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* 1. The health center's Board of Directors wants to be sure we are doing everything possible to serve you well. Please fill out this confidential survey that will tell us what we are doing well and what we can do better. We are very interested in learning your views on the manner services may be improved. 

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* 2. Who is your primary care provider?

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* 3. Who do you have an appointment with today?

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* 4. When requesting an appointment, I'm always given the opportunity to see my primary care provider.

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* 5. The office tries to coordinate my care so that I can see all the medical personnel I need to see and get all the tests I need during one visit.

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* 6. I am able to get an appointment as soon as I need it.

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* 7. I am able to get a same-day appointment when I request one.

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* 8. In the past 12 months, when you made an appointment for a check-up or routine care with your healthcare provider, how often did you get an appointment as soon as you needed?

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* 9. When I call Betances for advice or help, I get a call back on the same day.

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* 10. When I call Betances on the phone, I usually receive adequate information and I feel satisfied with the quality of the call.

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* 11. When I call Betances with a medical urgency, I get a response within a reasonable amount of time, 24 hours a day, 7 days a week.

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* 12. My family and I are satisfied with the level of care, treatment options and timely responses of Betances' staff.

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* 13. If I could comminucate with my provider through e-mail, I would.

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* 14. I know that Betances has a web site that I can go to about my health care or disease management.

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* 15. If I request information using Betances' web site or e-mail, I receive an adequate response in a timely manner.

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* 16. Betances gives me information in my language or helps to provide someone who will understand.

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* 17. Betances' staff helps me identify health insurance options when I need them.

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* 18. When I arrive to Betances for an appointment, I do not usually have to wait a long time to see a provider.

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* 19. My provider communicates effectively about my health, including information about diagnoses, medications prescribed, treatment plans, and follow-up care.

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* 20. I feel that my provider and I work as partners to take care of my health and my family's health.

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* 21. I feel that I am able to follow my provider's instructions regarding self care, including taking medications as instructed, following any exercise programs provided, and reporting changes in symptoms I am experiencing.

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* 22. Are you satisfied with Betances' hours of operation?

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* 23. Are you satisfied with the cleaniness of our facility?

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* 24. Would you recommend Betances to your family and friends?

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* 25. Comments

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