Form 30715 VHA_Medical_Centers_Questionnaire Redesign Questions 12-

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Overview

Current Model Qsts
Current Custom Qsts
Custom Qsts (3-8-18)
Custom Qsts (7-2-15)
Custom Qsts (1-19-15)
Custom Qsts (4-10-13)
Custom Qsts (12-13-10)
Custom Qsts (8-16-10)
Sheet3

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Sheet 1: Current Model Qsts

Model Name		VHA Medical Centers V2					Red & Strike-Through: Delete
Model ID							Underlined & Italicized: Re-order
Partitioned		2MQ					Pink: Addition
Date		12/14/2017					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this site.	19	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	22	Return	How likely are you to return to NOAA NGS?
2	Look and Feel - Balance	Please rate the balance of graphics and text on this site.	20	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
3	Look and Feel - Readability	Please rate the readability of the pages on this site.	21	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	23	Recommend	How likely are you to recommend NOAA NGS to someone else?
		Site Performance (1=Poor, 10=Excellent, Don't Know)
4	Site Performance - Loading	Please rate how quickly pages load on this site.
5	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
6	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Organized	Please rate how well the site is organized.
8	Navigation - Options	Please rate the options available for navigating this site.
9	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
		Information Browsing (1=Poor, 10=Excellent, Don't Know)
10	Information Browsing - Sort	Please rate the ability to sort information by criteria that are important to you on this site.
11	Information Browsing - Narrow	Please rate the ability to narrow choices to find the information you are looking for on this site.
12	Information Browsing - Features	Please rate how well the features on the site help you find the information you need.
		Site Information (1=Poor, 10=Excellent, Don't Know)
13	Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
14	Site Information - Understandable	Please rate how understandable this site’s information is.
15	Site Information - Answers	Please rate how well the site’s information provides answers to your questions.

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Sheet 2: Current Custom Qsts

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	Skip Logic	Visit Frequency
			A few times a year
			About once a month
			About once a week
			More than once a week
EDO03867		What is your primary role in visiting this VA website today?	Veteran	B	Radio button, one-up vertical	Single	Y	Skip Logic	Role
			Active Duty	B
			Family Member / Friend
			VA Employee
			Volunteer
			Healthcare Professional (MD, RN, etc.)
			Job Applicant
			Student / Healthcare Trainee
			Media
			Other	A
EDO03868	A	Please specify your other role.			Text area, no char limit	Single	N	Skip Logic	OE_Role
EDO03869	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	Y	Skip Logic	Conflict
			Korean Conflict
			Vietnam Era
			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
			65-74
			75+
			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	Skip Logic	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	QQ
			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	S	Y	Skip Logic	Alaska
EDO03874	B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Alabama
			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	S	Y	Skip Logic	Arkansas
			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	S	Y	Skip Logic	Arizona
			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	S	Y	Skip Logic	California
			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	S	Y	Skip Logic	Colorado
			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	S	Y	Skip Logic	Connecticut
			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	S	Y	Skip Logic	DC
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Delaware
EDO03882	J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Florida
			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	S	Y	Skip Logic	Georgia
			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	S	Y	Skip Logic	Hawaii
EDO03885	M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Iowa
			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	S	Y	Skip Logic	Idaho
EDO03887	O	Which Medical Center in Illinois do you visit?	Chicago - Jesse Brown VA Medical Center		Radio button, one-up vertical				Illinois
			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	S	Y	Skip Logic	Indiana
			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	S	Y	Skip Logic	Kansas
			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	S	Y	Skip Logic	Kentucky
			Lexington - Lexington VA Medical Center (Leestown Division)
			Louisville - Louisville VA Medical Center
EDO03891	S	Which Medical Center in Louisiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Louisiana
			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	S	Y	Skip Logic	Massachusetts
			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	S	Y	Skip Logic	Maryland
			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	S	Y	Skip Logic	Maine
EDO03895	W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Michigan
			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	S	Y	Skip Logic	Minnesota
			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	S	Y	Skip Logic	Missouri
			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	S	Y	Skip Logic	Mississippi
			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	S	Y	Skip Logic	Montana
EDO03900	BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	North Carolina
			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	S	Y	Skip Logic	North Dakota
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Nebraska
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	New Hampshire
EDO03904	FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	New Jersey
			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	S	Y	Skip Logic	New Mexico
EDO03906	HH	Which Medical Center in Nevada do you visit?	Las Vegas - VA Southern Nevada Healthcare System		Radio button, one-up vertical				Nevada
			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	S	Y	Skip Logic	New York
			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	S	Y	Skip Logic	Ohio
			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	S	Y	Skip Logic	Oklahoma
			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	S	Y	Skip Logic	Oregon
			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	S	Y	Skip Logic	Pennsylvania
			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	S	Y	Skip Logic	Puerto Rico
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Rhode Island
EDO03914	PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	South Carolina
			Columbia - Wm. Jennings Bryan Dorn VA Medical Center
EDO03915	QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	South Dakota
			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	S	Y	Skip Logic	Tennessee
			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	S	Y	Skip Logic	Texas
			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	S	Y	Skip Logic	Utah
EDO03919	UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Virginia
			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	S	Y	Skip Logic	Vermont
EDO03921	WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Washington
			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	S	Y	Skip Logic	Wisconsin
			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	S	Y	Skip Logic	West Virginia
			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	S	Y	Skip Logic	Wyoming
			Sheridan - Sheridan VA Medical Center
EDO03925		What type of information were you trying to find on this medical center website? (Check all that apply)	Facility information	B	Checkbox, one-up vertical	Multi	Y	Skip Logic	Type of Information Seeking
			Specific health issue information	C
			Benefits information	D
			Make, change, or cancel an appointment
			Prescription refills
			Jobs or volunteering info
			Health Education (classes, tutorials, etc.)
			Healthcare Professional Training (Students, Residents, etc.)
			Other	A
EDO03926	A	Please specify the information you were trying to find.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Reason
RUS0166251	B	What facility information you were looking for? (Check all that apply)	Facility contact information		Checkbox, one-up vertical	Multi	Y	Skip Logic	Facility Information
			Contact information for a doctor or clinic
			Directions / Locations
			Hours of Operation
			Services Available
			Other	E
RUS0166252	E	Please specify what other facility information you were looking for.		E	Open-ended text, no char limit	Single	N	Skip Logic	OE_Facility
RUS0216244	C	What health condition were you seeking information on? (Check all that apply)	Mental-health conditions		Checkbox, one-up vertical	Multi	Y	Skip Logic	Health Condition
			PTSD
			Agent Orange exposure
			I'd prefer not to say					Mutually Exclusive
			Other	F
RUS0216245	F	Please specify the health condition you were seeking information on.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Condition
RUS0166254	D	What benefits-related information were you seeking? (Check all that apply)	Disability compensation		Checkbox, one-up vertical	Multi	Y	Skip Logic	Benefits
			Education and training
			Employment services
			Health care
			Home loans and housing-related assistance
			Life insurance
			Memorial benefits
			Pension
			Spouses, dependents and survivors
			Other	G
RUS0166255	G	Please specify the benefits-related information you were seeking.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Benefits
EDO03927		Did you find what you were looking today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Find Info
			Partially	B
			No, I was looking for:	A
RUS0166256	B	What information could have been improved to help answer your questions?			Open-ended text, no char limit	Single	N	Skip Logic	OE_Partial Find
EDO03928	A	What specific information were you unable to find?			Open-ended text, no char limit	Single	N	Skip Logic	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	Skip Logic	Services Adequate
			No	A
EDO03934	A	Why not?			Text area, no char limit			Skip Logic	OE_Not Adequate
EDO03935		Where did you first hear about this VA website?	During Enrollment		Radio button, one-up vertical	Single	Y	Skip Logic	How Hear
			At the Medical Center
			From my provider (doctor, nurse, social worker, etc.)
			Search Engine (Google, Yahoo, etc.)
			Social Networks (Facebook, Twitter, etc.)
			www.va.gov
			www.va.gov/health
			I browsed directly to the site
			Veteran Service Organization
			Friend or family member
			Other	A
EDO03936	A	Please specify how you first heard about this site.						Skip Logic	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	Skip Logic	Add Info
			No
EDO03938	A	How would you like to see this information? (Check all that apply)	Directly on the medical center's website		Checkbox, one-up vertical	Multi	Y	Skip Logic	How Add Info
			Email
			Facebook
			Twitter
			YouTube
			Instagram
			Flickr
			Google+
			RSS
			SMS / Text Messaging
EDO03931		Do you use MyHealtheVet (prescription refills, personal health record, etc.)?	Yes	A	Radio button, one-up vertical	Single	Y	Skip Logic	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	Skip Logic	IPA
			No
EDO03932	B	Why not?			Text area, no char limit	Single	N	Skip Logic	OE_Not Use MHV
EDO03929		Do you use any of the following while on the Internet? (Check all that apply)	Facebook	B	Checkbox, one-up vertical	Multi	Y	Skip Logic	Social media
			LinkedIn
			Twitter	C
			YouTube
			Pinterest
			Google+
			Foursquare
			Yelp
			Flickr
			Blogs
			Podcasts
			I do not use any of these social media tools.			8889
			Other	A
EDO03930	A	Please specify other social media sites you use.			Text area, no char limit	Single	N	Skip Logic	OE_Social Media
RUS0166271	B	Do you interact with the VA on Facebook?	Yes		Radio button, one-up vertical	Single	N	Skip Logic	Facebook
			No
RUS0166272	C	Do you interact with the VA on Twitter?	Yes		Radio button, one-up vertical	Single	N	Skip Logic	Twitter
			No
HAR0074484		Do you ever access the Internet using a mobile phone or tablet?	Yes	A, B, D	Radio button, one-up vertical	Single	Y	Skip Logic	Access Mobile Internet
			No
HAR0074485	A	Which of the following devices do you have?	A SmartPhone	W	Checkbox, one-up vertical	Multi	Y	Skip Logic	Phone or Tablet
			A tablet	X
			None of these					Mutually Exclusive
HAR0074486	W	Specifically, which type of smartphone do you have?	iPhone		Radio button, one-up vertical	Single	Y	Skip Logic	Phone Type
			Android
			Another phone
HAR0074487	X	Specifically, which type of tablet do you have?	iPad		Radio button, one-up vertical	Single	Y	Skip Logic	Tablet Type
			Kindle
			Android
			Another tablet
HAR0074488	B	Have you ever accessed ANY federal website using a smartphone or tablet?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic	Federal Mobile Site Usage
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
HAR0074489	C	Have you ever accessed a VA medical center site using a smartphone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Site Usage
			No, but I plan to do so	Z
			No, but I might in the future	Z
			No, and I don't plan to do so
HAR0074491	Y	What was the main reason you last visited a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Primary Reason
HAR0074492	Z	What resources/additional resources might you want to access from a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Desired Resources
HAR0074490	D	Have you ever accessed a VA Medical Center Social Media site (e.g. Facebook, Twitter, etc.) using a smartphone or tablet?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Social Media
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
RUS0216246		Have you ever accessed a VA Medical Center website while actually visiting a medical center location? (i.e. on a mobile device)		A	Radio button, one-up vertical	Single	Y	Skip Logic	Access on Location
			Yes
			No
			Not sure
RUS0216247	A	Please explain the main reason you accessed the website while visiting the medical center.			Text area, no char limit	Single	N	Skip Logic	OE_Location
RUS0166273		How did you look for information on or navigate the site today? (Check all that apply)	Top navigation bar	L	Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	How Look for Info
			Links in the center of the page	L				Randomize
			Site map	L
			Search feature	M
			Other	L, N				Anchor Answer Choice
RUS0166274	N	How did you look for information or navigate the site?			Text area, no char limit	Single	N	Skip Logic Group*	OPS_How Look for Info
RUS0166275	L	How would you describe your experience navigating the site today? (Check all that apply)	Links often did not take me where I expected		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Navigation Experience
			Links/labels are difficult to understand
			Too many links/navigational options to choose from
			Had technical difficulties (error messages, broken links, etc.)
			Could not navigate back to previous information
			I had another navigation difficulty	O
			I had no difficulty navigating on this site					Mutually Exclusive
RUS0166277	O	Please tell us about the difficulty you experienced navigating the site.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Navigation Experience
RUS0166276	M	Please tell us about your experience with the site's search feature today. (Check all that apply)	I had issues with the basic search process (how to use it, terms to enter).		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Search Experience
			I had issues with the visual display of the search results (text size, images).
			I had issues with the search results I received.	Z
			I had issues with sorting, filtering, advanced search, or lack of these options.
			I had technical issues with the search feature.	P
			I had another search difficulty.	Q
			The search feature met my needs today.					Mutually Exclusive
RUS0166278	Q	Please tell us about the difficulty you experienced with the search feature.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Search Experience
RUS0166280	P	Please explain the technical issue you experienced with search.			Text area, no char limit	Single	N	Skip Logic Group*	OE_Technical Issue
RUS0166282	Z	What were your issues with the search results? (Check all that apply)	Results were not relevant/not what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Search Results Issue
			There were not enough results
			There were NO results
			There was too little information in the results to decide what to choose
			Many of the search results looked the same
			I had another issue with the search results.	R
RUS0166284	R	Please explain the issue(s) you experienced with your search results.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Search Results Issue

---

Sheet 3: Custom Qsts (3-8-18)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	Skip Logic	Visit Frequency
			Frequently (about once a month or more often)	A, B
			Infrequently (Every few months or less often)
			A few times a year
			About once a month
			About once a week
			More than once a week
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?			Text area, no character limit	Single	N	Skip Logic	OE_Redesign
EDO03867		What is your primary role in visiting this VA website today?	Veteran	B	Radio button, one-up vertical	Single	Y	Skip Logic	Role
			Active Duty	B
			Family Member / Friend
			VA Employee
			Volunteer
			Healthcare Professional (MD, RN, etc.)
			Job Applicant
			Student / Healthcare Trainee
			Media
			Other	A
EDO03868	A	Please specify your other role.			Text area, no char limit	Single	N	Skip Logic	OE_Role
EDO03869	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	Y	Skip Logic	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
			65-74
			75+
			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	Skip Logic	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	QQ
			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	S	Y	Skip Logic	Alaska
EDO03874	B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Alabama
			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	S	Y	Skip Logic	Arkansas
			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	S	Y	Skip Logic	Arizona
			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	S	Y	Skip Logic	California
			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	S	Y	Skip Logic	Colorado
			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	S	Y	Skip Logic	Connecticut
			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	S	Y	Skip Logic	DC
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Delaware
EDO03882	J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Florida
			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	S	Y	Skip Logic	Georgia
			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	S	Y	Skip Logic	Hawaii
EDO03885	M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Iowa
			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	S	Y	Skip Logic	Idaho
EDO03887	O	Which Medical Center in Illinois do you visit?	Chicago - Jesse Brown VA Medical Center		Radio button, one-up vertical				Illinois
			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	S	Y	Skip Logic	Indiana
			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	S	Y	Skip Logic	Kansas
			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	S	Y	Skip Logic	Kentucky
			Lexington - Lexington VA Medical Center (Leestown Division)
			Louisville - Louisville VA Medical Center
EDO03891	S	Which Medical Center in Louisiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Louisiana
			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	S	Y	Skip Logic	Massachusetts
			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	S	Y	Skip Logic	Maryland
			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	S	Y	Skip Logic	Maine
EDO03895	W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Michigan
			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	S	Y	Skip Logic	Minnesota
			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	S	Y	Skip Logic	Missouri
			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	S	Y	Skip Logic	Mississippi
			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	S	Y	Skip Logic	Montana
EDO03900	BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	North Carolina
			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	S	Y	Skip Logic	North Dakota
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Nebraska
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	New Hampshire
EDO03904	FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	New Jersey
			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	S	Y	Skip Logic	New Mexico
EDO03906	HH	Which Medical Center in Nevada do you visit?	Las Vegas - VA Southern Nevada Healthcare System		Radio button, one-up vertical				Nevada
			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	S	Y	Skip Logic	New York
			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	S	Y	Skip Logic	Ohio
			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	S	Y	Skip Logic	Oklahoma
			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	S	Y	Skip Logic	Oregon
			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	S	Y	Skip Logic	Pennsylvania
			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	S	Y	Skip Logic	Puerto Rico
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Rhode Island
EDO03914	PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	South Carolina
			Columbia - Wm. Jennings Bryan Dorn VA Medical Center
EDO03915	QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	South Dakota
			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	S	Y	Skip Logic	Tennessee
			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	S	Y	Skip Logic	Texas
			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	S	Y	Skip Logic	Utah
EDO03919	UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Virginia
			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	S	Y	Skip Logic	Vermont
EDO03921	WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Washington
			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	S	Y	Skip Logic	Wisconsin
			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	S	Y	Skip Logic	West Virginia
			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	S	Y	Skip Logic	Wyoming
			Sheridan - Sheridan VA Medical Center
EDO03925		What type of information were you trying to find on this medical center website? (Check all that apply)	Facility contact information		Checkbox, one-up vertical	Multi	Y	Skip Logic	Type of Information Seeking
			Directions / Locations
			Hours of Operation
			Services Available
			Facility information	B
			Specific health issue information	C
			Benefits information	D
			Make, change, or cancel an appointment
			Prescription refills
			Emergency information
			Jobs or volunteering info
			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	A
EDO03926	A	Please specify the information you were trying to find.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Reason
	B	What facility information you were looking for? (Check all that apply)	Facility contact information		Checkbox, one-up vertical	Multi	Y	Skip Logic	Facility Information
			Contact information for a doctor or clinic
			Directions / Locations
			Hours of Operation
			Services Available
			Other	E
	E	Please specify what other facility information you were looking for.		E	Open-ended text, no char limit	Single	N	Skip Logic	OE_Facility
	C	What health condition were you seeking information on? (Check all that apply)	Mental-health conditions		Checkbox, one-up vertical	Multi	Y	Skip Logic	Health Condition
			PTSD
			Agent Orange exposure
			I'd prefer not to say					Mutually Exclusive
			Other	F
	F	Please specify the health condition you were seeking information on.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Condition
	D	What benefits-related information were you seeking? (Check all that apply)	Disability compensation		Checkbox, one-up vertical	Multi	Y	Skip Logic	Benefits
			Education and training
			Employment services
			Health care
			Home loans and housing-related assistance
			Life insurance
			Memorial benefits
			Pension
			Spouses, dependents and survivors
			Other	G
	G	Please specify the benefits-related information you were seeking.			Open-ended text, no char limit	Single	N	Skip Logic	OE_Benefits
EDO03+308:312927		Did you find what you were looking today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Find Info
			Partially	B
			No, I was looking for:	A
	B	What information could have been improved to help answer your questions?			Open-ended text, no char limit	Single	N	Skip Logic	OE_Partial Find
EDO03928	A	What specific information were you unable to find?			Open-ended text, no char limit	Single	N	Skip Logic	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	Skip Logic	Services Adequate
			No	A
EDO03934	A	Why not?			Text area, no char limit			Skip Logic	OE_Not Adequate
EDO03935		Where did you first hear about this VA Medical Center website?	During Enrollment		Radio button, one-up vertical	Single	Y	Skip Logic	How Hear
			At the Medical Center
			From my provider (doctor, nurse, social worker, etc.)
			Search Engine (Google, Yahoo, etc.)
		Separate out Facebook and Twitter	Social Networks (Facebook, Twitter, etc.)
			www.va.gov
			www.va.gov/health
			I browsed directly to the site
			Veteran Service Organization
			Friend or family member
			Other	A
EDO03936	A	Please specify how you first heard about this site.						Skip Logic	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	Skip Logic	Add Info
			No
EDO03938	A	How would you like to see this information? (Check all that apply)	Directly on the medical center's website		Checkbox, one-up vertical	Multi	Y	Skip Logic	How Add Info
			Email
			Facebook
			Twitter
			YouTube
			Instagram
			Flickr
			Google+
			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	Skip Logic	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	Skip Logic	IPA
			No
EDO03932	B	Why not?			Text area, no char limit	Single	N	Skip Logic	OE_Not Use MHV
EDO03929		Do you use any of the following while on the Internet? (Check all that apply)	Facebook	B	Checkbox, one-up vertical	Multi	Y	Skip Logic	Social media
			MySpace
			LinkedIn
			Twitter	C
			YouTube
			Pinterest
			Google+
			Foursquare
			Yelp
			Flickr
			Blogs
			Del.icio.us
			Digg
			Podcasts
			I do not use any of these social media tools.			8889
			Other	A
EDO03930	A	Please specify other social media sites you use.			Text area, no char limit	Single	N	Skip Logic	OE_Social Media
	B	Do you interact with the VA on Facebook?			Radio button, one-up vertical	Single	N	Skip Logic	Facebook
	C	Do you interact with the VA on Twitter?			Radio button, one-up vertical	Single	N	Skip Logic	Twitter
HAR0074484		Do you ever access the Internet using a mobile phone or tablet?	Yes	A, B, D	Radio button, one-up vertical	Single	Y	Skip Logic	Access Mobile Internet
			No
HAR0074485	A	Which of the following devices do you have?	A SmartPhone	W	Checkbox, one-up vertical	Multi	Y	Skip Logic	Phone or Tablet
			A tablet	X
			None of these					Mutually Exclusive
HAR0074486	W	Specifically, which type of smartphone do you have?	iPhone		Radio button, one-up vertical	Single	Y	Skip Logic	Phone Type
			Android
			Blackberry
			Another phone
HAR0074487	X	Specifically, which type of tablet do you have?	iPad		Radio button, one-up vertical	Single	Y	Skip Logic	Tablet Type
			Kindle
			Android
			Blackberry
			Another tablet
HAR0074488	B	Have you ever accessed ANY federal website using a smartphone or tablet?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic	Federal Mobile Site Usage
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
HAR0074489	C	Have you ever accessed a VA medical center site using a smartphone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Site Usage
			No, but I plan to do so	Z
			No, but I might in the future	Z
			No, and I don't plan to do so
HAR0074491	Y	What was the main reason you last visited a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Primary Reason
HAR0074492	Z	What resources/additional resources might you want to access from a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Desired Resources
HAR0074490	D	Have you ever accessed a VA Medical Center Social Media site (e.g. Facebook, Twitter, etc.) using a smartphone or tablet?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Social Media
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
		Have you ever accessed a VA Medical Center website while actually visiting a medical center location? (i.e. on a mobile device)		A	Radio button, one-up vertical	Single	Y	Skip Logic	Access on Location
			Yes
			No
			Not sure
	A	Please explain the main reason you accessed the website while visiting the medical center.			Text area, no char limit	Single	N	Skip Logic	OE_Location
MHM5857Q012		How did you look for information on or navigate the site today? (Check all that apply)	Top navigation bar	L	Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	How Look for Info
			Links in the center of the page	L				Randomize
			Site map	L
			Search feature	M
			Other	L, N				Anchor Answer Choice
MHM5857Q013	N	How did you look for information or navigate the site?			Text area, no char limit	Single	N	Skip Logic Group*	OPS_How Look for Info
MHM5857Q014	L	How would you describe your experience navigating the site today? (Check all that apply)	Links often did not take me where I expected		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Navigation Experience
			Links/labels are difficult to understand
			Too many links/navigational options to choose from
			Had technical difficulties (error messages, broken links, etc.)
			Could not navigate back to previous information
			I had another navigation difficulty	O
			I had no difficulty navigating on this site					Mutually Exclusive
MHM5857Q015	O	Please tell us about the difficulty you experienced navigating the site.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Navigation Experience
MHM5857Q016	M	Please tell us about your experience with the site's search feature today. (Check all that apply)	I had issues with the basic search process (how to use it, terms to enter).		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Search Experience
			I had issues with the visual display of the search results (text size, images).
			I had issues with the search results I received.	Z
			I had issues with sorting, filtering, advanced search, or lack of these options.
			I had technical issues with the search feature.	P
			I had another search difficulty.	Q
			The search feature met my needs today.					Mutually Exclusive
MHM5857Q017	Q	Please tell us about the difficulty you experienced with the search feature.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Search Experience
MHM5857Q018	P	Please explain the technical issue you experienced with search.			Text area, no char limit	Single	N	Skip Logic Group*	OE_Technical Issue
MHM5857Q019	Z	What were your issues with the search results? (Check all that apply)	Results were not relevant/not what I wanted		Checkbox, one-up vertical	Multi	Y	Skip Logic Group*	Search Results Issue
			There were not enough results
			There were NO results
			There was too little information in the results to decide what to choose
			Many of the search results looked the same
			I had another issue with the search results.	R
MHM5857Q020	R	Please explain the issue(s) you experienced with your search results.			Text area, no char limit	Single	N	Skip Logic Group*	OPS_Search Results Issue

---

Sheet 4: Custom Qsts (7-2-15)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	Skip Logic	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	Single	N	Skip Logic	OE_Redesign
EDO03867		Please tell us who you are.	Veteran	B	Radio button, one-up vertical	Single	Y	Skip Logic	Role
			Active Duty	B
			Family Member / Friend
			VA Employee
			Volunteer
			Healthcare Professional (MD, RN, etc.)
			Job Applicant
			Student / Healthcare Trainee
			Media
			Other	A
EDO03868	A	Please specify your other role.			Text area, no char limit	Single	N	Skip Logic	OE_Role
EDO03869	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	Y	Skip Logic	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	Skip Logic	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	QQ
			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	S	Y	Skip Logic	Alaska
EDO03874	B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Alabama
			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	S	Y	Skip Logic	Arkansas
			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	S	Y	Skip Logic	Arizona
			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	S	Y	Skip Logic	California
			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	S	Y	Skip Logic	Colorado
			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	S	Y	Skip Logic	Connecticut
			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	S	Y	Skip Logic	DC
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Delaware
EDO03882	J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Florida
			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	S	Y	Skip Logic	Georgia
			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	S	Y	Skip Logic	Hawaii
EDO03885	M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Iowa
			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	S	Y	Skip Logic	Idaho
EDO03887	O	Which Medical Center in Illinois do you visit?	Chicago - Jesse Brown VA Medical Center		Radio button, one-up vertical				Illinois
			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	S	Y	Skip Logic	Indiana
			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	S	Y	Skip Logic	Kansas
			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	S	Y	Skip Logic	Kentucky
			Lexington - Lexington VA Medical Center (Leestown Division)
			Louisville - Louisville VA Medical Center
EDO03891	S	Which Medical Center in Louisiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Louisiana
			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	S	Y	Skip Logic	Massachusetts
			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	S	Y	Skip Logic	Maryland
			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	S	Y	Skip Logic	Maine
EDO03895	W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Radio button, one-up vertical	S	Y	Skip Logic	Michigan
			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	S	Y	Skip Logic	Minnesota
			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	S	Y	Skip Logic	Missouri
			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	S	Y	Skip Logic	Mississippi
			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	S	Y	Skip Logic	Montana
EDO03900	BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	North Carolina
			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	S	Y	Skip Logic	North Dakota
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Nebraska
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	New Hampshire
EDO03904	FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	New Jersey
			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	S	Y	Skip Logic	New Mexico
EDO03906	HH	Which Medical Center in Nevada do you visit?	Las Vegas - VA Southern Nevada Healthcare System		Radio button, one-up vertical				Nevada
			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	S	Y	Skip Logic	New York
			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	S	Y	Skip Logic	Ohio
			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	S	Y	Skip Logic	Oklahoma
			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	S	Y	Skip Logic	Oregon
			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	S	Y	Skip Logic	Pennsylvania
			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	S	Y	Skip Logic	Puerto Rico
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Rhode Island
EDO03914	PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	South Carolina
			Columbia - Wm. Jennings Bryan Dorn VA Medical Center
EDO03915	QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	South Dakota
			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	S	Y	Skip Logic	Tennessee
			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	S	Y	Skip Logic	Texas
			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	S	Y	Skip Logic	Utah
EDO03919	UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Radio button, one-up vertical	S	Y	Skip Logic	Virginia
			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	S	Y	Skip Logic	Vermont
EDO03921	WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Radio button, one-up vertical	S	Y	Skip Logic	Washington
			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	S	Y	Skip Logic	Wisconsin
			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	S	Y	Skip Logic	West Virginia
			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	S	Y	Skip Logic	Wyoming
			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	OPS Group	Type of Information Seeking
			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	A
EDO03926	A	Please specify the information you were trying to find.						OPS Group	OE_Reason
EDO03927		Did you find what you were looking today?	Yes		Radio button, one-up vertical	Single	Y	OPS Group	Find Info
			No, I was looking for:	A
EDO03928	A	What specific information were you unable to find?						OPS Group	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	Skip Logic	Services Adequate
			No	A
EDO03934	A	Why not?			Text area, no char limit			Skip Logic	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	OPS Group	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	A
EDO03936	A	Please specify how you first heard about this site.						OPS Group	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	Skip Logic	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	Skip Logic	How Add Info
			Email
			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	Skip Logic	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	Skip Logic	IPA
			No
EDO03932	B	Why not?			Text area, no char limit	Single	N	Skip Logic	OE_Not Use MHV
EDO03929		Do you use any of the following while on the Internet? (Check all that apply)	Facebook		Checkbox, one-up vertical	Multi	Y	Skip Logic	Social media
			MySpace
			LinkedIn
			Twitter
			YouTube
			Pinterest
			Google+
			Foursquare
			Yelp
			Flickr
			Blogs
			Del.icio.us
			Digg
			Podcasts
			I do not use any of these social media tools.			8889
			Other	A
EDO03930	A	Please specify other social media sites you use.			Text area, no char limit			Skip Logic	OE_Social Media
HAR0074484		Do you ever access the Internet using a mobile phone or tablet?	Yes	A, B, D	Radio button, one-up vertical	Single	Y	Skip Logic	Access Mobile Internet
			No
HAR0074485	A	Which of the following devices do you have?	A SmartPhone	W	Checkbox, one-up vertical	Multi	Y	Skip Logic	Phone or Tablet
			A tablet	X
			None of these					Mutually Exclusive
HAR0074486	W	Specifically, which type of smartphone do you have?	iPhone		Radio button, one-up vertical	Single	Y	Skip Logic	Phone Type
			Android
			Blackberry
			Another phone
HAR0074487	X	Specifically, which type of tablet do you have?	iPad		Radio button, one-up vertical	Single	Y	Skip Logic	Tablet Type
			Kindle
			Android
			Blackberry
			Another tablet
HAR0074488	B	Have you ever accessed ANY federal website using a smartphone or tablet?	Yes	C	Radio button, one-up vertical	Single	Y	Skip Logic	Federal Mobile Site Usage
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
HAR0074489	C	Have you ever accessed a VA medical center site using a smartphone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Site Usage
			No, but I plan to do so	Z
			No, but I might in the future	Z
			No, and I don't plan to do so
HAR0074491	Y	What was the main reason you last visited a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Primary Reason
HAR0074492	Z	What resources/additional resources might you want to access from a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N	Skip Logic	Desired Resources
HAR0074490	D	Have you ever accessed a VA Medical Center Social Media site (e.g. Facebook, Twitter, etc.) using a smartphone or tablet?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic	Mobile Social Media
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so

---

Sheet 5: Custom Qsts (1-19-15)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	QQ
			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	QQ	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
			Email
			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)	Facebook		Checkbox, one-up vertical	Multi	Y		Social media
			MySpace
			LinkedIn
			Twitter
			YouTube
			Pinterest
			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
ACQhar0018234		Do you ever access the Internet using a mobile phone or tablet?	Yes	A, B, D	Radio button, one-up vertical	Single	Y		Access Mobile Internet
			No
ACQhar0018235	A	Which of the following devices do you have?	A SmartPhone	W	Radio button, one-up vertical	Multi	Y		Phone or Tablet
			A tablet	X
			None of these
ACQhar0018237	W	Specifically, which type of smartphone do you have?	iPhone		Radio button, one-up vertical	Single	Y		Phone Type
			Android
			Blackberry
			Another phone
ACQhar0018238	X	Specifically, which type of tablet do you have?	iPad		Radio button, one-up vertical	Single	Y		Tablet Type
			Kindle
			Android
			Blackberry
			Another tablet
ACQhar0018236	B	Have you ever accessed ANY federal website using a smartphone or tablet?	Yes	C	Radio button, one-up vertical	Single	Y		Federal Mobile Site Usage
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
ACQhar0018239	C	Have you ever accessed a VA medical center site using a smartphone or tablet?	Yes	Y, Z	Radio button, one-up vertical	Single	Y		Mobile Site Usage
			No, but I plan to do so	Z
			No, but I might in the future	Z
			No, and I don't plan to do so
ACQinh0018956	D	Have you ever accessed a VA Medical Center Social Media site (e.g. Facebook, Twitter, etc.) using a smartphone or tablet?	Yes		Radio button, one-up vertical	Single	Y		Mobile Social Media
			No, but I plan to do so
			No, but I might in the future
			No, and I don't plan to do so
ACQhar0018205	Y	What was the main reason you last visited a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N		Primary Reason
ACQhar0018206	Z	What resources/additional resources might you want to access from a VA medical center site using a smartphone or tablet?			Text area, no char limit	Single	N		Desired Resources

---

Sheet 6: Custom Qsts (4-10-13)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	QQ
			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	QQ	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
			Email
			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)	Facebook		Checkbox, one-up vertical	Multi	Y		Social media
			MySpace
			LinkedIn
			Twitter
			YouTube
			Second Life
			Pinterest
			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 7: Custom Qsts (12-13-10)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	QQ
			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
			N/A
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
			N/A
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical
			N/A
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
			N/A
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
			N/A
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
			N/A
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
			N/A
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
			N/A
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical
			N/A
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical
			N/A
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
			N/A
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
			N/A
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical
			N/A
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	QQ	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
			N/A
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
			N/A
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
			Email
			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)	Facebook		Checkbox, one-up vertical	Multi	Y		Social media
			MySpace
			LinkedIn
			Twitter
			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 8: Custom Qsts (8-16-10)

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			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	QQ
			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
			N/A
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
			N/A
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical
			N/A
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
			N/A
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
			N/A
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
			N/A
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
			N/A
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
			N/A
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical
			N/A
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical
			N/A
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
			N/A
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
			N/A
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical
			N/A
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	QQ	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
			N/A
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
			N/A
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
			Email
			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)	Facebook		Checkbox, one-up vertical	Multi	Y		Social media
			MySpace
			LinkedIn
			Twitter
			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 9: 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
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NE		Omaha - VA Nebraska-Western Iowa Health Care System
		-
NH		Manchester - Manchester VA Medical Center
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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