Form 471 HealthIT+qnair 471 HealthIT+qnair 471 HealthIT+qnaire+for+dataload+final

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Overview

Welcome and Thank You
Custom Qsts

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Sheet 1: Welcome and Thank You

Welcome text

Customer Satisfaction Survey

Thanks for visiting the HealthIT.gov website. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve.

Your feedback will help us provide enhance our site and serve you better in the future. All results are strictly confidential.

Thank You text

Thank you for taking our survey. Your input is very valuable to us and we will take it into consideration.

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Sheet 2: Custom Qsts

Model Instance Name:						red & strike-through: DELETE
MID: NEW						underlined & italicized: RE-ORDER
Date:	July 12, 2011					pink: ADDITION
						blue + -->: REWORDING
CQID	Skip Logic Label	Question Text	AnswerID's	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
CWS07627		Which of the following best describes you?	CWS07627A001	Academic/Researcher		Radio button, one-up vertical	single	Y	Skip Logic Group	Best describes you
			CWS07627A002	General Public
			CWS07627A003	Government employee (State & Local)
			CWS07627A004	Government employee (Federal)
			CWS07627A005	Clinician/Healthcare Provider	B
			CWS07627A006	Health IT Professional
			CWS07627A007	Commercial Vendor
			CWS07627A008	Media
			CWS07627A009	Other	A
CWS07628	A	Please describe your role.				Text area, no char limit	single	N	Skip Logic Group	Other Role
CWS07629	B	Please indicate your specific role as a clinician or healthcare provider.	CWS07629A001	Doctor of medicine or osteopathy		Radio button, one-up vertical	single	Y	Skip Logic Group	HCP Role
			CWS07629A002	Doctor of dental surgery or dental medicine
			CWS07629A003	Doctor of podiatry
			CWS07629A004	Doctor of optometry
			CWS07629A005	Chiropractor
			CWS07629A006	Nurse practitioner
			CWS07629A007	Certified nurse-midwife
			CWS07629A008	Dentist
			CWS07629A009	Physician assistant
			CWS07629A010	Nurse
			CWS07629A011	Other	C
CWS07630	C	Please describe your role as a clinician or healthcare provider.				Text area, no char limit	single	N	Skip Logic Group	Other HCP Role
CWS07631		Are you currently a grantee/partner of ONC?	CWS07631A001	Yes		Drop down, select one	single	Y		Grantee
			CWS07631A002	No
CWS07632		What is your primary reason for visiting this site today?	CWS07632A001	Find funding opportunities		Radio button, one-up vertical	single	Y	Skip Logic Group	Reason for visit
			CWS07632A002	Find FACA meeting materials
			CWS07632A003	Learn about Meaningful Use
			CWS07632A004	Join the NHIN
			CWS07632A005	Read use cases
			CWS07632A006	Learn about Health IT
			CWS07632A007	Read Dr. Blumenthal's updates
			CWS07632A008	Just browsing
			CWS07632A009	Contact ONC
			CWS07632A010	Other	D
CWS07633	D	Please describe your primary reason for visiting this site.					single	N		Other Visit Reason
CWS07634		Did you find what you were looking for ?	CWS07634A001	I wasn’t looking for anything in particular		Radio button, one-up vertical	single	Y	Skip Logic Group	Did you find it
			CWS07634A002	Yes
			CWS07634A003	No	E
CWS07635	E	What specifically were you looking for?				Text area, no char limit	single	N	Skip Logic Group	Looking For
CWS07636		Did you use the site-wide search feature on this site? (open text box in the upper right)	CWS07636A001	Yes	1A, 1F	Radio button, one-up vertical			Skip Logic Group	Use Search
			CWS07636A002	No
CWS07637	1A	How would you rate the helpfulness of the site-wide search?	CWS07637A001	Very helpful		Radio button, one-up vertical			Skip Logic Group	Helpfulness of Search
			CWS07637A002	Somewhat helpful
			CWS07637A003	Not helpful	1B
CWS07638	1B	Which of the following describes your experience with the site-wide search?	CWS07638A001	Search difficult to use		Radio button, one-up vertical			Skip Logic Group	Search Experience
			CWS07638A002	Received too few results	1C
			CWS07638A003	Received too many results
			CWS07638A004	Search results were not what I was looking for	1D
			CWS07638A005	Could not sort or refine results
			CWS07638A006	Other	1E
CWS07639	1C	What search term(s) did you use?				Text area, no char limit			Skip Logic Group	Term - Too Few
CWS07640	1D	What search term(s) did you use?				Text area, no char limit			Skip Logic Group	Term - Not What Look For
CWS07641	1E	Please briefly explain your experience with the site-wide search.				Text area, no char limit			Skip Logic Group	Other Search Experience
CWS07642	1F	What one improvement to the site-wide search feature would be most beneficial?				Text area, no char limit			Skip Logic Group	Search Improvement
CWS07643		How often do you visit this site ?	CWS07643A001	First time		Radio button, one-up vertical	single	Y		Frequency of visits
			CWS07643A002	Daily
			CWS07643A003	About once a week
			CWS07643A004	About once a month
			CWS07643A005	Less often than monthly
CWS07644		Which of the following sources drove you to visit the site today? Please rank the top 3 (Rank 1 is most important). Rank 1 (Required)	CWS07644A001	Message or recommendation from a friend on a social network		Drop down, select one	single	Y	Rank Group	SV - Rank 1
			CWS07644A002	Video I saw on YouTube
			CWS07644A003	Internet blogs or discussion forums					Adjust Template/Style Sheet
			CWS07644A004	Advertising on social networks (Facebook, MySpace, Twitter)					Randomize
			CWS07644A005	Message directly from the organization on a social network
			CWS07644A006	Mobile phone text messages or alerts
			CWS07644A007	Instant Message from a friend or colleague
			CWS07644A008	Familiarity with the organization
			CWS07644A009	Email directly from the organization
			CWS07644A010	Search engine results
			CWS07644A011	Word of mouth recommendation from someone I know
			CWS07644A012	TV, radio, newspaper, or magazine advertising
			CWS07644A013	Typed the address (URL) into my browser
			CWS07644A014	Link from another website
			CWS07644A015	Internet advertising
			CWS07644A016	Don't know					Anchor Answer Choice
			CWS07644A017	Other					Anchor Answer Choice
CWS07645		Rank 2 (Optional)	CWS07645A001	Message or recommendation from a friend on a social network		Drop down, select one	single	N	Rank Group	SV - Rank 2
			CWS07645A002	Video I saw on YouTube
			CWS07645A003	Internet blogs or discussion forums					Adjust Template/Style Sheet
			CWS07645A004	Advertising on social networks (Facebook, MySpace, Twitter)					Randomize
			CWS07645A005	Message directly from the organization on a social network
			CWS07645A006	Mobile phone text messages or alerts
			CWS07645A007	Instant Message from a friend or colleague
			CWS07645A008	Familiarity with the organization
			CWS07645A009	Email directly from the organization
			CWS07645A010	Search engine results
			CWS07645A011	Word of mouth recommendation from someone I know
			CWS07645A012	TV, radio, newspaper, or magazine advertising
			CWS07645A013	Typed the address (URL) into my browser
			CWS07645A014	Link from another website
			CWS07645A015	Internet advertising
			CWS07645A016	Don't know					Anchor Answer Choice
			CWS07645A017	Other					Anchor Answer Choice
CWS07646		Rank 3 (Optional)	CWS07646A001	Message or recommendation from a friend on a social network		Drop down, select one	single	N	Rank Group	SV - Rank 3
			CWS07646A002	Video I saw on YouTube
			CWS07646A003	Internet blogs or discussion forums					Adjust Template/Style Sheet
			CWS07646A004	Advertising on social networks (Facebook, MySpace, Twitter)					Randomize
			CWS07646A005	Message directly from the organization on a social network
			CWS07646A006	Mobile phone text messages or alerts
			CWS07646A007	Instant Message from a friend or colleague
			CWS07646A008	Familiarity with the organization
			CWS07646A009	Email directly from the organization
			CWS07646A010	Search engine results
			CWS07646A011	Word of mouth recommendation from someone I know
			CWS07646A012	TV, radio, newspaper, or magazine advertising
			CWS07646A013	Typed the address (URL) into my browser
			CWS07646A014	Link from another website
			CWS07646A015	Internet advertising
			CWS07646A016	Don't know					Anchor Answer Choice
			CWS07646A017	Other					Anchor Answer Choice
CWS07647		How do you currently receive Health IT information from sources other than ONC? (Please select all that apply)	CWS07647A001	Social networks (i.e., Facebook, LinkedIn)		Checkbox, one-up vertical	multi	Y	Skip Logic Group	Receive HealthIT Info
			CWS07647A002	Reading blogs
			CWS07647A003	Following a microblog (i.e., Twitter)
			CWS07647A004	Contributing to wikis
			CWS07647A005	Receiving newsletters/email updates/RSS feeds
			CWS07647A006	Listening/Viewing Podcasts or Vodcasts
			CWS07647A007	None
			CWS07647A008	Other	F
CWS07648	F	I currently receive Health IT information via:				Text area, no char limit		N		Other receive healthIT info
CWS07649		Are you interested in participating in usability testing for our site?	CWS07649A001	No		Radio button, one-up vertical	single	Y	OPS Group	Interest in usability testing
			CWS07649A002	Yes, my email address is	G
CWS07650	G	Email addresses for visitors interested in participating in usability testing				Text field, <100 char	single	N		Email for usability testing
CWS07651		If you could change one thing about the site, what would it be?				Text area, no char limit	single	N		Change one thing