62. Do you know if [NAME OF PROVIDER] 67. In the past 12 months, have you seen a has a website? doctor or other health professional three or more times for the same condition or 1 Yes problem? 2 No If No, go to #65 1 Yes 2 No If No, go to #69 63. In the last 12 months, did you visit the [NAME OF PROVIDER] website to get information or help about the hospital or 68. Is this a condition or problem that has clinics? lasted for at least 3 months? Do not include pregnancy. 1 Yes 1 Yes 2 No If No, go to #65 2 No 64. In the last 12 months, how often did the [NAME OF PROVIDER] website provide 69. Do you now need or take medicine the information or help you wanted about prescribed by a doctor? Do include not the hospitals or clinics? birth control. 1 Never 1 Yes 2 Sometimes 2 No If No, go to #71 3 Usually 4 Always 70. Is this to treat a condition that has lasted for About You at least 3 months? Do not include pregnancy or menopause. are only a few questions left. 1 Yes 2 No 65. In general, how you rate your overall health? 71. What is your age? 1 Excellent 2 Very good 1 18 to 24 3 Good 2 25 to 34 4 Fair 3 35 to 44 5 Poor 4 45 to 54 5 55 to 64 6 65 to 74 66. In general, how would you rate your overall mental or emotional health? 7 75 or 1 Excellent 72. Are you male or female? 2 Very good 3 Good 1 Male 4 Fair 2 Female 5 Poor
62. Do you know if [NAME OF PROVIDER] has a website? 1 Yes 2 No If No, go to #65 63. In the last 12 months, did you visit the [NAME OF PROVIDER] website to get information or help about the hospital or clinics? 1 Yes 2 No If No, go to #65 64. In the last 12 months, how often did the [NAME OF PROVIDER] website provide the information or help you wanted about the hospitals or clinics? 1 Never 2 Sometimes 3 Usually 4 Always About You are only a few questions left. 65. In general, how you rate your overall health? 1 Excellent 2 Very good 3 Good 4 Fair 5 Poor 66. In general, how would you rate your overall mental or emotional health? 1 Excellent 2 Very good 3 Good 4 Fair 5 Poor 67. In the past 12 months, have you seen a doctor or other health professional three or more times for the same condition or problem? 1 Yes 2 No If No, go to #69 68. Is this a condition or problem that has lasted for at least 3 months? Do not include pregnancy. 1 Yes 2 No 69. Do you now need or take medicine prescribed by a doctor? Do not include birth control. 1 Yes 2 No If No, go to #71 70. Is this to treat a condition that has lasted for at least 3 months? Do not include pregnancy or menopause. 1 Yes 2 No 71. What is your age? 1 18 to 24 2 25 to 34 3 35 to 44 4 45 to 54 5 55 to 64 6 65 to 74 7 75 or 72. Are you male or female? 1 Male 2 Female
american-indian-eng-851.docx