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| We are conducting a survey regarding some issues about Women's health care. The survey takes approximately 20 minutes. |
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2. Do you personally have a private physician; that is, one you feel you could call if you needed medical attention?
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| 3. If you answered yes, please answer the following five questions.
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What kind of physician is he/she?
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4. Where is your personal physician located?
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| 5. Do you use the same physican for most of your personal medical needs? |
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| 6. How likely are you to switch hospitals on your physician�s advice (from your preferred hospital)? |
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| 7. Have you ever been hospitalized; if yes, when was the last time you were hospitalized? |
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| 8. If you have been hospitalized: Thinking back to your last hospitalization, would you say you chose your physician first or the hospital first? |
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| 9. Hypothetically, if you needed to be hospitalized, would you choose your physician or your hospital first? |
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| 11. Have you been hospitalized for OB/Maternity? |
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| 12. When were you last hospitalized for OB/Maternity? |
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| 13. Where were you last hospitalized for OB/Maternity care? |
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| 14. Have you ever been hospitalized for anything other than OB/Maternity? |
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| 15. If yes: When were you last hospitalized for non-OB care? |
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16. Where were you last hospitalized for non-OB care?
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| 17. Are you employed outside the home? |
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| 18. If employed outside the home; what is your approximate income? |
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| 19. What is your approximate annual household income: |
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| 20. Which type of medical insurance do you have? |
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| 23. Number of children delivered: |
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