Form 1086 2014 841 VHA Medical Centers
E-Government Website Customer Satisfaction Surveys
2014 841 VHA Medical Centers.xlsx
2014 841 VHA Medical Centers
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Current Custom Qsts
Custom Qsts (4-10-13)
Custom Qsts (12-13-10)
Custom Qsts (8-16-10)
Sheet3
Overview
Current Model QstsCurrent Custom Qsts
Custom Qsts (4-10-13)
Custom Qsts (12-13-10)
Custom Qsts (8-16-10)
Sheet3
Sheet 1: Current Model Qsts
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| VHA Medical Centers | |||||
| MID: | 4E989k41otEAc5w1UI9opw== | ||||
| Date: | Fill In Date | ||||
| \ | |||||
| Model questions utilize the ACSI methodology to determine scores and impacts | |||||
| ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | |||
| Content (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Return (1=Very Unlikely, 10=Very Likely) | |||
| Please rate the accuracy of information on this site. | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
How likely are you to return to this site? | |||
| Please rate the quality of information on this site. | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend (1=Very Unlikely, 10=Very Likely) | |||
| Please rate the freshness of content on this site. | How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) |
How likely are you to recommend this site to someone else? | |||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | |||||
| Please rate the visual appeal of this site. | |||||
| Please rate the balance of graphics and text on this site. | |||||
| Please rate the readability of the pages on this site. | |||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | |||||
| Please rate how well the site is organized. | |||||
| Please rate the options available for navigating this site. | 
|
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| Please rate how well the site layout helps you find what you are looking for. | |||||
| Please rate the number of clicks to get where you want on this site. | |||||
| Search (1=Poor, 10=Excellent, Don't Know) | |||||
| Please rate the relevance of search results on this site. | |||||
| Please rate the organization of search results on this site. | |||||
| Please rate how well the search results help you decide what to select. | |||||
| Please rate how well the search feature helps you to narrow the results to find what you want. | |||||
| Site Performance (1=Poor, 10=Excellent, Don't Know) | |||||
| Please rate how quickly pages load on this site. | |||||
| Please rate the consistency of speed from page to page on this site. | |||||
| Please rate the ability to load pages without getting error messages on this site. | |||||
Sheet 2: Current Custom Qsts
| Model Instance Name: VHA Medical Centers |
|
|||||||||
| underlined & italicized: RE-ORDER | ||||||||||
| MID: 4E989k41otEAc5w1UI9opw== | pink: ADDITION | |||||||||
| blue + -->: REWORDING | ||||||||||
| CUSTOM QUESTION LIST | ||||||||||
| QID (Group ID) |
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| EDO03866 | How frequently do you visit this site? | First time | Radio button, one-up vertical | Single | Y | Visit Frequency | ||||
| Frequently (about once a month or more often) | A, B | |||||||||
| Infrequently (Every few months or less often) | A,B | |||||||||
| ACQinh0025396 | A | We’ve recently redesigned our VA Medical Center websites. Please select the statement which best describes your experience with the redesign. | It is easier to find what I am looking for | Radio button, one-up vertical | Single | Y | Skip Logic | Redesign Ability to find | ||
| It is harder to find what I am looking for | ||||||||||
| My experience is no different when looking for information on the new site | ||||||||||
| Don't Know | ||||||||||
| ACQinh0025397 | B | Do you like the new layout of the medical center pages? | Yes | Radio button, one-up vertical | Single | Yes | Skip Logic | Opinion of Redesign | ||
| No | BB | |||||||||
| No Opinion | ||||||||||
| ACQinh0025398 | BB | What didn't you like about the new medical center pages? | Test area, no character limit | N | Skip Logic | OE_Redesign | ||||
| EDO03867 | Please tell us who you are. | Veteran | B | Radio button, one-up vertical | Single | Y | Role | |||
| Active Duty | B | |||||||||
| Family Member / Friend | ||||||||||
| VA Employee | ||||||||||
| Volunteer | ||||||||||
| Healthcare Professional (MD, RN, etc.) | ||||||||||
| Job Applicant | ||||||||||
| Student / Healthcare Trainee | ||||||||||
| Media | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03868 | A | Other, please specify: | Text area, no char limit | OE_Role | ||||||
| EDO03869 | B | Please check the conflict(s) in which you served. | World War II | Checkbox, one-up vertical | Multi | Y | Conflict | |||
| Korean Conflict | ||||||||||
| Vietnam Era | ||||||||||
| Persian Gulf War | ||||||||||
| Operation Enduring Freedom | ||||||||||
| Operation Iraqi Freedom | ||||||||||
| Operation New Dawn | ||||||||||
| No conflict / war service | ||||||||||
| EDO03870 | Please select your age range: | 17 or under | Radio button, one-up vertical | Single | Y | Age | ||||
| 18-24 | ||||||||||
| 25-34 | ||||||||||
| 35-44 | ||||||||||
| 45-54 | ||||||||||
| 55-64 | ||||||||||
| 65+ | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03871 | Please select your gender: | Male | Radio button, one-up vertical | Single | Y | Age | ||||
| Female | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03872 | From which medical center do you get the majority of your care? (Choose State First) (If you receive most of your care at a community-based outpatient clinic, please select the medical center from which you would receive advanced care if needed). |
Do not have a primary medical center | Drop down, select one | Single | Y | State | ||||
| Alaska | A | |||||||||
| Alabama | B | |||||||||
| Arkansas | C | |||||||||
| Arizona | D | |||||||||
| California | E | |||||||||
| Colorado | F | |||||||||
| Connecticut | G | |||||||||
| District of Columbia | H | |||||||||
| Delaware | I | |||||||||
| Florida | J | |||||||||
| Georgia | K | |||||||||
| Hawaii | L | |||||||||
| Iowa | M | |||||||||
| Idaho | N | |||||||||
| Illinois | O | |||||||||
| Indiana | P | |||||||||
| Kansas | Q | |||||||||
| Kentucky | R | |||||||||
| Louisiana | S | |||||||||
| Massachusetts | T | |||||||||
| Maryland | U | |||||||||
| Maine | V | |||||||||
| Michigan | W | |||||||||
| Minnesota | X | |||||||||
| Missouri | Y | |||||||||
| Mississippi | Z | |||||||||
| Montana | AA | |||||||||
| North Carolina | BB | |||||||||
| North Dakota | CC | |||||||||
| Nebraska | DD | |||||||||
| New Hampshire | EE | |||||||||
| New Jersey | FF | |||||||||
| New Mexico | GG | |||||||||
| Nevada | HH | |||||||||
| New York | II | |||||||||
| Ohio | JJ | |||||||||
| Oklahoma | KK | |||||||||
| Oregon | LL | |||||||||
| Pennsylvania | MM | |||||||||
| Puerto Rico | NN | |||||||||
| Rhode Island | OO | |||||||||
| South Carolina | PP | |||||||||
| South Dakota | ||||||||||
| Tennessee | RR | |||||||||
| Texas | SS | |||||||||
| Utah | TT | |||||||||
| Virginia | UU | |||||||||
| Vermont | VV | |||||||||
| Washington | WW | |||||||||
| Wisconsin | XX | |||||||||
| West Virginia | YY | |||||||||
| Wyoming | ZZ | |||||||||
| EDO03873 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Radio button, one-up vertical | ||||||
| EDO03874 | B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Radio button, one-up vertical | ||||||
| Montgomery - Central Alabama Veterans Health Care System | ||||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | ||||||||||
| Tuskegee - Central Alabama Veterans Health Care System | ||||||||||
| EDO03875 | C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Radio button, one-up vertical | ||||||
| Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| EDO03876 | D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Radio button, one-up vertical | ||||||
| Prescott - Northern Arizona VA Health Care System | ||||||||||
| Tucson - Southern Arizona VA Health Care System | ||||||||||
| EDO03877 | E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Radio button, one-up vertical | ||||||
| Livermore - VA Palo Alto Health Care System | ||||||||||
| Loma Linda - VA Loma Linda Healthcare System | ||||||||||
| Long Beach - VA Long Beach Healthcare System | ||||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | ||||||||||
| Mather - VA Northern California Health Care System | ||||||||||
| Menlo Park - VA Palo Alto Health Care System | ||||||||||
| Palo Alto - VA Palo Alto Health Care System | ||||||||||
| San Diego - VA San Diego Healthcare System | ||||||||||
| San Francisco - San Francisco VA Medical Center | ||||||||||
| EDO03878 | F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Radio button, one-up vertical | ||||||
| Grand Junction - Grand Junction VA Medical Center | ||||||||||
| EDO03879 | G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Radio button, one-up vertical | ||||||
| West Haven - VA Connecticut Healthcare System | ||||||||||
| EDO03880 | H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03881 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03882 | J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Radio button, one-up vertical | ||||||
| Miami - Miami VA Healthcare System | ||||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | ||||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | ||||||||||
| Orlando - Orlando VA Medical Center | ||||||||||
| Tampa - James A. Haley Veterans' Hospital | ||||||||||
| West Palm Beach - West Palm Beach VA Medical Center | ||||||||||
| EDO03883 | K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Radio button, one-up vertical | ||||||
| Decatur - Atlanta VA Medical Center | ||||||||||
| Dublin - Carl Vinson VA Medical Center | ||||||||||
| EDO03884 | L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Radio button, one-up vertical | ||||||
| EDO03885 | M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Radio button, one-up vertical | ||||||
| Iowa City - Iowa City VA Medical Center | ||||||||||
| EDO03886 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03887 | O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | ||||||
| Danville - VA Illiana Health Care System | ||||||||||
| Hines - Edward Hines Jr. VA Hospital | ||||||||||
| Marion - Marion VA Medical Center | ||||||||||
| North Chicago – Captain James A. Lovell Federal Healthcare Center | ||||||||||
| EDO03888 | P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Radio button, one-up vertical | ||||||
| Indianapolis - Richard L. Roudebush VA Medical Center | ||||||||||
| Marion - VA Northern Indiana Health Care System | ||||||||||
| EDO03889 | Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Radio button, one-up vertical | ||||||
| Topeka - VA Eastern Kansas Health Care System | ||||||||||
| Wichita - Robert J. Dole VA Medical Center | ||||||||||
| EDO03890 | R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Radio button, one-up vertical | ||||||
| Lexington - Lexington VA Medical Center (Leestown Division) | ||||||||||
| Louisville - Louisville VA Medical Center | ||||||||||
| EDO03891 | S | Which Medical Center in Lousiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Radio button, one-up vertical | ||||||
| Pineville - Alexandria VA Medical Center | ||||||||||
| Shreveport - Overton Brooks VA Medical Center | ||||||||||
| EDO03892 | T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Brockton - VA Boston Healthcare System | ||||||||||
| Jamaica Plain - VA Boston Healthcare System | ||||||||||
| Leeds – Central Western Massachusetts Health Care System | ||||||||||
| West Roxbury - VA Boston Healthcare System | ||||||||||
| EDO03893 | U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Radio button, one-up vertical | ||||||
| Perry Point - Perry Point VA Medical Center | ||||||||||
| EDO03894 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03895 | W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Radio button, one-up vertical | ||||||
| Battle Creek - Battle Creek VA Medical Center | ||||||||||
| Detroit - John D. Dingell VA Medical Center | ||||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | ||||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | ||||||||||
| EDO03896 | X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Radio button, one-up vertical | ||||||
| St. Cloud - St. Cloud VA Medical Center | ||||||||||
| EDO03897 | Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Radio button, one-up vertical | ||||||
| Kansas City - Kansas City VA Medical Center | ||||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | ||||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | ||||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | ||||||||||
| EDO03898 | Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Radio button, one-up vertical | ||||||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | ||||||||||
| EDO03899 | AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Radio button, one-up vertical | ||||||
| EDO03900 | BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Radio button, one-up vertical | ||||||
| Durham - Durham VA Medical Center | ||||||||||
| Fayetteville - Fayetteville VA Medical Center | ||||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | ||||||||||
| EDO03901 | CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03902 | DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Radio button, one-up vertical | ||||||
| EDO03903 | EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03904 | FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Radio button, one-up vertical | ||||||
| Lyons - VA New Jersey Health Care System | ||||||||||
| EDO03905 | GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Radio button, one-up vertical | ||||||
| EDO03906 | HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | ||||||
| Reno - VA Sierra Nevada Health Care System | ||||||||||
| EDO03907 | II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Radio button, one-up vertical | ||||||
| Batavia - VA Western New York Healthcare System | ||||||||||
| Bath - Bath VA Medical Center | ||||||||||
| Bronx - James J. Peters VA Medical Center | ||||||||||
| Brooklyn - VA NY Harbor Healthcare System | ||||||||||
| Buffalo - VA Western New York Healthcare System | ||||||||||
| Canandaigua - Canandaigua VA Medical Center | ||||||||||
| Castle Point - VA Hudson Valley Health Care System | ||||||||||
| Montrose - VA Hudson Valley Health Care System | ||||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | ||||||||||
| Northport - Northport VA Medical Center | ||||||||||
| Syracuse - Syracuse VA Medical Center | ||||||||||
| EDO03908 | JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Radio button, one-up vertical | ||||||
| Cincinnati - Cincinnati VA Medical Center | ||||||||||
| Cleveland - Louis Stokes VA Medical Center | ||||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | ||||||||||
| Dayton - Dayton VA Medical Center | ||||||||||
| EDO03909 | KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Radio button, one-up vertical | ||||||
| Oklahoma City - Oklahoma City VA Medical Center | ||||||||||
| EDO03910 | LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Radio button, one-up vertical | ||||||
| Portland - Portland VA Medical Center | ||||||||||
| EDO03911 | MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Radio button, one-up vertical | ||||||
| Butler - VA Butler Healthcare System | ||||||||||
| Coatesville - Coatesville VA Medical Center | ||||||||||
| Erie - Erie VA Medical Center | ||||||||||
| Lebanon - Lebanon VA Medical Center | ||||||||||
| Philadelphia - Philadelphia VA Medical Center | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | ||||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | ||||||||||
| EDO03912 | NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Radio button, one-up vertical | ||||||
| EDO03913 | OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03914 | PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Radio button, one-up vertical | ||||||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | ||||||||||
| EDO03915 | Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Radio button, one-up vertical | |||||||
| Hot Springs - VA Black Hills Health Care System | ||||||||||
| Sioux Falls - Sioux Falls VA Medical Center | ||||||||||
| EDO03916 | RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Radio button, one-up vertical | ||||||
| Mountain Home - Mountain Home VA Medical Center | ||||||||||
| Murfreesboro - Tennessee Valley Healthcare System | ||||||||||
| Nashville - Tennessee Valley Healthcare System | ||||||||||
| EDO03917 | SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Radio button, one-up vertical | ||||||
| Big Spring - West Texas VA Health Care System | ||||||||||
| Dallas - VA North Texas Health Care System | ||||||||||
| El Paso - El Paso VA Health Care System | ||||||||||
| San Antonio - South Texas Veterans Health Care System | ||||||||||
| Temple - Central Texas Veterans Health Care System | ||||||||||
| Bonham - VA North Texas Health Care System | ||||||||||
| Houston - Michael E. DeBakey VA Medical Center | ||||||||||
| Kerrville - Kerrville VA Medical Center | ||||||||||
| Waco - Central Texas Veterans Health Care System | ||||||||||
| EDO03918 | TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Radio button, one-up vertical | ||||||
| EDO03919 | UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Radio button, one-up vertical | ||||||
| Richmond - Hunter Holmes McGuire VA Medical Center | ||||||||||
| Salem - Salem VA Medical Center | ||||||||||
| EDO03920 | VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03921 | WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Radio button, one-up vertical | ||||||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | ||||||||||
| Spokane - Spokane VA Medical Center | ||||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | ||||||||||
| EDO03922 | XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | ||||||||||
| Tomah - Tomah VA Medical Center | ||||||||||
| EDO03923 | YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Radio button, one-up vertical | ||||||
| Clarksburg - Louis A. Johnson VA Medical Center | ||||||||||
| Huntington - Huntington VA Medical Center | ||||||||||
| Martinsburg - Martinsburg VA Medical Center | ||||||||||
| EDO03924 | ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Radio button, one-up vertical | ||||||
| Sheridan - Sheridan VA Medical Center | ||||||||||
| EDO03925 | What type of information were you trying to find on this medical center web site? (Check all that apply) | Facility contact information | Checkbox, one-up vertical | Multi | Y | |||||
| Directions / Locations | ||||||||||
| Hours of Operation | ||||||||||
| Services Available | ||||||||||
| Make, change, or cancel an appointment | ||||||||||
| Prescription refills | ||||||||||
| Emergency information | ||||||||||
| Jobs | ||||||||||
| Volunteer Information | ||||||||||
| Transportation (Rural, DAV, etc.) | ||||||||||
| Family & Dependent Health Benefits | ||||||||||
| Healthcare Eligibility | ||||||||||
| Health Education (classes, tutorials, etc.) | ||||||||||
| General Health Information | ||||||||||
| Healthcare Professional Training (Students, Residents, etc.) | ||||||||||
| Home Health Care | ||||||||||
| Nursing Home Care | ||||||||||
| Telephone Care (after hours) | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03926 | A | Other, please specify | OE_Reason | |||||||
| EDO03927 | Did you find what you were looking today? | Yes | Radio button, one-up vertical | Single | Y | Find Info | ||||
| No, I was looking for: | A | |||||||||
| EDO03928 | A | What specific information were you unable to find? | OE_Find | |||||||
| EDO03933 | Do you believe the amount of information provided about services offered at this VA Medical Center is adequate? | Yes | Radio button, one-up vertical | Single | Y | Services Adequate | ||||
| No | A | |||||||||
| EDO03934 | A | Why not? | Text area, no char limit | OE_Not Adequate | ||||||
| EDO03935 | Where did you first hear about this VA Medical Center web site? | During Enrollment | Radio button, one-up vertical | Single | Y | How Hear | ||||
| At the Medical Center | ||||||||||
| From my provider (doctor, nurse, social worker, etc.) | ||||||||||
| Search Engine | ||||||||||
| Social Networks (Facebook, Twitter, etc.) | ||||||||||
| www.va.gov | ||||||||||
| www.va.gov/health | ||||||||||
| I browsed directly to the site | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03936 | A | Other, please specify: | OE_How Hear | |||||||
| EDO03937 | Would you like to see additional information about recent news & events at this medical center and its clinics? | Yes | A | Radio button, one-up vertical | Single | Y | Add Info | |||
| No | ||||||||||
| EDO03938 | A | How would you like to see this information? (Check all that apply) | Directly on the medical center's web site | Checkbox, one-up vertical | Multi | Y | How Add Info | |||
| Social Networking (Facebook, Twitter, etc.) | ||||||||||
| RSS | ||||||||||
| SMS / Text Messaging | ||||||||||
| EDO03931 | Do you use MyHealtheVet (prescription refills, personal health record, etc.)? | Yes | A | Radio button, one-up vertical | Single | Y | MHV Usage | |||
| No | B | |||||||||
| EDO03939 | A | Have you completed the In-Person Authentication (IPA) which allows you to view the names of your prescriptions, view lab test results, and see your upcoming appointments? | Yes | Radio button, one-up vertical | Single | Y | IPA | |||
| No | ||||||||||
| EDO03932 | B | Why not? | Text area, no char limit | OE_Not Use MHV | ||||||
| EDO03929 | Do you use any of the following while on the Internet? (Check all that apply) | Checkbox, one-up vertical | Multi | Y | Social media | |||||
| MySpace | ||||||||||
| YouTube | ||||||||||
| Google+ | ||||||||||
| Foursquare | ||||||||||
| Yelp | ||||||||||
| Flickr | ||||||||||
| Blogs | ||||||||||
| Del.icio.us | ||||||||||
| Digg | ||||||||||
| Podcasts | ||||||||||
| I do not use any of these social media tools. | 8889 | |||||||||
| Other, please specify: | A | |||||||||
| EDO03930 | A | Other, please specify: | Text area, no char limit | OE_Social Media | ||||||
Sheet 3: Custom Qsts (4-10-13)
| Model Instance Name: VHA Medical Centers |
|
|||||||||
| underlined & italicized: RE-ORDER | ||||||||||
| MID: 4E989k41otEAc5w1UI9opw== | pink: ADDITION | |||||||||
| blue + -->: REWORDING | ||||||||||
| CUSTOM QUESTION LIST | ||||||||||
| QID (Group ID) |
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| EDO03866 | How frequently do you visit this site? | First time | Radio button, one-up vertical | Single | Y | Visit Frequency | ||||
| Frequently (about once a month or more often) | A, B | |||||||||
| Infrequently (Every few months or less often) | A,B | |||||||||
| A | We’ve recently redesigned our VA Medical Center websites. Please select the statement which best describes your experience with the redesign | It is easier to find what I am looking for | Checkbox, one-up vertical | Single | Y | Skip Logic | Redesign Ability to find | |||
| It is harder to find what I am looking for | ||||||||||
| My experience is no different when looking for information on the new site | ||||||||||
| Don't Know | ||||||||||
| B | Do you like the new layout of the medical center pages? | Yes | Single | Yes | Skip Logic | Opinion of Redesign | ||||
| No | BB | |||||||||
| No Opinion | ||||||||||
| BB | What didn't you like about the new medical center pages? | Test area, no character limit | N | Skip Logic | OE_Redesign | |||||
| EDO03867 | Please tell us who you are. | Veteran | B | Radio button, one-up vertical | Single | Y | Role | |||
| Active Duty | B | |||||||||
| Family Member / Friend | ||||||||||
| VA Employee | ||||||||||
| Volunteer | ||||||||||
| Healthcare Professional (MD, RN, etc.) | ||||||||||
| Job Applicant | ||||||||||
| Student / Healthcare Trainee | ||||||||||
| Media | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03868 | A | Other, please specify: | Text area, no char limit | OE_Role | ||||||
| EDO03869 | B | Please check the conflict(s) in which you served. | World War II | Checkbox, one-up vertical | Multi | Y | Conflict | |||
| Korean Conflict | ||||||||||
| Vietnam Era | ||||||||||
| Persian Gulf War | ||||||||||
| Operation Enduring Freedom | ||||||||||
| Operation Iraqi Freedom | ||||||||||
| Operation New Dawn | ||||||||||
| No conflict / war service | ||||||||||
| EDO03870 | Please select your age range: | 17 or under | Radio button, one-up vertical | Single | Y | Age | ||||
| 18-24 | ||||||||||
| 25-34 | ||||||||||
| 35-44 | ||||||||||
| 45-54 | ||||||||||
| 55-64 | ||||||||||
| 65+ | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03871 | Please select your gender: | Male | Radio button, one-up vertical | Single | Y | Age | ||||
| Female | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03872 | From which medical center do you get the majority of your care? (Choose State First) (If you receive most of your care at a community-based outpatient clinic, please select the medical center from which you would receive advanced care if needed). |
Do not have a primary medical center | Drop down, select one | Single | Y | State | ||||
| Alaska | A | |||||||||
| Alabama | B | |||||||||
| Arkansas | C | |||||||||
| Arizona | D | |||||||||
| California | E | |||||||||
| Colorado | F | |||||||||
| Connecticut | G | |||||||||
| District of Columbia | H | |||||||||
| Delaware | I | |||||||||
| Florida | J | |||||||||
| Georgia | K | |||||||||
| Hawaii | L | |||||||||
| Iowa | M | |||||||||
| Idaho | N | |||||||||
| Illinois | O | |||||||||
| Indiana | P | |||||||||
| Kansas | Q | |||||||||
| Kentucky | R | |||||||||
| Louisiana | S | |||||||||
| Massachusetts | T | |||||||||
| Maryland | U | |||||||||
| Maine | V | |||||||||
| Michigan | W | |||||||||
| Minnesota | X | |||||||||
| Missouri | Y | |||||||||
| Mississippi | Z | |||||||||
| Montana | AA | |||||||||
| North Carolina | BB | |||||||||
| North Dakota | CC | |||||||||
| Nebraska | DD | |||||||||
| New Hampshire | EE | |||||||||
| New Jersey | FF | |||||||||
| New Mexico | GG | |||||||||
| Nevada | HH | |||||||||
| New York | II | |||||||||
| Ohio | JJ | |||||||||
| Oklahoma | KK | |||||||||
| Oregon | LL | |||||||||
| Pennsylvania | MM | |||||||||
| Puerto Rico | NN | |||||||||
| Rhode Island | OO | |||||||||
| South Carolina | PP | |||||||||
| South Dakota | ||||||||||
| Tennessee | RR | |||||||||
| Texas | SS | |||||||||
| Utah | TT | |||||||||
| Virginia | UU | |||||||||
| Vermont | VV | |||||||||
| Washington | WW | |||||||||
| Wisconsin | XX | |||||||||
| West Virginia | YY | |||||||||
| Wyoming | ZZ | |||||||||
| EDO03873 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Radio button, one-up vertical | ||||||
| EDO03874 | B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Radio button, one-up vertical | ||||||
| Montgomery - Central Alabama Veterans Health Care System | ||||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | ||||||||||
| Tuskegee - Central Alabama Veterans Health Care System | ||||||||||
| EDO03875 | C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Radio button, one-up vertical | ||||||
| Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| EDO03876 | D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Radio button, one-up vertical | ||||||
| Prescott - Northern Arizona VA Health Care System | ||||||||||
| Tucson - Southern Arizona VA Health Care System | ||||||||||
| EDO03877 | E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Radio button, one-up vertical | ||||||
| Livermore - VA Palo Alto Health Care System | ||||||||||
| Loma Linda - VA Loma Linda Healthcare System | ||||||||||
| Long Beach - VA Long Beach Healthcare System | ||||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | ||||||||||
| Mather - VA Northern California Health Care System | ||||||||||
| Menlo Park - VA Palo Alto Health Care System | ||||||||||
| Palo Alto - VA Palo Alto Health Care System | ||||||||||
| San Diego - VA San Diego Healthcare System | ||||||||||
| San Francisco - San Francisco VA Medical Center | ||||||||||
| EDO03878 | F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Radio button, one-up vertical | ||||||
| Grand Junction - Grand Junction VA Medical Center | ||||||||||
| EDO03879 | G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Radio button, one-up vertical | ||||||
| West Haven - VA Connecticut Healthcare System | ||||||||||
| EDO03880 | H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03881 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03882 | J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Radio button, one-up vertical | ||||||
| Miami - Miami VA Healthcare System | ||||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | ||||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | ||||||||||
| Orlando - Orlando VA Medical Center | ||||||||||
| Tampa - James A. Haley Veterans' Hospital | ||||||||||
| West Palm Beach - West Palm Beach VA Medical Center | ||||||||||
| EDO03883 | K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Radio button, one-up vertical | ||||||
| Decatur - Atlanta VA Medical Center | ||||||||||
| Dublin - Carl Vinson VA Medical Center | ||||||||||
| EDO03884 | L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Radio button, one-up vertical | ||||||
| EDO03885 | M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Radio button, one-up vertical | ||||||
| Iowa City - Iowa City VA Medical Center | ||||||||||
| EDO03886 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03887 | O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | ||||||
| Danville - VA Illiana Health Care System | ||||||||||
| Hines - Edward Hines Jr. VA Hospital | ||||||||||
| Marion - Marion VA Medical Center | ||||||||||
| North Chicago - North Chicago VA Medical Center -> North Chicago – Captain James A. Lovell Federal Healthcare Center | ||||||||||
| EDO03888 | P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Radio button, one-up vertical | ||||||
| Indianapolis - Richard L. Roudebush VA Medical Center | ||||||||||
| Marion - VA Northern Indiana Health Care System | ||||||||||
| EDO03889 | Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Radio button, one-up vertical | ||||||
| Topeka - VA Eastern Kansas Health Care System | ||||||||||
| Wichita - Robert J. Dole VA Medical Center | ||||||||||
| EDO03890 | R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Radio button, one-up vertical | ||||||
| Lexington - Lexington VA Medical Center (Leestown Division) | ||||||||||
| Louisville - Louisville VA Medical Center | ||||||||||
| EDO03891 | S | Which Medical Center in Lousiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Radio button, one-up vertical | ||||||
| Pineville - Alexandria VA Medical Center | ||||||||||
| Shreveport - Overton Brooks VA Medical Center | ||||||||||
| EDO03892 | T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Brockton - VA Boston Healthcare System | ||||||||||
| Jamaica Plain - VA Boston Healthcare System | ||||||||||
| Leeds - Northampton VA Medical Center -> Leeds – Central Western Massachusetts Health Care System | ||||||||||
| West Roxbury - VA Boston Healthcare System | ||||||||||
| EDO03893 | U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Radio button, one-up vertical | ||||||
| Perry Point - Perry Point VA Medical Center | ||||||||||
| EDO03894 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03895 | W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Radio button, one-up vertical | ||||||
| Battle Creek - Battle Creek VA Medical Center | ||||||||||
| Detroit - John D. Dingell VA Medical Center | ||||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | ||||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | ||||||||||
| EDO03896 | X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Radio button, one-up vertical | ||||||
| St. Cloud - St. Cloud VA Medical Center | ||||||||||
| EDO03897 | Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Radio button, one-up vertical | ||||||
| Kansas City - Kansas City VA Medical Center | ||||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | ||||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | ||||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | ||||||||||
| EDO03898 | Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Radio button, one-up vertical | ||||||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | ||||||||||
| EDO03899 | AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Radio button, one-up vertical | ||||||
| EDO03900 | BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Radio button, one-up vertical | ||||||
| Durham - Durham VA Medical Center | ||||||||||
| Fayetteville - Fayetteville VA Medical Center | ||||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | ||||||||||
| EDO03901 | CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03902 | DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Radio button, one-up vertical | ||||||
| EDO03903 | EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03904 | FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Radio button, one-up vertical | ||||||
| Lyons - VA New Jersey Health Care System | ||||||||||
| EDO03905 | GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Radio button, one-up vertical | ||||||
| EDO03906 | HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | ||||||
| Reno - VA Sierra Nevada Health Care System | ||||||||||
| EDO03907 | II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Radio button, one-up vertical | ||||||
| Batavia - VA Western New York Healthcare System | ||||||||||
| Bath - Bath VA Medical Center | ||||||||||
| Bronx - James J. Peters VA Medical Center | ||||||||||
| Brooklyn - VA NY Harbor Healthcare System | ||||||||||
| Buffalo - VA Western New York Healthcare System | ||||||||||
| Canandaigua - Canandaigua VA Medical Center | ||||||||||
| Castle Point - VA Hudson Valley Health Care System | ||||||||||
| Montrose - VA Hudson Valley Health Care System | ||||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | ||||||||||
| Northport - Northport VA Medical Center | ||||||||||
| Syracuse - Syracuse VA Medical Center | ||||||||||
| EDO03908 | JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Radio button, one-up vertical | ||||||
| Cincinnati - Cincinnati VA Medical Center | ||||||||||
| Cleveland - Louis Stokes VA Medical Center | ||||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | ||||||||||
| Dayton - Dayton VA Medical Center | ||||||||||
| EDO03909 | KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Radio button, one-up vertical | ||||||
| Oklahoma City - Oklahoma City VA Medical Center | ||||||||||
| EDO03910 | LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Radio button, one-up vertical | ||||||
| Portland - Portland VA Medical Center | ||||||||||
| EDO03911 | MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Radio button, one-up vertical | ||||||
| Butler - VA Butler Healthcare System | ||||||||||
| Coatesville - Coatesville VA Medical Center | ||||||||||
| Erie - Erie VA Medical Center | ||||||||||
| Lebanon - Lebanon VA Medical Center | ||||||||||
| Philadelphia - Philadelphia VA Medical Center | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | ||||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | ||||||||||
| EDO03912 | NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Radio button, one-up vertical | ||||||
| EDO03913 | OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03914 | PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Radio button, one-up vertical | ||||||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | ||||||||||
| EDO03915 | Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Radio button, one-up vertical | |||||||
| Hot Springs - VA Black Hills Health Care System | ||||||||||
| Sioux Falls - Sioux Falls VA Medical Center | ||||||||||
| EDO03916 | RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Radio button, one-up vertical | ||||||
| Mountain Home - Mountain Home VA Medical Center | ||||||||||
| Murfreesboro - Tennessee Valley Healthcare System | ||||||||||
| Nashville - Tennessee Valley Healthcare System | ||||||||||
| EDO03917 | SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Radio button, one-up vertical | ||||||
| Big Spring - West Texas VA Health Care System | ||||||||||
| Dallas - VA North Texas Health Care System | ||||||||||
| El Paso - El Paso VA Health Care System | ||||||||||
| San Antonio - South Texas Veterans Health Care System | ||||||||||
| Temple - Central Texas Veterans Health Care System | ||||||||||
| Bonham - VA North Texas Health Care System | ||||||||||
| Houston - Michael E. DeBakey VA Medical Center | ||||||||||
| Kerrville - Kerrville VA Medical Center | ||||||||||
| Waco - Central Texas Veterans Health Care System | ||||||||||
| EDO03918 | TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Radio button, one-up vertical | ||||||
| EDO03919 | UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Radio button, one-up vertical | ||||||
| Richmond - Hunter Holmes McGuire VA Medical Center | ||||||||||
| Salem - Salem VA Medical Center | ||||||||||
| EDO03920 | VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03921 | WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Radio button, one-up vertical | ||||||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | ||||||||||
| Spokane - Spokane VA Medical Center | ||||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | ||||||||||
| EDO03922 | XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | ||||||||||
| Tomah - Tomah VA Medical Center | ||||||||||
| EDO03923 | YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Radio button, one-up vertical | ||||||
| Clarksburg - Louis A. Johnson VA Medical Center | ||||||||||
| Huntington - Huntington VA Medical Center | ||||||||||
| Martinsburg - Martinsburg VA Medical Center | ||||||||||
| EDO03924 | ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Radio button, one-up vertical | ||||||
| Sheridan - Sheridan VA Medical Center | ||||||||||
| EDO03925 | What type of information were you trying to find on this medical center web site? (Check all that apply) | Facility contact information | Checkbox, one-up vertical | Multi | Y | |||||
| Directions / Locations | ||||||||||
| Hours of Operation | ||||||||||
| Services Available | ||||||||||
| Make, change, or cancel an appointment | ||||||||||
| Prescription refills | ||||||||||
| Emergency information | ||||||||||
| Jobs | ||||||||||
| Volunteer Information | ||||||||||
| Transportation (Rural, DAV, etc.) | ||||||||||
| Family & Dependent Health Benefits | ||||||||||
| Healthcare Eligibility | ||||||||||
| Health Education (classes, tutorials, etc.) | ||||||||||
| General Health Information | ||||||||||
| Healthcare Professional Training (Students, Residents, etc.) | ||||||||||
| Home Health Care | ||||||||||
| Nursing Home Care | ||||||||||
| Telephone Care (after hours) | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03926 | A | Other, please specify | OE_Reason | |||||||
| EDO03927 | Did you find what you were looking today? | Yes | Radio button, one-up vertical | Single | Y | Find Info | ||||
| No, I was looking for: | A | |||||||||
| EDO03928 | A | What specific information were you unable to find? | OE_Find | |||||||
| EDO03933 | Do you believe the amount of information provided about services offered at this VA Medical Center is adequate? | Yes | Radio button, one-up vertical | Single | Y | Services Adequate | ||||
| No | A | |||||||||
| EDO03934 | A | Why not? | Text area, no char limit | OE_Not Adequate | ||||||
| EDO03935 | Where did you first hear about this VA Medical Center web site? | During Enrollment | Radio button, one-up vertical | Single | Y | How Hear | ||||
| At the Medical Center | ||||||||||
| From my provider (doctor, nurse, social worker, etc.) | ||||||||||
| Search Engine | ||||||||||
| Social Networks (Facebook, Twitter, etc.) | ||||||||||
| www.va.gov | ||||||||||
| www.va.gov/health | ||||||||||
| I browsed directly to the site | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03936 | A | Other, please specify: | OE_How Hear | |||||||
| EDO03937 | Would you like to see additional information about recent news & events at this medical center and its clinics? | Yes | A | Radio button, one-up vertical | Single | Y | Add Info | |||
| No | ||||||||||
| EDO03938 | A | How would you like to see this information? (Check all that apply) | Directly on the medical center's web site | Checkbox, one-up vertical | Multi | Y | How Add Info | |||
| Social Networking (Facebook, Twitter, etc.) | ||||||||||
| RSS | ||||||||||
| SMS / Text Messaging | ||||||||||
| EDO03931 | Do you use MyHealtheVet (prescription refills, personal health record, etc.)? | Yes | A | Radio button, one-up vertical | Single | Y | MHV Usage | |||
| No | B | |||||||||
| EDO03939 | A | Have you completed the In-Person Authentication (IPA) which allows you to view the names of your prescriptions, view lab test results, and see your upcoming appointments? | Yes | Radio button, one-up vertical | Single | Y | IPA | |||
| No | ||||||||||
| EDO03932 | B | Why not? | Text area, no char limit | OE_Not Use MHV | ||||||
| EDO03929 | Do you use any of the following while on the Internet? (Check all that apply) | Checkbox, one-up vertical | Multi | Y | Social media | |||||
| MySpace | ||||||||||
| YouTube | ||||||||||
| Google+ | ||||||||||
| Foursquare | ||||||||||
| Yelp | ||||||||||
| Flickr | ||||||||||
| Blogs | ||||||||||
| Del.icio.us | ||||||||||
| Digg | ||||||||||
| Podcasts | ||||||||||
| I do not use any of these social media tools. | 8889 | |||||||||
| Other, please specify: | A | |||||||||
| EDO03930 | A | Other, please specify: | Text area, no char limit | OE_Social Media | ||||||
Sheet 4: Custom Qsts (12-13-10)
| Model Instance Name: VHA Medical Centers |
|
|||||||||
| underlined & italicized: RE-ORDER | ||||||||||
| MID: 4E989k41otEAc5w1UI9opw== | pink: ADDITION | |||||||||
| blue + -->: REWORDING | ||||||||||
| CUSTOM QUESTION LIST | ||||||||||
| QID (Group ID) |
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| EDO03866 | How frequently do you visit this site? | First time | Radio button, one-up vertical | Single | Y | |||||
| Frequently (about once a month or more often) | ||||||||||
| Infrequently (Every few months or less often) | ||||||||||
| EDO03867 | Please tell us who you are. | Veteran | B | Radio button, one-up vertical | Single | Y | Role | |||
| Active Duty | B | |||||||||
| Family Member / Friend | ||||||||||
| VA Employee | ||||||||||
| Volunteer | ||||||||||
| Healthcare Professional (MD, RN, etc.) | ||||||||||
| Job Applicant | ||||||||||
| Student / Healthcare Trainee | ||||||||||
| Media | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03868 | A | Other, please specify: | Text area, no char limit | OE_Role | ||||||
| EDO03869 | B | Please check the conflict(s) in which you served. | World War II | Checkbox, one-up vertical | Multi | Y | Conflict | |||
| Korean Conflict | ||||||||||
| Vietnam Era | ||||||||||
| Persian Gulf War | ||||||||||
| Operation Enduring Freedom | ||||||||||
| Operation Iraqi Freedom | ||||||||||
| No conflict / war service | ||||||||||
| EDO03870 | Please select your age range: | 17 or under | Radio button, one-up vertical | Single | Y | Age | ||||
| 18-24 | ||||||||||
| 25-34 | ||||||||||
| 35-44 | ||||||||||
| 45-54 | ||||||||||
| 55-64 | ||||||||||
| 65+ | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03871 | Please select your gender: | Male | Radio button, one-up vertical | Single | Y | Age | ||||
| Female | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03872 | From which medical center do you get the majority of your care? (Choose State First) (If you receive most of your care at a community-based outpatient clinic, please select the medical center from which you would receive advanced care if needed). |
Do not have a primary medical center | Drop down, select one | Single | Y | State | ||||
| Alaska | A | |||||||||
| Alabama | B | |||||||||
| Arkansas | C | |||||||||
| Arizona | D | |||||||||
| California | E | |||||||||
| Colorado | F | |||||||||
| Connecticut | G | |||||||||
| District of Columbia | H | |||||||||
| Delaware | I | |||||||||
| Florida | J | |||||||||
| Georgia | K | |||||||||
| Hawaii | L | |||||||||
| Iowa | M | |||||||||
| Idaho | N | |||||||||
| Illinois | O | |||||||||
| Indiana | P | |||||||||
| Kansas | Q | |||||||||
| Kentucky | R | |||||||||
| Louisiana | S | |||||||||
| Massachusetts | T | |||||||||
| Maryland | U | |||||||||
| Maine | V | |||||||||
| Michigan | W | |||||||||
| Minnesota | X | |||||||||
| Missouri | Y | |||||||||
| Mississippi | Z | |||||||||
| Montana | AA | |||||||||
| North Carolina | BB | |||||||||
| North Dakota | CC | |||||||||
| Nebraska | DD | |||||||||
| New Hampshire | EE | |||||||||
| New Jersey | FF | |||||||||
| New Mexico | GG | |||||||||
| Nevada | HH | |||||||||
| New York | II | |||||||||
| Ohio | JJ | |||||||||
| Oklahoma | KK | |||||||||
| Oregon | LL | |||||||||
| Pennsylvania | MM | |||||||||
| Puerto Rico | NN | |||||||||
| Rhode Island | OO | |||||||||
| South Carolina | PP | |||||||||
| South Dakota | ||||||||||
| Tennessee | RR | |||||||||
| Texas | SS | |||||||||
| Utah | TT | |||||||||
| Virginia | UU | |||||||||
| Vermont | VV | |||||||||
| Washington | WW | |||||||||
| Wisconsin | XX | |||||||||
| West Virginia | YY | |||||||||
| Wyoming | ZZ | |||||||||
| EDO03873 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Radio button, one-up vertical | ||||||
| EDO03874 | B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Radio button, one-up vertical | ||||||
| Montgomery - Central Alabama Veterans Health Care System | ||||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | ||||||||||
| Tuskegee - Central Alabama Veterans Health Care System | ||||||||||
| EDO03875 | C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Radio button, one-up vertical | ||||||
| Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| EDO03876 | D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Radio button, one-up vertical | ||||||
| Prescott - Northern Arizona VA Health Care System | ||||||||||
| Tucson - Southern Arizona VA Health Care System | ||||||||||
| EDO03877 | E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Radio button, one-up vertical | ||||||
| Livermore - VA Palo Alto Health Care System | ||||||||||
| Loma Linda - VA Loma Linda Healthcare System | ||||||||||
| Long Beach - VA Long Beach Healthcare System | ||||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | ||||||||||
| Mather - VA Northern California Health Care System | ||||||||||
| Menlo Park - VA Palo Alto Health Care System | ||||||||||
| Palo Alto - VA Palo Alto Health Care System | ||||||||||
| San Diego - VA San Diego Healthcare System | ||||||||||
| San Francisco - San Francisco VA Medical Center | ||||||||||
| EDO03878 | F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Radio button, one-up vertical | ||||||
| Grand Junction - Grand Junction VA Medical Center | ||||||||||
| EDO03879 | G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Radio button, one-up vertical | ||||||
| West Haven - VA Connecticut Healthcare System | ||||||||||
| EDO03880 | H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03881 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03882 | J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Radio button, one-up vertical | ||||||
| Miami - Miami VA Healthcare System | ||||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | ||||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | ||||||||||
| Orlando - Orlando VA Medical Center | ||||||||||
| Tampa - James A. Haley Veterans' Hospital | ||||||||||
| West Palm Beach - West Palm Beach VA Medical Center | ||||||||||
| EDO03883 | K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Radio button, one-up vertical | ||||||
| Decatur - Atlanta VA Medical Center | ||||||||||
| Dublin - Carl Vinson VA Medical Center | ||||||||||
| EDO03884 | L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Radio button, one-up vertical | ||||||
| EDO03885 | M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Radio button, one-up vertical | ||||||
| Iowa City - Iowa City VA Medical Center | ||||||||||
| EDO03886 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03887 | O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | ||||||
| Danville - VA Illiana Health Care System | ||||||||||
| Hines - Edward Hines Jr. VA Hospital | ||||||||||
| Marion - Marion VA Medical Center | ||||||||||
| North Chicago - North Chicago VA Medical Center | ||||||||||
| EDO03888 | P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Radio button, one-up vertical | ||||||
| Indianapolis - Richard L. Roudebush VA Medical Center | ||||||||||
| Marion - VA Northern Indiana Health Care System | ||||||||||
| EDO03889 | Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Radio button, one-up vertical | ||||||
| Topeka - VA Eastern Kansas Health Care System | ||||||||||
| Wichita - Robert J. Dole VA Medical Center | ||||||||||
| EDO03890 | R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Radio button, one-up vertical | ||||||
| Lexington - Lexington VA Medical Center (Leestown Division) | ||||||||||
| Louisville - Louisville VA Medical Center | ||||||||||
| EDO03891 | S | Which Medical Center in Lousiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Radio button, one-up vertical | ||||||
| Pineville - Alexandria VA Medical Center | ||||||||||
| Shreveport - Overton Brooks VA Medical Center | ||||||||||
| EDO03892 | T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Brockton - VA Boston Healthcare System | ||||||||||
| Jamaica Plain - VA Boston Healthcare System | ||||||||||
| Leeds - Northampton VA Medical Center | ||||||||||
| West Roxbury - VA Boston Healthcare System | ||||||||||
| EDO03893 | U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Radio button, one-up vertical | ||||||
| Perry Point - Perry Point VA Medical Center | ||||||||||
| EDO03894 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03895 | W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Radio button, one-up vertical | ||||||
| Battle Creek - Battle Creek VA Medical Center | ||||||||||
| Detroit - John D. Dingell VA Medical Center | ||||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | ||||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | ||||||||||
| EDO03896 | X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Radio button, one-up vertical | ||||||
| St. Cloud - St. Cloud VA Medical Center | ||||||||||
| EDO03897 | Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Radio button, one-up vertical | ||||||
| Kansas City - Kansas City VA Medical Center | ||||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | ||||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | ||||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | ||||||||||
| EDO03898 | Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Radio button, one-up vertical | ||||||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | ||||||||||
| EDO03899 | AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Radio button, one-up vertical | ||||||
| EDO03900 | BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Radio button, one-up vertical | ||||||
| Durham - Durham VA Medical Center | ||||||||||
| Fayetteville - Fayetteville VA Medical Center | ||||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | ||||||||||
| EDO03901 | CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03902 | DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Radio button, one-up vertical | ||||||
| EDO03903 | EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03904 | FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Radio button, one-up vertical | ||||||
| Lyons - VA New Jersey Health Care System | ||||||||||
| EDO03905 | GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Radio button, one-up vertical | ||||||
| EDO03906 | HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | ||||||
| Reno - VA Sierra Nevada Health Care System | ||||||||||
| EDO03907 | II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Radio button, one-up vertical | ||||||
| Batavia - VA Western New York Healthcare System | ||||||||||
| Bath - Bath VA Medical Center | ||||||||||
| Bronx - James J. Peters VA Medical Center | ||||||||||
| Brooklyn - VA NY Harbor Healthcare System | ||||||||||
| Buffalo - VA Western New York Healthcare System | ||||||||||
| Canandaigua - Canandaigua VA Medical Center | ||||||||||
| Castle Point - VA Hudson Valley Health Care System | ||||||||||
| Montrose - VA Hudson Valley Health Care System | ||||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | ||||||||||
| Northport - Northport VA Medical Center | ||||||||||
| Syracuse - Syracuse VA Medical Center | ||||||||||
| EDO03908 | JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Radio button, one-up vertical | ||||||
| Cincinnati - Cincinnati VA Medical Center | ||||||||||
| Cleveland - Louis Stokes VA Medical Center | ||||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | ||||||||||
| Dayton - Dayton VA Medical Center | ||||||||||
| EDO03909 | KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Radio button, one-up vertical | ||||||
| Oklahoma City - Oklahoma City VA Medical Center | ||||||||||
| EDO03910 | LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Radio button, one-up vertical | ||||||
| Portland - Portland VA Medical Center | ||||||||||
| EDO03911 | MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Radio button, one-up vertical | ||||||
| Butler - VA Butler Healthcare System | ||||||||||
| Coatesville - Coatesville VA Medical Center | ||||||||||
| Erie - Erie VA Medical Center | ||||||||||
| Lebanon - Lebanon VA Medical Center | ||||||||||
| Philadelphia - Philadelphia VA Medical Center | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | ||||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | ||||||||||
| EDO03912 | NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Radio button, one-up vertical | ||||||
| EDO03913 | OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03914 | PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Radio button, one-up vertical | ||||||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | ||||||||||
| EDO03915 | Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Radio button, one-up vertical | |||||||
| Hot Springs - VA Black Hills Health Care System | ||||||||||
| Sioux Falls - Sioux Falls VA Medical Center | ||||||||||
| EDO03916 | RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Radio button, one-up vertical | ||||||
| Mountain Home - Mountain Home VA Medical Center | ||||||||||
| Murfreesboro - Tennessee Valley Healthcare System | ||||||||||
| Nashville - Tennessee Valley Healthcare System | ||||||||||
| EDO03917 | SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Radio button, one-up vertical | ||||||
| Big Spring - West Texas VA Health Care System | ||||||||||
| Dallas - VA North Texas Health Care System | ||||||||||
| El Paso - El Paso VA Health Care System | ||||||||||
| San Antonio - South Texas Veterans Health Care System | ||||||||||
| Temple - Central Texas Veterans Health Care System | ||||||||||
| Bonham - VA North Texas Health Care System | ||||||||||
| Houston - Michael E. DeBakey VA Medical Center | ||||||||||
| Kerrville - Kerrville VA Medical Center | ||||||||||
| Waco - Central Texas Veterans Health Care System | ||||||||||
| EDO03918 | TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Radio button, one-up vertical | ||||||
| EDO03919 | UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Radio button, one-up vertical | ||||||
| Richmond - Hunter Holmes McGuire VA Medical Center | ||||||||||
| Salem - Salem VA Medical Center | ||||||||||
| EDO03920 | VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03921 | WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Radio button, one-up vertical | ||||||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | ||||||||||
| Spokane - Spokane VA Medical Center | ||||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | ||||||||||
| EDO03922 | XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | ||||||||||
| Tomah - Tomah VA Medical Center | ||||||||||
| EDO03923 | YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Radio button, one-up vertical | ||||||
| Clarksburg - Louis A. Johnson VA Medical Center | ||||||||||
| Huntington - Huntington VA Medical Center | ||||||||||
| Martinsburg - Martinsburg VA Medical Center | ||||||||||
| EDO03924 | ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Radio button, one-up vertical | ||||||
| Sheridan - Sheridan VA Medical Center | ||||||||||
| EDO03925 | What type of information were you trying to find on this medical center web site? (Check all that apply) | Facility contact information | Checkbox, one-up vertical | Multi | Y | |||||
| Directions / Locations | ||||||||||
| Hours of Operation | ||||||||||
| Services Available | ||||||||||
| Make, change, or cancel an appointment | ||||||||||
| Prescription refills | ||||||||||
| Emergency information | ||||||||||
| Jobs | ||||||||||
| Volunteer Information | ||||||||||
| Transportation (Rural, DAV, etc.) | ||||||||||
| Family & Dependent Health Benefits | ||||||||||
| Healthcare Eligibility | ||||||||||
| Health Education (classes, tutorials, etc.) | ||||||||||
| General Health Information | ||||||||||
| Healthcare Professional Training (Students, Residents, etc.) | ||||||||||
| Home Health Care | ||||||||||
| Nursing Home Care | ||||||||||
| Telephone Care (after hours) | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03926 | A | Other, please specify | OE_Reason | |||||||
| EDO03927 | Did you find what you were looking today? | Yes | Radio button, one-up vertical | Single | Y | Find Info | ||||
| No, I was looking for: | A | |||||||||
| EDO03928 | A | What specific information were you unable to find? | OE_Find | |||||||
| EDO03933 | Do you believe the amount of information provided about services offered at this VA Medical Center is adequate? | Yes | Radio button, one-up vertical | Single | Y | Services Adequate | ||||
| No | A | |||||||||
| EDO03934 | A | Why not? | Text area, no char limit | OE_Not Adequate | ||||||
| EDO03935 | Where did you first hear about this VA Medical Center web site? | During Enrollment | Radio button, one-up vertical | Single | Y | How Hear | ||||
| At the Medical Center | ||||||||||
| From my provider (doctor, nurse, social worker, etc.) | ||||||||||
| Search Engine | ||||||||||
| Social Networks (Facebook, Twitter, etc.) | ||||||||||
| www.va.gov | ||||||||||
| www.va.gov/health | ||||||||||
| I browsed directly to the site | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03936 | A | Other, please specify: | OE_How Hear | |||||||
| EDO03937 | Would you like to see additional information about recent news & events at this medical center and its clinics? | Yes | A | Radio button, one-up vertical | Single | Y | Add Info | |||
| No | ||||||||||
| EDO03938 | A | How would you like to see this information? (Check all that apply) | Directly on the medical center's web site | Checkbox, one-up vertical | Multi | Y | How Add Info | |||
| Social Networking (Facebook, Twitter, etc.) | ||||||||||
| RSS | ||||||||||
| SMS / Text Messaging | ||||||||||
| EDO03931 | Do you use MyHealtheVet (prescription refills, personal health record, etc.)? | Yes | A | Radio button, one-up vertical | Single | Y | MHV Usage | |||
| No | B | |||||||||
| EDO03939 | A | Have you completed the In-Person Authentication (IPA) which allows you to view the names of your prescriptions? | Yes | Radio button, one-up vertical | Single | Y | IPA | |||
| No | ||||||||||
| EDO03932 | B | Why not? | Text area, no char limit | OE_Not Use MHV | ||||||
| EDO03929 | Do you use any of the following while on the Internet? (Check all that apply) | Checkbox, one-up vertical | Multi | Y | Social media | |||||
| MySpace | ||||||||||
| YouTube | ||||||||||
| Second Life | ||||||||||
| Flickr | ||||||||||
| Blogs | ||||||||||
| Del.icio.us | ||||||||||
| Digg | ||||||||||
| Podcasts | ||||||||||
| I do not use any of these social media tools. | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03930 | A | Other, please specify: | Text area, no char limit | OE_Social Media | ||||||
Sheet 5: Custom Qsts (8-16-10)
| Model Instance Name: VHA Medical Centers |
|
|||||||||
| underlined & italicized: RE-ORDER | ||||||||||
| MID: 4E989k41otEAc5w1UI9opw== | pink: ADDITION | |||||||||
| blue + -->: REWORDING | ||||||||||
| CUSTOM QUESTION LIST | ||||||||||
| QID (Group ID) |
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | CQ Label | |
| EDO03866 | How frequently do you visit this site? | First time | Radio button, one-up vertical | Single | Y | |||||
| Frequently (about once a month or more often) | ||||||||||
| Infrequently (Every few months or less often) | ||||||||||
| EDO03867 | Please tell us who you are. | Veteran | B | Radio button, one-up vertical | Single | Y | Role | |||
| Active Duty | B | |||||||||
| Family Member / Friend | ||||||||||
| VA Employee | ||||||||||
| Volunteer | ||||||||||
| Healthcare Professional (MD, RN, etc.) | ||||||||||
| Job Applicant | ||||||||||
| Student / Healthcare Trainee | ||||||||||
| Media | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03868 | A | Other, please specify: | Text area, no char limit | OE_Role | ||||||
| EDO03869 | B | Please check the conflict(s) in which you served. | World War II | Checkbox, one-up vertical | Multi | Y | Conflict | |||
| Korean Conflict | ||||||||||
| Vietnam Era | ||||||||||
| Persian Gulf War | ||||||||||
| Operation Enduring Freedom | ||||||||||
| Operation Iraqi Freedom | ||||||||||
| No conflict / war service | ||||||||||
| EDO03870 | Please select your age range: | 17 or under | Radio button, one-up vertical | Single | Y | Age | ||||
| 18-24 | ||||||||||
| 25-34 | ||||||||||
| 35-44 | ||||||||||
| 45-54 | ||||||||||
| 55-64 | ||||||||||
| 65+ | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03871 | Please select your gender: | Male | Radio button, one-up vertical | Single | Y | Age | ||||
| Female | ||||||||||
| Prefer not to answer | ||||||||||
| EDO03872 | From which medical center do you get the majority of your care? (Choose State First) (If you receive most of your care at a community-based outpatient clinic, please select the medical center from which you would receive advanced care if needed). |
Do not have a primary medical center | Drop down, select one | Single | Y | State | ||||
| Alaska | A | |||||||||
| Alabama | B | |||||||||
| Arkansas | C | |||||||||
| Arizona | D | |||||||||
| California | E | |||||||||
| Colorado | F | |||||||||
| Connecticut | G | |||||||||
| District of Columbia | H | |||||||||
| Delaware | I | |||||||||
| Florida | J | |||||||||
| Georgia | K | |||||||||
| Hawaii | L | |||||||||
| Iowa | M | |||||||||
| Idaho | N | |||||||||
| Illinois | O | |||||||||
| Indiana | P | |||||||||
| Kansas | Q | |||||||||
| Kentucky | R | |||||||||
| Louisiana | S | |||||||||
| Massachusetts | T | |||||||||
| Maryland | U | |||||||||
| Maine | V | |||||||||
| Michigan | W | |||||||||
| Minnesota | X | |||||||||
| Missouri | Y | |||||||||
| Mississippi | Z | |||||||||
| Montana | AA | |||||||||
| North Carolina | BB | |||||||||
| North Dakota | CC | |||||||||
| Nebraska | DD | |||||||||
| New Hampshire | EE | |||||||||
| New Jersey | FF | |||||||||
| New Mexico | GG | |||||||||
| Nevada | HH | |||||||||
| New York | II | |||||||||
| Ohio | JJ | |||||||||
| Oklahoma | KK | |||||||||
| Oregon | LL | |||||||||
| Pennsylvania | MM | |||||||||
| Puerto Rico | NN | |||||||||
| Rhode Island | OO | |||||||||
| South Carolina | PP | |||||||||
| South Dakota | ||||||||||
| Tennessee | RR | |||||||||
| Texas | SS | |||||||||
| Utah | TT | |||||||||
| Virginia | UU | |||||||||
| Vermont | VV | |||||||||
| Washington | WW | |||||||||
| Wisconsin | XX | |||||||||
| West Virginia | YY | |||||||||
| Wyoming | ZZ | |||||||||
| EDO03873 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Radio button, one-up vertical | ||||||
| EDO03874 | B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Radio button, one-up vertical | ||||||
| Montgomery - Central Alabama Veterans Health Care System | ||||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | ||||||||||
| Tuskegee - Central Alabama Veterans Health Care System | ||||||||||
| EDO03875 | C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Radio button, one-up vertical | ||||||
| Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | ||||||||||
| EDO03876 | D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Radio button, one-up vertical | ||||||
| Prescott - Northern Arizona VA Health Care System | ||||||||||
| Tucson - Southern Arizona VA Health Care System | ||||||||||
| EDO03877 | E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Radio button, one-up vertical | ||||||
| Livermore - VA Palo Alto Health Care System | ||||||||||
| Loma Linda - VA Loma Linda Healthcare System | ||||||||||
| Long Beach - VA Long Beach Healthcare System | ||||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | ||||||||||
| Mather - VA Northern California Health Care System | ||||||||||
| Menlo Park - VA Palo Alto Health Care System | ||||||||||
| Palo Alto - VA Palo Alto Health Care System | ||||||||||
| San Diego - VA San Diego Healthcare System | ||||||||||
| San Francisco - San Francisco VA Medical Center | ||||||||||
| EDO03878 | F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Radio button, one-up vertical | ||||||
| Grand Junction - Grand Junction VA Medical Center | ||||||||||
| EDO03879 | G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Radio button, one-up vertical | ||||||
| West Haven - VA Connecticut Healthcare System | ||||||||||
| EDO03880 | H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03881 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03882 | J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Radio button, one-up vertical | ||||||
| Miami - Miami VA Healthcare System | ||||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | ||||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | ||||||||||
| Orlando - Orlando VA Medical Center | ||||||||||
| Tampa - James A. Haley Veterans' Hospital | ||||||||||
| West Palm Beach - West Palm Beach VA Medical Center | ||||||||||
| EDO03883 | K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Radio button, one-up vertical | ||||||
| Decatur - Atlanta VA Medical Center | ||||||||||
| Dublin - Carl Vinson VA Medical Center | ||||||||||
| EDO03884 | L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Radio button, one-up vertical | ||||||
| EDO03885 | M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Radio button, one-up vertical | ||||||
| Iowa City - Iowa City VA Medical Center | ||||||||||
| EDO03886 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03887 | O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | ||||||
| Danville - VA Illiana Health Care System | ||||||||||
| Hines - Edward Hines Jr. VA Hospital | ||||||||||
| Marion - Marion VA Medical Center | ||||||||||
| North Chicago - North Chicago VA Medical Center | ||||||||||
| EDO03888 | P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Radio button, one-up vertical | ||||||
| Indianapolis - Richard L. Roudebush VA Medical Center | ||||||||||
| Marion - VA Northern Indiana Health Care System | ||||||||||
| EDO03889 | Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Radio button, one-up vertical | ||||||
| Topeka - VA Eastern Kansas Health Care System | ||||||||||
| Wichita - Robert J. Dole VA Medical Center | ||||||||||
| EDO03890 | R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Radio button, one-up vertical | ||||||
| Lexington - Lexington VA Medical Center (Leestown Division) | ||||||||||
| Louisville - Louisville VA Medical Center | ||||||||||
| EDO03891 | S | Which Medical Center in Lousiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Radio button, one-up vertical | ||||||
| Pineville - Alexandria VA Medical Center | ||||||||||
| Shreveport - Overton Brooks VA Medical Center | ||||||||||
| EDO03892 | T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Brockton - VA Boston Healthcare System | ||||||||||
| Jamaica Plain - VA Boston Healthcare System | ||||||||||
| Leeds - Northampton VA Medical Center | ||||||||||
| West Roxbury - VA Boston Healthcare System | ||||||||||
| EDO03893 | U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Radio button, one-up vertical | ||||||
| Perry Point - Perry Point VA Medical Center | ||||||||||
| EDO03894 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03895 | W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Radio button, one-up vertical | ||||||
| Battle Creek - Battle Creek VA Medical Center | ||||||||||
| Detroit - John D. Dingell VA Medical Center | ||||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | ||||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | ||||||||||
| EDO03896 | X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Radio button, one-up vertical | ||||||
| St. Cloud - St. Cloud VA Medical Center | ||||||||||
| EDO03897 | Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Radio button, one-up vertical | ||||||
| Kansas City - Kansas City VA Medical Center | ||||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | ||||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | ||||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | ||||||||||
| EDO03898 | Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Radio button, one-up vertical | ||||||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | ||||||||||
| EDO03899 | AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Radio button, one-up vertical | ||||||
| EDO03900 | BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Radio button, one-up vertical | ||||||
| Durham - Durham VA Medical Center | ||||||||||
| Fayetteville - Fayetteville VA Medical Center | ||||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | ||||||||||
| EDO03901 | CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03902 | DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Radio button, one-up vertical | ||||||
| EDO03903 | EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03904 | FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Radio button, one-up vertical | ||||||
| Lyons - VA New Jersey Health Care System | ||||||||||
| EDO03905 | GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Radio button, one-up vertical | ||||||
| EDO03906 | HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | ||||||
| Reno - VA Sierra Nevada Health Care System | ||||||||||
| EDO03907 | II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Radio button, one-up vertical | ||||||
| Batavia - VA Western New York Healthcare System | ||||||||||
| Bath - Bath VA Medical Center | ||||||||||
| Bronx - James J. Peters VA Medical Center | ||||||||||
| Brooklyn - VA NY Harbor Healthcare System | ||||||||||
| Buffalo - VA Western New York Healthcare System | ||||||||||
| Canandaigua - Canandaigua VA Medical Center | ||||||||||
| Castle Point - VA Hudson Valley Health Care System | ||||||||||
| Montrose - VA Hudson Valley Health Care System | ||||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | ||||||||||
| Northport - Northport VA Medical Center | ||||||||||
| Syracuse - Syracuse VA Medical Center | ||||||||||
| EDO03908 | JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Radio button, one-up vertical | ||||||
| Cincinnati - Cincinnati VA Medical Center | ||||||||||
| Cleveland - Louis Stokes VA Medical Center | ||||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | ||||||||||
| Dayton - Dayton VA Medical Center | ||||||||||
| EDO03909 | KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Radio button, one-up vertical | ||||||
| Oklahoma City - Oklahoma City VA Medical Center | ||||||||||
| EDO03910 | LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Radio button, one-up vertical | ||||||
| Portland - Portland VA Medical Center | ||||||||||
| EDO03911 | MM | Which Medical Center in Pennsylvannia do you visit? | Altoona - James E. Van Zandt VA Medical Center | Radio button, one-up vertical | ||||||
| Butler - VA Butler Healthcare System | ||||||||||
| Coatesville - Coatesville VA Medical Center | ||||||||||
| Erie - Erie VA Medical Center | ||||||||||
| Lebanon - Lebanon VA Medical Center | ||||||||||
| Philadelphia - Philadelphia VA Medical Center | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | ||||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | ||||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | ||||||||||
| EDO03912 | NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Radio button, one-up vertical | ||||||
| EDO03913 | OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03914 | PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Radio button, one-up vertical | ||||||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | ||||||||||
| EDO03915 | Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Radio button, one-up vertical | |||||||
| Hot Springs - VA Black Hills Health Care System | ||||||||||
| Sioux Falls - Sioux Falls VA Medical Center | ||||||||||
| EDO03916 | RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Radio button, one-up vertical | ||||||
| Mountain Home - Mountain Home VA Medical Center | ||||||||||
| Murfreesboro - Tennessee Valley Healthcare System | ||||||||||
| Nashville - Tennessee Valley Healthcare System | ||||||||||
| EDO03917 | SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Radio button, one-up vertical | ||||||
| Big Spring - West Texas VA Health Care System | ||||||||||
| Dallas - VA North Texas Health Care System | ||||||||||
| El Paso - El Paso VA Health Care System | ||||||||||
| San Antonio - South Texas Veterans Health Care System | ||||||||||
| Temple - Central Texas Veterans Health Care System | ||||||||||
| Bonham - VA North Texas Health Care System | ||||||||||
| Houston - Michael E. DeBakey VA Medical Center | ||||||||||
| Kerrville - Kerrville VA Medical Center | ||||||||||
| Waco - Central Texas Veterans Health Care System | ||||||||||
| EDO03918 | TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Radio button, one-up vertical | ||||||
| EDO03919 | UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Radio button, one-up vertical | ||||||
| Richmond - Hunter Holmes McGuire VA Medical Center | ||||||||||
| Salem - Salem VA Medical Center | ||||||||||
| EDO03920 | VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Radio button, one-up vertical | ||||||
| EDO03921 | WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Radio button, one-up vertical | ||||||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | ||||||||||
| Spokane - Spokane VA Medical Center | ||||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | ||||||||||
| EDO03922 | XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Radio button, one-up vertical | ||||||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | ||||||||||
| Tomah - Tomah VA Medical Center | ||||||||||
| EDO03923 | YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Radio button, one-up vertical | ||||||
| Clarksburg - Louis A. Johnson VA Medical Center | ||||||||||
| Huntington - Huntington VA Medical Center | ||||||||||
| Martinsburg - Martinsburg VA Medical Center | ||||||||||
| EDO03924 | ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Radio button, one-up vertical | ||||||
| Sheridan - Sheridan VA Medical Center | ||||||||||
| EDO03925 | What type of information were you trying to find on this medical center web site? (Check all that apply) | Facility contact information | Checkbox, one-up vertical | Multi | Y | |||||
| Directions / Locations | ||||||||||
| Hours of Operation | ||||||||||
| Services Available | ||||||||||
| Make, change, or cancel an appointment | ||||||||||
| Prescription refills | ||||||||||
| Emergency information | ||||||||||
| Jobs | ||||||||||
| Volunteer Information | ||||||||||
| Transportation (Rural, DAV, etc.) | ||||||||||
| Family & Dependent Health Benefits | ||||||||||
| Healthcare Eligibility | ||||||||||
| Health Education (classes, tutorials, etc.) | ||||||||||
| General Health Information | ||||||||||
| Healthcare Professional Training (Students, Residents, etc.) | ||||||||||
| Home Health Care | ||||||||||
| Nursing Home Care | ||||||||||
| Telephone Care (after hours) | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03926 | A | Other, please specify | OE_Reason | |||||||
| EDO03927 | Did you find what you were looking today? | Yes | Radio button, one-up vertical | Single | Y | Find Info | ||||
| No, I was looking for: | A | |||||||||
| EDO03928 | A | What specific information were you unable to find? | OE_Find | |||||||
| EDO03933 | Do you believe the amount of information provided about services offered at this VA Medical Center is adequate? | Yes | Radio button, one-up vertical | Single | Y | Services Adequate | ||||
| No | A | |||||||||
| EDO03934 | A | Why not? | Text area, no char limit | OE_Not Adequate | ||||||
| EDO03935 | Where did you first hear about this VA Medical Center web site? | During Enrollment | Radio button, one-up vertical | Single | Y | How Hear | ||||
| At the Medical Center | ||||||||||
| From my provider (doctor, nurse, social worker, etc.) | ||||||||||
| Search Engine | ||||||||||
| Social Networks (Facebook, Twitter, etc.) | ||||||||||
| www.va.gov | ||||||||||
| www.va.gov/health | ||||||||||
| I browsed directly to the site | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03936 | A | Other, please specify: | OE_How Hear | |||||||
| EDO03937 | Would you like to see additional information about recent news & events at this medical center and its clinics? | Yes | A | Radio button, one-up vertical | Single | Y | Add Info | |||
| No | ||||||||||
| EDO03938 | A | How would you like to see this information? (Check all that apply) | Directly on the medical center's web site | Checkbox, one-up vertical | Single | Y | How Add Info | |||
| Social Networking (Facebook, Twitter, etc.) | ||||||||||
| RSS | ||||||||||
| SMS / Text Messaging | ||||||||||
| EDO03931 | Do you use MyHealtheVet (prescription refills, personal health record, etc.)? | Yes | A | Radio button, one-up vertical | Single | Y | MHV Usage | |||
| No | B | |||||||||
| EDO03939 | A | Have you completed the In-Person Authentication (IPA) which allows you to view the names of your prescriptions? | Yes | Radio button, one-up vertical | Single | Y | IPA | |||
| No | ||||||||||
| EDO03932 | B | Why not? | Text area, no char limit | OE_Not Use MHV | ||||||
| EDO03929 | Do you use any of the following while on the Internet? (Check all that apply) | Checkbox, one-up vertical | Multi | Y | Social media | |||||
| MySpace | ||||||||||
| YouTube | ||||||||||
| Second Life | ||||||||||
| Flickr | ||||||||||
| Blogs | ||||||||||
| Del.icio.us | ||||||||||
| Digg | ||||||||||
| Podcasts | ||||||||||
| Other, please specify: | A | |||||||||
| EDO03930 | A | Other, please specify: | Text area, no char limit | OE_Social Media | ||||||
Sheet 6: Sheet3
| AK | Anchorage - Alaska VA Healthcare System | |
| AL | Birmingham - Birmingham VA Medical Center | |
| AL | Montgomery - Central Alabama Veterans Health Care System | |
| AL | Tuscaloosa - Tuscaloosa VA Medical Center | |
| AL | Tuskegee - Central Alabama Veterans Health Care System | |
| AR | Fayetteville - Veterans Health Care System of the Ozarks | |
| AR | Little Rock - Central Arkansas Veterans Healthcare System | |
| AR | North Little Rock - Central Arkansas Veterans Healthcare System | |
| AZ | Phoenix - Phoenix VA Health Care System | |
| AZ | Prescott - Northern Arizona VA Health Care System | |
| AZ | Tucson - Southern Arizona VA Health Care System | |
| - | ||
| CA | Fresno - VA Central California Health Care System | |
| CA | Livermore - VA Palo Alto Health Care System | |
| CA | Loma Linda - VA Loma Linda Healthcare System | |
| CA | Long Beach - VA Long Beach Healthcare System | |
| CA | Los Angeles - VA Greater Los Angeles Healthcare System | |
| CA | Mather - VA Northern California Health Care System | |
| CA | Menlo Park - VA Palo Alto Health Care System | |
| CA | Palo Alto - VA Palo Alto Health Care System | |
| CA | San Diego - VA San Diego Healthcare System | |
| CA | San Francisco - San Francisco VA Medical Center | |
| - | ||
| CO | Denver - VA Eastern Colorado Health Care System | |
| CO | Grand Junction - Grand Junction VA Medical Center | |
| - | ||
| CT | Newington - VA Connecticut Healthcare System | |
| CT | West Haven - VA Connecticut Healthcare System | |
| - | ||
| DC | Washington DC - Washington DC VA Medical Center | |
| - | ||
| DE | Wilmington - Wilmington VA Medical Center | |
| FL | Bay Pines - Bay Pines VA Healthcare System | |
| FL | Miami - Miami VA Healthcare System | |
| FL | Gainesville - North Florida / South Georgia VA Healthcare System | |
| FL | Lake City - North Florida / South Georgia VA Healthcare System | |
| FL | Orlando - Orlando VA Medical Center | |
| FL | Tampa - James A. Haley Veterans' Hospital | |
| FL | West Palm Beach - West Palm Beach VA Medical Center | |
| - | ||
| GA | Augusta - Charlie Norwood VA Medical Center | |
| GA | Decatur - Atlanta VA Medical Center | |
| GA | Dublin - Carl Vinson VA Medical Center | |
| - | ||
| HI | Honolulu - VA Pacific Islands Health Care System | |
| - | ||
| IA | Des Moines - VA Central Iowa Health Care System | |
| IA | Iowa City - Iowa City VA Medical Center | |
| - | ||
| ID | Boise - Boise VA Medical Center | |
| - | ||
| IL | Chicago - Jesse Brown VA Medical Center | |
| IL | Danville - VA Illiana Health Care System | |
| IL | Hines - Edward Hines Jr. VA Hospital | |
| IL | Marion - Marion VA Medical Center | |
| IL | North Chicago - North Chicago VA Medical Center | |
| - | ||
| IN | Fort Wayne - VA Northern Indiana Health Care System | |
| IN | Indianapolis - Richard L. Roudebush VA Medical Center | |
| IN | Marion - VA Northern Indiana Health Care System | |
| - | ||
| KS | Leavenworth - VA Eastern Kansas Health Care System | |
| KS | Topeka - VA Eastern Kansas Health Care System | |
| KS | Wichita - Robert J. Dole VA Medical Center | |
| - | ||
| KY | Lexington - Lexington VA Medical Center (Cooper Division) | |
| KY | Lexington - Lexington VA Medical Center (Leestown Division) | |
| KY | Louisville - Louisville VA Medical Center | |
| - | ||
| LA | New Orleans - Southeast Louisiana Veterans Health Care System | |
| LA | Pineville - Alexandria VA Medical Center | |
| LA | Shreveport - Overton Brooks VA Medical Center | |
| - | ||
| MA | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | |
| MA | Brockton - VA Boston Healthcare System | |
| MA | Jamaica Plain - VA Boston Healthcare System | |
| MA | Leeds - Northampton VA Medical Center | |
| MA | West Roxbury - VA Boston Healthcare System | |
| - | ||
| MD | Baltimore - VA Maryland Health Care System | |
| MD | Perry Point - Perry Point VA Medical Center | |
| - | ||
| ME | Augusta - Togus VA Medical Center | |
| - | ||
| MI | Ann Arbor - VA Ann Arbor Healthcare System | |
| MI | Battle Creek - Battle Creek VA Medical Center | |
| MI | Detroit - John D. Dingell VA Medical Center | |
| MI | Iron Mountain - Oscar G. Johnson VA Medical Center | |
| MI | Saginaw - Aleda E. Lutz VA Medical Center | |
| - | ||
| MN | Minneapolis - Minneapolis VA Medical Center | |
| MN | St. Cloud - St. Cloud VA Medical Center | |
| - | ||
| MO | Columbia - Harry S. Truman Memorial VA Medical Center | |
| MO | Kansas City - Kansas City VA Medical Center | |
| MO | Poplar Bluff - John J. Pershing VA Medical Center | |
| MO | St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | |
| MO | St. Louis - St. Louis VA Medical Center (John Cochran Division) | |
| - | ||
| MS | Biloxi - VA Gulf Coast Veterans Health Care System | |
| MS | Jackson - G.V. (Sonny) Montgomery VA Medical Center | |
| - | ||
| MT | Fort Harrison - VA Montana Health Care System | |
| - | ||
| NC | Asheville - Asheville VA Medical Center | |
| NC | Durham - Durham VA Medical Center | |
| NC | Fayetteville - Fayetteville VA Medical Center | |
| NC | Salisbury - W.G. (Bill) Hefner VA Medical Center | |
| - | ||
| ND | Fargo - Fargo VA Medical Center | |
| - | ||
| NE | Omaha - VA Nebraska-Western Iowa Health Care System | |
| - | ||
| NH | Manchester - Manchester VA Medical Center | |
| - | ||
| NJ | East Orange - VA New Jersey Health Care System | |
| NJ | Lyons - VA New Jersey Health Care System | |
| - | ||
| NM | Albuquerque - New Mexico VA Health Care System | |
| - | ||
| NV | Las Vegas - VA Southern Nevada Healthcare System | |
| NV | Reno - VA Sierra Nevada Health Care System | |
| - | ||
| NY | Albany - Samuel S. Stratton VA Medical Center | |
| NY | Batavia - VA Western New York Healthcare System | |
| NY | Bath - Bath VA Medical Center | |
| NY | Bronx - James J. Peters VA Medical Center | |
| NY | Brooklyn - VA NY Harbor Healthcare System | |
| NY | Buffalo - VA Western New York Healthcare System | |
| NY | Canandaigua - Canandaigua VA Medical Center | |
| NY | Castle Point - VA Hudson Valley Health Care System | |
| NY | Montrose - VA Hudson Valley Health Care System | |
| NY | New York - VA NY Harbor Healthcare System - Manhattan Campus | |
| NY | Northport - Northport VA Medical Center | |
| NY | Syracuse - Syracuse VA Medical Center | |
| - | ||
| OH | Chillicothe - Chillicothe VA Medical Center | |
| OH | Cincinnati - Cincinnati VA Medical Center | |
| OH | Cleveland - Louis Stokes VA Medical Center | |
| OH | Columbus - Chalmbers P. Wylie Ambulatory Care Center | |
| OH | Dayton - Dayton VA Medical Center | |
| - | ||
| OK | Muskogee - Jack C. Montgomery VA Medical Center | |
| OK | Oklahoma City - Oklahoma City VA Medical Center | |
| - | ||
| OR | Roseburg - VA Roseburg Healthcare System | |
| OR | Portland - Portland VA Medical Center | |
| - | ||
| PA | Altoona - James E. Van Zandt VA Medical Center | |
| PA | Butler - VA Butler Healthcare System | |
| PA | Coatesville - Coatesville VA Medical Center | |
| PA | Erie - Erie VA Medical Center | |
| PA | Lebanon - Lebanon VA Medical Center | |
| PA | Philadelphia - Philadelphia VA Medical Center | |
| PA | Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | |
| PA | Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | |
| PA | Wilkes-Barre - Wilkes-Barre VA Medical Center | |
| - | ||
| PR | San Juan - VA Caribbean Healthcare System | |
| - | ||
| RI | Providence - Providence VA Medical Center | |
| - | ||
| SC | Charleston - Ralph H. Johnson VA Medical Center | |
| SC | Columbia - Wm. Jennings Bryan Dorn VA Medical Center | |
| - | ||
| SD | Fort Meade - VA Black Hills Health Care System | |
| SD | Hot Springs - VA Black Hills Health Care System | |
| SD | Sioux Falls - Sioux Falls VA Medical Center | |
| - | ||
| TN | Memphis - Memphis VA Medical Center | |
| TN | Mountain Home - Mountain Home VA Medical Center | |
| TN | Murfreesboro - Tennessee Valley Healthcare System | |
| TN | Nashville - Tennessee Valley Healthcare System | |
| - | ||
| TX | Amarillo - Amarillo VA Health Care System | |
| TX | Big Spring - West Texas VA Health Care System | |
| TX | Dallas - VA North Texas Health Care System | |
| TX | El Paso - El Paso VA Health Care System | |
| TX | San Antonio - South Texas Veterans Health Care System | |
| TX | Temple - Central Texas Veterans Health Care System | |
| TX | Bonham - VA North Texas Health Care System | |
| TX | Houston - Michael E. DeBakey VA Medical Center | |
| TX | Kerrville - Kerrville VA Medical Center | |
| TX | Waco - Central Texas Veterans Health Care System | |
| - | ||
| UT | Salt Lake City - VA Salt Lake City Health Care System | |
| - | ||
| VA | Hampton - Hampton VA Medical Center | |
| VA | Richmond - Hunter Holmes McGuire VA Medical Center | |
| VA | Salem - Salem VA Medical Center | |
| - | ||
| VT | White River Junction - White River Junction VA Medical Center | |
| - | ||
| WA | Seattle - VA Puget Sound Health Care System | |
| WA | Tacoma - VA Puget Sound Health Care System (American Lake Division) | |
| WA | Spokane - Spokane VA Medical Center | |
| WA | Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | |
| - | ||
| WI | Madison - William S. Middleton Memorial Veterans Hospital | |
| WI | Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | |
| WI | Tomah - Tomah VA Medical Center | |
| - | ||
| WV | Beckley - Beckley VA Medical Center | |
| WV | Clarksburg - Louis A. Johnson VA Medical Center | |
| WV | Huntington - Huntington VA Medical Center | |
| WV | Martinsburg - Martinsburg VA Medical Center | |
| - | ||
| WY | Cheyenne - Cheyenne VA Medical Center | |
| WY | Sheridan - Sheridan VA Medical Center |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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