Pagrukodan Ti Pannakapnek Dagiti Pasyente Ken Kasapulan ti Komyunidad Nga Ited Ti L.C.H.C. Survey

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* 1. Maysa ka kadi a pasyente ti Lanai Community Health Center?

WEN, maysaak a pasyente.

NO SAAN, Mapanka iti saludsod a numero 4.

Question Title

* 2. Kasano ti pananggradom kadagiti sumaganad nga “health care services” iti Health Center?

	Good - 3	Okay - 2	Poor - 1	Not applicable - 0
General Medical Care	General Medical Care Good - 3	General Medical Care Okay - 2	General Medical Care Poor - 1	General Medical Care Not applicable - 0
Women’s Health Exams	Women’s Health Exams Good - 3	Women’s Health Exams Okay - 2	Women’s Health Exams Poor - 1	Women’s Health Exams Not applicable - 0
Men’s Health Exams	Men’s Health Exams Good - 3	Men’s Health Exams Okay - 2	Men’s Health Exams Poor - 1	Men’s Health Exams Not applicable - 0
Children’s Health	Children’s Health Good - 3	Children’s Health Okay - 2	Children’s Health Poor - 1	Children’s Health Not applicable - 0
Drug/Alcohol Counseling	Drug/Alcohol Counseling Good - 3	Drug/Alcohol Counseling Okay - 2	Drug/Alcohol Counseling Poor - 1	Drug/Alcohol Counseling Not applicable - 0
Health Checkups	Health Checkups Good - 3	Health Checkups Okay - 2	Health Checkups Poor - 1	Health Checkups Not applicable - 0
Transportation (to health visit)	Transportation (to health visit) Good - 3	Transportation (to health visit) Okay - 2	Transportation (to health visit) Poor - 1	Transportation (to health visit) Not applicable - 0
Language Translation	Language Translation Good - 3	Language Translation Okay - 2	Language Translation Poor - 1	Language Translation Not applicable - 0
Prescription Assistance	Prescription Assistance Good - 3	Prescription Assistance Okay - 2	Prescription Assistance Poor - 1	Prescription Assistance Not applicable - 0
Shots & TB Tests	Shots & TB Tests Good - 3	Shots & TB Tests Okay - 2	Shots & TB Tests Poor - 1	Shots & TB Tests Not applicable - 0
Family Planning Services	Family Planning Services Good - 3	Family Planning Services Okay - 2	Family Planning Services Poor - 1	Family Planning Services Not applicable - 0
Skin Rashes	Skin Rashes Good - 3	Skin Rashes Okay - 2	Skin Rashes Poor - 1	Skin Rashes Not applicable - 0
Diabetes & Nutrition	Diabetes & Nutrition Good - 3	Diabetes & Nutrition Okay - 2	Diabetes & Nutrition Poor - 1	Diabetes & Nutrition Not applicable - 0
Dental	Dental Good - 3	Dental Okay - 2	Dental Poor - 1	Dental Not applicable - 0
Behavioral Health	Behavioral Health Good - 3	Behavioral Health Okay - 2	Behavioral Health Poor - 1	Behavioral Health Not applicable - 0
Other Service Assistance	Other Service Assistance Good - 3	Other Service Assistance Okay - 2	Other Service Assistance Poor - 1	Other Service Assistance Not applicable - 0

If other service assistance, please list those services here:

Question Title

* 3. Kasano met ti pananggradom kadagiti sumaganad nga “customer service elements” iti Health Center?

	Good - 3	Okay - 2	Poor - 1	Not applicable - 0
Friendliness of staff	Friendliness of staff Good - 3	Friendliness of staff Okay - 2	Friendliness of staff Poor - 1	Friendliness of staff Not applicable - 0
Helpfulness of staff	Helpfulness of staff Good - 3	Helpfulness of staff Okay - 2	Helpfulness of staff Poor - 1	Helpfulness of staff Not applicable - 0
Cleanliness of facility	Cleanliness of facility Good - 3	Cleanliness of facility Okay - 2	Cleanliness of facility Poor - 1	Cleanliness of facility Not applicable - 0
Knowledgeable providers	Knowledgeable providers Good - 3	Knowledgeable providers Okay - 2	Knowledgeable providers Poor - 1	Knowledgeable providers Not applicable - 0
Respect for privacy	Respect for privacy Good - 3	Respect for privacy Okay - 2	Respect for privacy Poor - 1	Respect for privacy Not applicable - 0
Timeliness of service	Timeliness of service Good - 3	Timeliness of service Okay - 2	Timeliness of service Poor - 1	Timeliness of service Not applicable - 0
Ability to make an appointment	Ability to make an appointment Good - 3	Ability to make an appointment Okay - 2	Ability to make an appointment Poor - 1	Ability to make an appointment Not applicable - 0
Problem solving ability	Problem solving ability Good - 3	Problem solving ability Okay - 2	Problem solving ability Poor - 1	Problem solving ability Not applicable - 0
Follow-up	Follow-up Good - 3	Follow-up Okay - 2	Follow-up Poor - 1	Follow-up Not applicable - 0

Question Title

* 4. Ania dagiti serbisyo nga kayatmo a mapaadda ditoy Lanai?

	High Priority - 3	Medium Priority - 2	Low Priority - 1	Don’t Know - 0
Dental Care	Dental Care High Priority - 3	Dental Care Medium Priority - 2	Dental Care Low Priority - 1	Dental Care Don’t Know - 0
Medical Care for Elderly	Medical Care for Elderly High Priority - 3	Medical Care for Elderly Medium Priority - 2	Medical Care for Elderly Low Priority - 1	Medical Care for Elderly Don’t Know - 0
Mental Health/Behavioral Health	Mental Health/Behavioral Health High Priority - 3	Mental Health/Behavioral Health Medium Priority - 2	Mental Health/Behavioral Health Low Priority - 1	Mental Health/Behavioral Health Don’t Know - 0
Children’s Health Care	Children’s Health Care High Priority - 3	Children’s Health Care Medium Priority - 2	Children’s Health Care Low Priority - 1	Children’s Health Care Don’t Know - 0
Pregnancy Care	Pregnancy Care High Priority - 3	Pregnancy Care Medium Priority - 2	Pregnancy Care Low Priority - 1	Pregnancy Care Don’t Know - 0
Traditional Healing	Traditional Healing High Priority - 3	Traditional Healing Medium Priority - 2	Traditional Healing Low Priority - 1	Traditional Healing Don’t Know - 0
Support Groups	Support Groups High Priority - 3	Support Groups Medium Priority - 2	Support Groups Low Priority - 1	Support Groups Don’t Know - 0
Health Education	Health Education High Priority - 3	Health Education Medium Priority - 2	Health Education Low Priority - 1	Health Education Don’t Know - 0
Gynecology	Gynecology High Priority - 3	Gynecology Medium Priority - 2	Gynecology Low Priority - 1	Gynecology Don’t Know - 0

Question Title

* 5. Ania pay ti dadduma a serbisyo ti kayatmo nga mapaadda ditoy komyunidad?

Question Title

* 6. No saan ka pay a pasyente ti Lanai Community Health Center (LCHC), ania ti rason? (Pilien smin nga aplikable kenka)

Didn’t know it was there.

Don’t know the location of the LCHC

My doctor practices elsewhere.

Difficult or don’t know how to switch from current provider.

No Physician/Medical Doctor, only Nurse Practitioners. Don’t know what Nurse Practitioner’s do.

Difficult to get an appointment. Reason (i.e. No one answered the phone, no appointments available - type in reason in box at end of this question.)

Didn’t know I could walk in without an appointment.

Didn’t know the LCHC provides service to people who don’t have insurance.

Didn’t know they provided services to men.

Services cost too much.

Hours of service/operation don’t match my schedule.

No transportation.

Other: (Please list if other in box at end of this question.)

Iba pa (mangyaring tiyakin)

Question Title

* 7. No SAAN ka a pasyente ti LCHC, ania kadagiti sumaganad ti nangawis kenka a mangpadas iti serbisyo ti Lanai Communlty Health Center? (Pilien amin nga aplikable kenka)

Facility with a more convenient location.

More available appointment slots.

Question Title

* 8. No SAAN ka pay a pasyente ti Lanai Community Health Center, mapanunotmo kadi a papanan ti Lanai Community Health Center no ad-adu dagiti mangted ti serbisyo wenno dodoktor? Ania a klase ti kayatmo a pagpakitaan ( kas koma: Doktor, Nurses, Spesyalista, kdpy)?

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* 9. No SAAN ka a dati nga pasyente ti LCHC, mapanunotmo ngata ti mapan ditoy Lanai Community Health Center no ad-adu dagiti pagpilian a serbisyo nga maipaay?

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* 10. No SAAN ka a pasyente ti LCHC, adda kadi pay sabali a tulong malaksid kadagiti nailista iti ngato tapno mapanunotmo ti mapan ditoy Lanai Community Health Center? Ilista iti baba:

Question Title

* 11. No SAAN ka pay a pasyente ti LCHC, ken saanmo a kayat ti mapan iti health center, mabalin kadi nga ammoen no ania ti rason?

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* 12. No mabalin, mangpilika iti tallo kadagiti kangatoan nga pinakaimportante nga “health issues” ditoy a communidad?

Diabetes

High Blood Pressure

Heart Disease

Chronic Pain

Teen Pregnancy

No Insurance

Substance Abuse

Infant Deaths

Poor Oral Health

Low Birth Weight

High Level of Stress

Aging Population

Lack of Health Information

Obesity

Lack of Access to Services

Cancer

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* 13. No ti panagriknam ket adda importante a pakaseknan ti salun-at iti komyunidad nga saan a nailista iti ngato, pangngaasim ta ilista iti baba.

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* 14. Impormasyon maipanggep kenka – Lalaki wenno babai

Male

Female

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* 15. Impormasyo maipanggep kenka – Mano ti taw-en mo?

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* 16. Ania ti kangatoan nga grado ti nagaw-atmo nga edukasyon? Patimbukelan ti MAYSA.

Grade school

Middle/Intermediate High school

Some college

College (BA/BS)

Graduate or higher

Question Title

* 17. Ania kadagitoy sumaganad nga categoria ti kaasitgan nga numero no mano ti “gross household income” mo iti napalabas a taw-en?

1…Less than $24,920

2…$24,921 - $33,520

3…$33,521 - $42,120

4…$42,121 - $50,720

5…$50,721 - $59,320

6…$59,321 and over

Question Title

* 18. Mano nga tao ti agnanaed iti balaymo, iraman nga ibilang ta bagim?

8 or more

Question Title

* 19. Ania kadagitoy nga “ethnicity” ti kangatoan nga pangilugaram iti kinataom?

Filipino

Japanese

Native Hawaiian

Native American

Pacific Islander

Hispanic/Latino

African American

Caucasian

Iba pa (mangyaring tiyakin)

Question Title

* 1. Maysa ka kadi a pasyente ti Lanai Community Health Center?

Question Title

* 2. Kasano ti pananggradom kadagiti sumaganad nga “health care services” iti Health Center?

Question Title

* 3. Kasano met ti pananggradom kadagiti sumaganad nga “customer service elements” iti Health Center?

Question Title

* 4. Ania dagiti serbisyo nga kayatmo a mapaadda ditoy Lanai?

Question Title

* 5. Ania pay ti dadduma a serbisyo ti kayatmo nga mapaadda ditoy komyunidad?

Question Title

* 6. No saan ka pay a pasyente ti Lanai Community Health Center (LCHC), ania ti rason? (Pilien smin nga aplikable kenka)

Question Title

* 7. No SAAN ka a pasyente ti LCHC, ania kadagiti sumaganad ti nangawis kenka a mangpadas iti serbisyo ti Lanai Communlty Health Center? (Pilien amin nga aplikable kenka)

Question Title

* 8. No SAAN ka pay a pasyente ti Lanai Community Health Center, mapanunotmo kadi a papanan ti Lanai Community Health Center no ad-adu dagiti mangted ti serbisyo wenno dodoktor? Ania a klase ti kayatmo a pagpakitaan ( kas koma: Doktor, Nurses, Spesyalista, kdpy)?

Question Title

* 9. No SAAN ka a dati nga pasyente ti LCHC, mapanunotmo ngata ti mapan ditoy Lanai Community Health Center no ad-adu dagiti pagpilian a serbisyo nga maipaay?

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* 10. No SAAN ka a pasyente ti LCHC, adda kadi pay sabali a tulong malaksid kadagiti nailista iti ngato tapno mapanunotmo ti mapan ditoy Lanai Community Health Center? Ilista iti baba:

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* 11. No SAAN ka pay a pasyente ti LCHC, ken saanmo a kayat ti mapan iti health center, mabalin kadi nga ammoen no ania ti rason?

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* 12. No mabalin, mangpilika iti tallo kadagiti kangatoan nga pinakaimportante nga “health issues” ditoy a communidad?

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* 13. No ti panagriknam ket adda importante a pakaseknan ti salun-at iti komyunidad nga saan a nailista iti ngato, pangngaasim ta ilista iti baba.

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* 14. Impormasyon maipanggep kenka – Lalaki wenno babai

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* 15. Impormasyo maipanggep kenka – Mano ti taw-en mo?

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* 16. Ania ti kangatoan nga grado ti nagaw-atmo nga edukasyon? Patimbukelan ti MAYSA.

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* 17. Ania kadagitoy sumaganad nga categoria ti kaasitgan nga numero no mano ti “gross household income” mo iti napalabas a taw-en?

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* 18. Mano nga tao ti agnanaed iti balaymo, iraman nga ibilang ta bagim?

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* 19. Ania kadagitoy nga “ethnicity” ti kangatoan nga pangilugaram iti kinataom?

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* 20. Sakit wenno problema ti salun-atmo iti agdama: ( Pangngaasim ta ilistam ida)