| 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 for yourself 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”
|
AC6. In the last 6 months, when you contacted this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC5
Note: Use with AC5
|
AC7. In the last 6 months, did your child need to visit this provider's office after regular office hours?
1 __ Yes
2 __ No → If No, go to AC9 |
After AC6 |
AC8. In the last 6 months, how often were you able to get the care your child needed from this provider's office after regular office hours?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC7
Note: Use with AC7
|
AC9. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did your child see this provider within 15 minutes of your appointment time?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always → If Always, go to core question 18 |
After AC8 |
AC10. In the last 6 months, after you checked in for your child's appointment at this provider's office, how often were you kept informed about how long you would need to wait for your child's appointment to start?
1 __ Never
2 __ Sometimes
3 __ Usually
4 __ Always |
After AC9
Note: Use with AC9
|
