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Survey Questions (CAHPS Version 5.0)

Getting Needed Care-Composite

In the last 12 months, how often did you get an appointment to see a specialist as soon as you needed?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often was it easy to get the care, tests or treatment you needed?

  • Never
  • Sometimes
  • Usually
  • Always

Getting Care Quickly-Composite

In the last 12 months, when you needed care right away, how often did you get care as soon as you needed?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, not counting times you needed care right away, how often did you get an appointment for your health care at a doctor's office or clinic as soon as you needed?

  • Never
  • Sometimes
  • Usually
  • Always

How Well Doctors Communicate-Composite

In the last 12 months, how often did your personal doctor listen carefully to you?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often did your personal doctor explain things in a way that was easy to understand?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often did your personal doctor show respect for what you had to say?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often did your personal doctor spend enough time with you?

  • Never
  • Sometimes
  • Usually
  • Always

Customer Service-Composite

In the last 12 months, how often did your health plan's customer service give you the information or help you needed?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often did your health plan's customer service staff treat you with courtesy and respect?

  • Never
  • Sometimes
  • Usually
  • Always

Claims Processing-Composite

In the last 12 months, how often did your health plan handle your claims quickly?

  • Never
  • Sometimes
  • Usually
  • Always

In the last 12 months, how often did your health plan handle your claims correctly?

  • Never
  • Sometimes
  • Usually
  • Always

Rating of Health Plan

Using any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?

  • 0 Worst health plan possible
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10 Best health plan possible

Rating of All Health Care

Using any number from 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 12 months?

  • 0 Worst health care possible
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10 Best health care possible

Rating of Personal Doctor

Using any number from 0 to 10, where 0 is the worst personal doctor or nurse possible and 10 is the best personal doctor or nurse possible, what number would you use to rate your personal doctor or nurse?

  • 0 Worst personal doctor possible
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10 Best personal doctor possible

Rating of Specialist

We want to know your rating of the specialist you saw most often in the last 12 months. Using any number from 0 to 10 where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate the specialist?

  • 0 Worst specialist possible
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10 Best specialist possible

Preventive Care-Composite

When did you last have a blood pressure reading?

  • Less than 12 months ago
  • 1 to 2 years ago
  • More than 2 years ago

Do you know if your blood pressure is too high?

  • Yes it is too high
  • No it is not too high
  • More than 2 years ago

When did you last have a Pap smear test?

  • Within the last 12 months
  • 1 to 3 years ago
  • More than 3 but less than 5 years ago
  • 5 or more years ago
  • Never had a Pap smear test

Are you under age 40?

  • Yes
  • No

When was the last time your breasts were checked by mammography?

  • Within the last 12 months
  • 1 to 2 years ago
  • 2 years to less than 5 years ago
  • 5 or more years ago
  • Never had a mammogram

In which trimester is your pregnancy?

  • First trimester
  • Second trimester
  • Third trimester

In which trimester did you first receive prenatal care?

  • First trimester
  • Second trimester
  • Third trimester

Healthy Behaviors-Composite

Have you ever smoked at least 100 cigarettes in your entire life?

  • Yes
  • No

Do you now smoke every day, some days or not at all?

  • Every day
  • Some days
  • Not at all

In the last 12 months, on how many visits were you advised to quit smoking by a doctor or other health provider in your plan?

  • None
  • 1 visit
  • 2 to 4 visits
  • 5 to 9 visits
  • 10 or more visits
  • I had no visits in the last 12 months

On how many visits did your doctor or health provider recommend or discuss methods and strategies (other than medication) to assist you with quitting smoking?

  • None
  • 1 visit
  • 2 to 4 visits
  • 5 to 9 visits
  • 10 or more visits
  • I had no visits in the last 12 months

How much do you weigh without your shoes on?

How tall are you without your shoes on?

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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