somewhat No Question Title 28. During your most recent visit, were clerks and receptionists at your Goshen Medical Center provider’s office as helpful as you thought they should be? Yes, definitely Yes, somewhat No Question Title 29. During your most recent visit, did clerks and receptionists at your Goshen Medical Center provider’s office treat you with courtesy and respect? Yes, definitely Yes, somewhat No Question Title 30. In general, how would you rate your overall health? Excellent Very good Good Fair Poor Question Title 31. In general, how would you rate your overall mental or emotional health? Excellent Very good Good Fair Poor Question Title 32. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title 33. Are you male or female? Male Female Question Title 34. What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree Question Title 35. Are you of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino Question Title 36. What is your race? Mark one or more. White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Question Title 37. Are you a member of one or more of the following population groups? U.S. Military - Active Duty or Reserve U.S. Military - Veteran Homeless (Living in a Shelter) Homeless (Living with Friend or Relative) Migrant or Seasonal Farmworker None of the Above Question Title 38. Did someone help you complete this survey? Yes No Question Title 39. How did that person help you? Mark one or more. Not Applicable Read the questions to me Wrote down the answers I gave Answered the questions for me Translated the questions into my language Helped in some other way Done