Making Decisions About Your Care Clerks and Receptionists at Your [NAME OF PROVIDER] Clinic Choices for your treatment or health care 47. can include choices about medicine, 51. In the last 12 months, how often were surgery, or other treatment. In the last 12 clerks and receptionists at your [NAME OF months, did a doctor or other health PROVIDER] clinic as helpful as you professional recommend a treatment for a thought they should be? health problem that was bothering you? 1 Never 1 Yes 2 Sometimes 2 No 3 Usually 4 Always 48. In the last 12 months, did a doctor or health professional tell you there was more 52. In the last 12 months, how often did clerks than one choice for your treatment or health and receptionists at your [NAME OF care? PROVIDER] clinic treat you with courtesy and respect? 1 Yes 2 No If No, go to #51 1 Never 2 Sometimes 3 Usually 49. In the last 12 months, did a doctor or other health professional talk with you about the 4 Always pros and cons of each choice for your treatment or health care? 1 Definitely yes Prescriptions 2 Somewhat yes 3 Somewhat no In the last 12 months, did you need any new 53. 4 Definitely no prescription medicine or need to refill a prescription? 50. In the last 12 months, when there was more 1 Yes than one choice for your treatment or health 2 No If No, go to #56 care, did a doctor or other health professional ask which choice you thought was best for you? 54. In the last 12 months, was it easy to get prescription medicine you needed through 1 Definitely yes your [NAME OF PROVIDER] clinic? 2 Somewhat yes 1 Definitely yes 3 Somewhat no 2 Somewhat yes 4 Definitely no 3 Somewhat no 4 Definitely no
Making Decisions About Your Care 47. Choices for your treatment or health care can include choices about medicine, surgery, or other treatment. In the last 12 months, did a doctor or other health professional recommend a treatment for a health problem that was bothering you? 1 Yes 2 No 48. In the last 12 months, did a doctor or health professional tell you there was more than one choice for your treatment or health care? 1 Yes 2 No If No, go to #51 49. In the last 12 months, did a doctor or other health professional talk with you about the pros and cons of each choice for your treatment or health care? 1 Definitely yes 2 Somewhat yes 3 Somewhat no 4 Definitely no 50. In the last 12 months, when there was more than one choice for your treatment or health care, did a doctor or other health professional ask which choice you thought was best for you? 1 Definitely yes 2 Somewhat yes 3 Somewhat no 4 Definitely no Clerks and Receptionists at Your [NAME OF PROVIDER] Clinic 51. In the last 12 months, how often were clerks and receptionists at your [NAME OF PROVIDER] clinic as helpful as you thought they should be? 1 Never 2 Sometimes 3 Usually 4 Always 52. In the last 12 months, how often did clerks and receptionists at your [NAME OF PROVIDER] clinic treat you with courtesy and respect? 1 Never 2 Sometimes 3 Usually 4 Always Prescriptions 53. In the last 12 months, did you need any new prescription medicine or need to refill a prescription? 1 Yes 2 No If No, go to #56 54. In the last 12 months, was it easy to get prescription medicine you needed through your [NAME OF PROVIDER] clinic? 1 Definitely yes 2 Somewhat yes 3 Somewhat no 4 Definitely no
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