Form 30715 2021 Proposed-Revision_VHA_Medical_Centers_Questio

E-Government Website Customer Satisfaction Surveys

30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021.xlsx

30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Current Model Qsts
Current Custom Qsts
Custom Qsts (5-5-20)
Custom Qsts (3-8-18)
Types
Custom Qsts (7-2-15)
Custom Qsts (12-13-10)
Custom Qsts (1-19-15)
Custom Qsts (4-10-13)
Custom Qsts (8-16-10)
Sheet3


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.






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








Bronx - James J. Peters VA Medical Center








Brooklyn - VA NY Harbor Healthcare System








Buffalo - VA Western New York Healthcare System








Castle Point - VA Hudson Valley Health Care System








Finger Lakes - VA Finger Lakes Healthcare 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 Activities (classes, tutorials, etc.) H







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.

Open-ended text, no char limit Single N Skip Logic OE_Facility
RUS0216244 C What health information were you looking for? (Check all that apply) PTSD
Checkbox, one-up vertical Multi Y Skip Logic Health Condition



Other mental-health conditions








Exposures (Agent Orange, airborne hazards, etc.)








Traumatic Brain Injury








Military Sexual Trauma








COVID-19-related health information








Preventative medicine








Health and well being








Rehabilitation








Labs and Tests








Medications








I'd prefer not to say








Other F


Mutually Exclusive
RUS0216245 F Please specify the health information you were looking for.

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

H Please specify the health education activities you were looking for.

Open-ended text, no char limit
N Skip Logic OE_Health Education
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 looking for?

Open-ended text, no char limit Single N Skip Logic OE_Find


Please rate your level of agreement with the following statement. The information I found on this website was easy to understand 1=Strongly Disagree AA Radio button, scale, no don't know Single Y Skip Logic Info Understand



2 AA







3 AA







4








5=Strongly Agree






AA What could make the content easier to understand?

Open-ended text, no char limit
N Skip Logic OE_Info Understand


Rate the amount of information you found: Too much
Radio button Single Y Skip Logic Info Amount



Too little








Just right





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 (5-5-20)

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








Finger Lakes - VA Finger Lakes Healthcare 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 4: 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 5: Types

Types
Instructions
Text field, <100 char
Randomize
Text area, no char limit
Shared
Drop down, select one
OPS Group
Radio button, one-up vertical
Matrix Group
Radio button, two-up vertical
Rank Group
Radio button, three-up vertical
Comparative Matrix Group
Radio button, scale, has don't know
Skip Logic Group
Radio button, scale, no don't know
Multiple Lists Group
Checkbox, one-up vertical
Anchor Answer Choice
Checkbox, two-up vertical
Partitioned
Checkbox, three-up vertical
Adjust Template/Style Sheet






Please Select a Language
Please Select
Arabic - AR
Yes
Australia - AU
No
Belgium - BG
Unsure (PLEASE SEE DOT)
Brazil Portuguese - BP

China - CH

Chinese Traditional - CT

Colombian - CO

Croatian - CR

Czech Republic - CZ

Danish - DN

Dutch - DU

English - EN

Farsi - FS

French - FR

French Canadian - FC

Germany - GR

Global English - GE

Greek - GK

Hungary - HU

Italian - IT

Japan - JP

Korean - KR

Malaysian English - MA

Mandarin - MD

Norwegian - NW

Persian - PN

Poland - PL

Portuguese - PO

Russia - RU

South Africa - SA

South Korean - SK

Spanish - SP

Spanish Original - SO

Spanish Traditional - ST

Swedish - SW

Turkey - TR

United Kingdom - UK

Vietnamese - VT

OTHER LANGUAGE (PLEASE SEE DOT)


Sheet 6: 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 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 (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 9: 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 10: 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 11: 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


-
NE
Omaha - VA Nebraska-Western Iowa Health Care System


-
NH
Manchester - Manchester VA Medical Center


-
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
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