Placement and Other Questions Instructions AC1. In the last 6 months, how many days did you usually have to After core question 13 wait for an appointment when your child needed care right away? Note: Do not insert precodes to the left of check boxes Same day 1 day 2 to 3 days 4 to 7 days More than 7 days AC2. In the last 6 months, how many days did you usually have to After core question 15 wait for an appointment for a check-up or routine care for your child? Note: Do not insert precodes to the left of check boxes Same day 1 day 2 to 3 days 4 to 7 days 8 to 14 days 15 to 30 days More than 30 days AC3. In the last 6 months, did your child need care during evenings, After AC2 weekends, or holidays? Note: If using AC3, change 1 Yes skip pattern for core 2 No If No, go to core question 16 question 14 to No, go to “If AC3” In the last 6 months, how often were you able to get the care After AC3 AC4. your child needed during evenings, from this provider’s office weekends, or holidays? Note: Use with AC3 1 Never 2 Sometimes 3 Usually 4 Always In the last 6 months, did you contact After core question 17 AC5. this provider’s office with a medical question about your child after regular office hours? Note: If using AC5, change skip pattern for core 1 Yes question 16 to No, go to “If 2 No If No, go to AC7 AC5”
Questions Placement and Other Instructions AC1. In the last 6 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 13 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 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 15 Note: Do not insert precodes to the left of check boxes AC3. In the last 6 months, did your child need care during evenings, weekends, or holidays? 1 Yes 2 No If No, go to core question 16 After AC2 Note: If using AC3, change skip pattern for core question 14 to “If No, go to AC3” AC4. In the last 6 months, how often were you able to get the care your child 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 about your child after regular office hours? 1 Yes 2 No If No, go to AC7 After core question 17 Note: If using AC5, change skip pattern for core question 16 to “If No, go to AC5”
suppl-access_items_cg-cahps-child-survey_2358-1a.docx