Access

Days you had to wait for an appointment for urgent care

Visited emergency room on evenings, weekends, or holidays because could not get needed care from provider

Got answer to medical question as soon as you needed when e-mailed provider’s office

Got information about office hours, appointments, and prescription refills

Kept informed about wait time for appointment

Communication

Asked how you would like to receive information

Received reminders between visits

Provider used medical words you did not understand

Provider interrupted you

Provider answered all your questions

Provider gave you as much information as you wanted about health problems or concerns

Coordination of Care

Provider had your medical records

Got test results as soon as you needed

Got help managing care from different providers

Offered after visit notes

Got help contacting child’s school or daycare

Comprehensiveness

Usual place for urgent care

Usual place for routine care

Usual place for care for on-going problem

Got needed help for personal or family problem/alcohol or drug use

Whole Person Orientation

Provider seemed to understand what was important to you about your health

Provider knew you as a person

Rating of provider’s knowledge of your medical history

Rating of provider’s knowledge of your responsibilities at home/work/school

Rating of provider’s knowledge of you as a person

Self-Management Support

Talked about things you could do to change your habits or lifestyle

Talked about what was available in community to change habits or lifestyle

Got help making changes in your habits or lifestyle

Talked about health monitoring

Talked about health goals

Offered help for things that make it hard to manage your health

Got instructions about how to manage your health

Talked about what was available in community to manage your health

Got help to get community services to manage your health

Helped you learn skills to manage your health

Shared Decision Making

Provider talked about reasons to have surgery or procedure

Provider talked about reasons not to have surgery or procedure

Provider asked what you thought was best for you regarding surgery or procedure