Attachment C2 – Cognitive Interview Show Cards

Attachment C_2 Cognitive Interview Showcards.docx

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

Attachment C2 – Cognitive Interview Show Cards

OMB: 0935-0124

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CARD HX-X



Government or State Sources of Insurance

Maryland



-- Medicare

-- Medical Assistance

-- Maryland Children’s Health Program (MCHP)

-- TRICARE

-- CHAMPVA

-- VA (VETERAN’S ADMINISTRATION)

-- Other Government Program Providing Hospital/Physician Benefits





CARD HX-4



Sources of Insurance

Maryland



-- From a Group or Association

-- Directly Through a School

-- Directly From an Insurance Agent

-- Directly From Insurance Company

-- Directly From an HMO

-- From a Union

-- From Anyone’s Previous Employer

-- From Spouse/Deceased Spouse’s Previous Employer

-- From Some Other Employer

-- Under a Plan of Someone Not Living Here

-- Directly from Maryland Health Connection

-- Other Source

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKaren Stein
File Modified0000-00-00
File Created2021-01-22

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