30820 Q VAMyHealth 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson

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Overview

Welcome and Thank You Text
Model Questions
Current CQs
CQs (09-27-2021)

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Sheet 1: Welcome and Thank You Text

Welcome and Thank You Text
	Welcome Text			Thank You Text
	Thanks for visiting our site. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. All input you provide is strictly confidential. No personal information is being collected. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.			Thank you for taking our survey - and for helping us serve you better. Since all responses are confidential, you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.

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Sheet 2: Model Questions

Model Name	VA - My HealtheVet Mobile			Red & Strike-Through: Delete
Model ID	I0pRF5sUZBwwcMZREtAZkg4C			Underlined & Italicized: Re-order
Partitioned	Yes (2MQ)			Pink: Addition
Date				Blue: Reword
Label	Element Questions	Label	Satisfaction Questions	Label	Future Behaviors
	Look and Feel (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Likelihood to Return (1=Not Very Likely, 10=Very Likely)
Look and Feel - Appeal	Please rate the visual appeal of this site.	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	Return	How likely are you to return to this site in the next 12 months?
Look and Feel - Balance	Please rate the balance of graphics and text on this site.	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Not Very Likely, 10=Very Likely)
Look and Feel - Readability	Please rate the readability of the pages on this site.	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	Recommend	How likely are you to recommend this site to someone else?
	Site Performance (1=Poor, 10=Excellent, Don't Know)				Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Loading	Please rate how quickly pages load on this site.			Trust - Level MHV	Please rate your level of trust in My HealtheVet.
Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.				Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Completeness	Please rate how completely the page content loads on this site.			Trust - Level VA	Please rate your level of trust in the VA.
	Navigation (1=Poor, 10=Excellent, Don't Know)				Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely)
Navigation - Organized	Please rate how well the site is organized.			Use Web Channel Over Others	How likely are you to use this site rather than seeking information from other sources?
Navigation - Options	Please rate the options available for navigating this site.
Navigation - Layout	Please rate how well the site layout helps you find what you need.
	Site Information (1=Poor, 10=Excellent, Don't Know)	o
Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
Site Information - Understandable	Please rate how understandable this site’s information is.
Site Information - Answers	Please rate how well the site’s information provides answers to your questions.
IF Applicable	Task Process (1=Poor, 10=Excellent, Don't Know)
Task Process - Time	Please rate the time it takes to complete task(s) on this site.
Task Process - Procedures	Please rate the procedures to accomplish tasks on this site.
Task Process - Efficiency	Please rate the number of steps needed to complete task(s) on this site.

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Sheet 3: Current CQs

VA - My HealtheVet Mobile			Red & Strike-Through: Delete
Mobile	I0pRF5sUZBwwcMZREtAZkg4C		Underlined & Italicized: Re-order
Yes (2MQ)			Pink: Addition
5/11/2020			Blue: Reword
QIDs	Meta Tags	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
RUS0456741			What is your age range?	Under 20		N	Drop down, select one		ANAge
				20-29
				30-39
				40-49
				50-59
				60-69
				70-79
				80 or older
SBD9167Q011			What is your gender?	Male		N	Radio button, one-up vertical		ANGender
				Female
PAT0503418			In which state do you receive medical care?	Do not have a primary medical center		Y	Drop down, select one	Skip Logic Group*	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
PAT0503580		A	Which Medical Center in Alaska do you visit?	Anchorage - Alaska VA Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Alaska
PAT0503581		B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Alabama
				Montgomery - Central Alabama Veterans Health Care System
				Tuscaloosa - Tuscaloosa VA Medical Center
				Tuskegee - Central Alabama Veterans Health Care System
PAT0503582		C	Which Medical Center in Arkansas do you visit?	Fayetteville - Veterans Health Care System of the Ozarks		Y	Radio button, one-up vertical	Skip Logic	Arkansas
				Little Rock - Central Arkansas Veterans Healthcare System
				North Little Rock - Central Arkansas Veterans Healthcare System
PAT0503583		D	Which Medical Center in Arizona do you visit?	Phoenix - Phoenix VA Health Care System		Y	Radio button, one-up vertical	Skip Logic	Arizona
				Prescott - Northern Arizona VA Health Care System
				Tucson - Southern Arizona VA Health Care System
PAT0503584		E	Which Medical Center in California do you visit?	Fresno - VA Central California Health Care System		Y	Radio button, one-up vertical	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
PAT0503559		F	Which Medical Center in Colorado do you visit?	Denver - VA Eastern Colorado Health Care System		Y	Radio button, one-up vertical	Skip Logic	Colorado
				Grand Junction - Grand Junction VA Medical Center
PAT0503585		G	Which Medical Center in Connecticut do you visit?	Newington - VA Connecticut Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Connecticut
				West Haven - VA Connecticut Healthcare System
PAT0503560		H	Which Medical Center in District of Columbia do you visit?	Washington DC - Washington DC VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	DC
PAT0503561		I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Delaware
PAT0503562		J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Y	Radio button, one-up vertical	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
PAT0503563		K	Which Medical Center in Georgia do you visit?	Augusta - Charlie Norwood VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Georgia
				Decatur - Atlanta VA Medical Center
				Dublin - Carl Vinson VA Medical Center
PAT0503564		L	Which Medical Center in Hawaii do you visit?	Honolulu - VA Pacific Islands Health Care System		Y	Radio button, one-up vertical	Skip Logic	Hawaii
PAT0503565		M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Y	Radio button, one-up vertical	Skip Logic	Iowa
				Iowa City - Iowa City VA Medical Center
PAT0503566		N	Which Medical Center in Idaho do you visit?	Boise VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Idaho
PAT0503567		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
PAT0503568		P	Which Medical Center in Indiana do you visit?	Fort Wayne - VA Northern Indiana Health Care System		Y	Radio button, one-up vertical	Skip Logic	Indiana
				Indianapolis - Richard L. Roudebush VA Medical Center
				Marion - VA Northern Indiana Health Care System
PAT0503569		Q	Which Medical Center in Kansas do you visit?	Leavenworth - VA Eastern Kansas Health Care System		Y	Radio button, one-up vertical	Skip Logic	Kansas
				Topeka - VA Eastern Kansas Health Care System
				Wichita - Robert J. Dole VA Medical Center
PAT0503570		R	Which Medical Center in Kentucky do you visit?	Lexington - Lexington VA Medical Center (Cooper Division)		Y	Radio button, one-up vertical	Skip Logic	Kentucky
				Lexington - Lexington VA Medical Center (Leestown Division)
				Louisville - Louisville VA Medical Center
PAT0503571		S	Which Medical Center in Louisiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Y	Radio button, one-up vertical	Skip Logic	Louisiana
				Pineville - Alexandria VA Medical Center
				Shreveport - Overton Brooks VA Medical Center
PAT0503592		T	Which Medical Center in Massachusetts do you visit?	Bedford - Edith Nourse Rogers Memorial Veterans Hospital		Y	Radio button, one-up vertical	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
PAT0503593		U	Which Medical Center in Maryland do you visit?	Baltimore - VA Maryland Health Care System		Y	Radio button, one-up vertical	Skip Logic	Maryland
				Perry Point - Perry Point VA Medical Center
PAT0503586		V	Which Medical Center in Maine do you visit?	Augusta - Togus VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Maine
PAT0503587		W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Y	Radio button, one-up vertical	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
PAT0503588		X	Which Medical Center in Minnesota do you visit?	Minneapolis - Minneapolis VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Minnesota
				St. Cloud - St. Cloud VA Medical Center
PAT0503589		Y	Which Medical Center in Missouri do you visit?	Columbia - Harry S. Truman Memorial VA Medical Center		Y	Radio button, one-up vertical	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)
PAT0503590		Z	Which Medical Center in Mississippi do you visit?	Biloxi - VA Gulf Coast Veterans Health Care System		Y	Radio button, one-up vertical	Skip Logic	Mississippi
				Jackson - G.V. (Sonny) Montgomery VA Medical Center
PAT0503878		AA	Which Medical Center in Montana do you visit?	Fort Harrison - VA Montana Health Care System		Y	Radio button, one-up vertical	Skip Logic	Montana
PAT0503879		BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	North Carolina
				Durham - Durham VA Medical Center
				Fayetteville - Fayetteville VA Medical Center
				Salisbury - W.G. (Bill) Hefner VA Medical Center
PAT0503880		CC	Which Medical Center in North Dakota do you visit?	Fargo - Fargo VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	North Dakota
PAT0503881		DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Y	Radio button, one-up vertical	Skip Logic	Nebraska
PAT0503882		EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	New Hampshire
PAT0503883		FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Y	Radio button, one-up vertical	Skip Logic	New Jersey
				Lyons - VA New Jersey Health Care System
PAT0503910		GG	Which Medical Center in New Mexico do you visit?	Albuquerque - New Mexico VA Health Care System		Y	Radio button, one-up vertical	Skip Logic	New Mexico
PAT0503911		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
PAT0503912		II	Which Medical Center in New York do you visit?	Albany - Samuel S. Stratton VA Medical Center		Y	Radio button, one-up vertical	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
PAT0503913		JJ	Which Medical Center in Ohio do you visit?	Chillicothe - Chillicothe VA Medical Center		Y	Radio button, one-up vertical	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
PAT0503914		KK	Which Medical Center in Oklahoma do you visit?	Muskogee - Jack C. Montgomery VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Oklahoma
				Oklahoma City - Oklahoma City VA Medical Center
PAT0503915		LL	Which Medical Center in Oregon do you visit?	Roseburg - VA Roseburg Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Oregon
				Portland - Portland VA Medical Center
PAT0503916		MM	Which Medical Center in Pennsylvania do you visit?	Altoona - James E. Van Zandt VA Medical Center		Y	Radio button, one-up vertical	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
PAT0503917		NN	Which Medical Center in Puerto Rico do you visit?	San Juan - VA Caribbean Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Puerto Rico
PAT0503918		OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Rhode Island
PAT0503919		PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	South Carolina
				Columbia - Wm. Jennings Bryan Dorn VA Medical Center
PAT0503920		QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Y	Radio button, one-up vertical	Skip Logic	South Dakota
				Hot Springs - VA Black Hills Health Care System
				Sioux Falls - Sioux Falls VA Medical Center
PAT0503921		RR	Which Medical Center in Tennessee do you visit?	Memphis - Memphis VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Tennessee
				Mountain Home - Mountain Home VA Medical Center
				Murfreesboro - Tennessee Valley Healthcare System
				Nashville - Tennessee Valley Healthcare System
PAT0503922		SS	Which Medical Center in Texas do you visit?	Amarillo - Amarillo VA Health Care System		Y	Radio button, one-up vertical	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
PAT0503923		TT	Which Medical Center in Utah do you visit?	Salt Lake City - VA Salt Lake City Health Care System		Y	Radio button, one-up vertical	Skip Logic	Utah
PAT0503924		UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Virginia
				Richmond - Hunter Holmes McGuire VA Medical Center
				Salem - Salem VA Medical Center
PAT0503925		VV	Which Medical Center in Vermont do you visit?	White River Junction - White River Junction VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Vermont
PAT0503926		WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Y	Radio button, one-up vertical	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
PAT0503884		XX	Which Medical Center in Wisconsin do you visit?	Madison - William S. Middleton Memorial Veterans Hospital		Y	Radio button, one-up vertical	Skip Logic	Wisconsin
				Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center
				Tomah - Tomah VA Medical Center
PAT0503885		YY	Which Medical Center in West Virginia do you visit?	Beckley - Beckley VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	West Virginia
				Clarksburg - Louis A. Johnson VA Medical Center
				Huntington - Huntington VA Medical Center
				Martinsburg - Martinsburg VA Medical Center
PAT0503886		ZZ	Which Medical Center in Wyoming do you visit?	Cheyenne - Cheyenne VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Wyoming
				Sheridan - Sheridan VA Medical Center
PAT0503389			The My HealtheVet website provides articles on topics of interest to Veterans. What topics are you most interested in for upcoming articles?			N	Text area, no char limit		OE_Topics
PAT0503390			In general, how would you rate your overall health?	Excellent		Y	Radio button, one-up vertical		ANHealth
				Very Good
				Good
				Fair
				Poor
PAT0503391			How did you hear about upgrading your Advanced to Premium Account?	Newsletter		Y	Radio button, one-up vertical		Referral
				VA Flyers, brochures
				Someone personally contacted me
				Health care team/provider
				Caregiver
				Family member
				My HealtheVet coordinator
				Other
				Not applicable
PAT0503432			How frequently do you visit the My HealtheVet web site?	First time		Y	Radio button, one-up vertical		ANMHVFreq
				Daily or more than once a day
				About once a week
				About once a month
				About every 6 months
				Less than every 6 months
				Not sure/Do not recall
PAT0503433	Accomplish		Did you accomplish what you wanted to in My HealtheVet?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	ANTaskAcc
				No	B
				Partially	B
PAT0503416		B	Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply)	Learn more about features that are available		Y	Checkbox, one-up vertical	Skip Logic Group*	NotAccomplished
				Request a prescription refill				Randomize
				Track the status of my prescription refill delivery
				View my medication history
				Use Secure Messaging to communicate with my VA health care team
				Access my VA health records/Use the Blue Button or VA Health Summary
				View my VA Appointments
				Look up information about a health condition or medication
				View my lab or other test results
				View my VA Notes (written by my health care team)
				Enter my personal information (emergency contacts, etc.)
				Enter data that I track myself such as weight, blood pressure, blood sugar, etc.
				Enter information about my non-VA medications or supplements
				Find a VA facility
				Find information about VA Health Benefits
				Find information about VA Benefits other than health benefits
				Use the Veterans Health Library
				Complete a HealtheLiving Assessment
				Other				Anchor Answer Choice
PAT0503417			What is the main improvement that you would suggest for the My HealtheVet web site?			N	Text area, no char limit		ENDRequest
			Have you tracked your health information under the ‘Track Health’ section in My HealtheVet?	Yes		Y	Radio button, one-up vertical		Track Health
				No
				Not sure
			Have you used the new ‘Shared Vitals’ section of Track Health in My HealtheVet?	Yes	AAA	Y	Radio button, one-up vertical	Skip Logic Group*	Vitals Use
				No
				Not sure
		AAA	Which health information have you tracked using ‘Shared Vitals’? (Please select all that apply)	Blood pressure		Y	Checkbox, one-up vertical	Skip Logic Group*	Vitals Info Tracked
				Heart rate				Randomize
				Body weight
				Body temperature
				Pain
				Blood sugar
				Cholesterol (Lipids Profile)
				Pulse oximetry
				I have not tracked my Vitals in My HealtheVet				Anchor Answer Choice
			Have you discussed any of the health information below from the Shared Vitals feature of My HealtheVet with your care provider? (Please select all that apply)	Blood pressure		Y	Checkbox, one-up vertical	Randomize	Vitals Discuss CP
				Heart rate
				Body weight
				Body temperature
				Pain
				Blood sugar
				Cholesterol (Lipids Profile)
				Pulse oximetry
				I have not tracked my Vitals in My HealtheVet				Anchor Answer Choice
			What other type of health information would you like share with your provider using the Shared Vitals feature? (Please select all that apply)	Activity level (e.g., steps, exercise)		N	Checkbox, one-up vertical	Randomize	Vitals Share CP
				Breathing difficulty
				Sleep quality
				Mood (e.g., depression, anxiety)
				Overall well-being
				Alcohol use, tobacco use, and/or substance use
				Wellness goals
				Immunizations
				Allergies
				Symptoms related to traumatic brain injury
			How has the use of the ‘Vitals’ feature of My HealtheVet impacted you? (Please select all that apply)	Increased understanding of your health condition		N	Checkbox, one-up vertical	Randomize	Vitals Impact
				Increased engagement with your own health
				Improved monitoring the health of yourself or a loved one
				Improved overall quality of care
				Improved patient/physician communication
				Improved accuracy of your medical record
				Improved your satisfaction with your care in the VA
				None of the above				Anchor Answer Choice

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Sheet 4: CQs (09-27-2021)

VA - My HealtheVet Mobile			Red & Strike-Through: Delete
Mobile			Underlined & Italicized: Re-order
Yes (2MQ)			Pink: Addition
5/11/2020			Blue: Reword
QIDs	Meta Tags	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
RUS0456736			How likely is it that you will get a COVID-19 vaccine?	Definitely would not get vaccine		Y	Radio button, one-up vertical		Likely get vaccine
				Probably would not get vaccine
				Unsure
				Probably would get vaccine
				Very likely
				Already received COVID vaccine
RUS0456737			Which of the following are reasons that you would get a COVID-19 vaccine? (Check all that apply)	It would be the best way to prevent me from getting COVID-19		Y	Checkbox, one-up vertical		Why would get vaccine
				It would be the best way to prevent others from getting COVID-19
				So I would not have to worry about infecting other people
				I have a health condition that makes me more at risk from COVID-19
				If my doctor recommended it
				It is a way that I can contribute to ending the COVID-19 pandemic
				So life can go back to the way it was before the pandemic
				Drug companies were careful to ensure the saftey of their vaccines
RUS0456738			Which of the following are reasons that you would not get the COVID-19 vaccine? (check all that apply)	I'm concerned about immediate side effects from the vaccine		Y	Checkbox, one-up vertical		Why would not get vaccine
				I'm worried I'll get COVID-19 from the vaccine
				I do not think I'll get COVID-19
				I do not think I'll get very sick if I get COVID-19
				I am worried about side effects from the vaccine that might occur in the future
				I do not think the vaccine will work very well
				I intend to get pregnant, am pregnant or am breastfeeding
				You have to get 2 shots about one month apart for the vaccine to work
				The COVID-19 outbreak in the U.S. is not as serious as some people say it is
				I will not have time to get the vaccine
				I am allergic to vaccines
				I do not like needles
				It is against my religious or philosophical beliefs
				I am concerned about how quickly the vaccines were developed
RUS0456739			Please select up to 3 sources of information from the list below that you trust the most to provide correct information about COVID‑19? (check up to 3 sources)	Your faith leader		Y	Checkbox, one-up vertical	Select up to 3 choices	Info source
				People you go to work or school with or other people you know
				News on the radio, TV, online, or in the newspapers
				Your contacts on social media
				The U.S. government
				The U.S. Coronavirus Task Force
				The Veterans Health Administration
				Science experts like Dr. Anthony Fauci
				State and local government
				Veterans groups/organizations
				Local VA leaders
				Local community organizations
RUS0456740			How safe do you feel the current COVID-19 vaccines are?	Very Unsafe		Y	Radio button, one-up vertical		How safe vaccine
				Unsafe
				Neither safe or unsafe
				Safe
				Very Safe
RUS0456741			What is your age range?	Under 20		N	Drop down, select one		ANAge
				20-29
				30-39
				40-49
				50-59
				60-69
				70-79
				80 or older
SBD9167Q011			What is your gender?	Male		N	Radio button, one-up vertical		ANGender
				Female
RUS0456742			What is your race/ethnicity? (check all that apply)	White		Y	Checkbox, one-up vertical		Race/Ethnicity
				Black or African American
				Native American or American Indian
				Asian/Pacific Islander
				Multi-racial
				Hispanic or Latino
				Prefer not to answer
			The My HealtheVet website provides articles on topics of interest to Veterans. What topics are you most interested in for upcoming articles?			N	Text area, no char limit		OE_Topics
			In general, how would you rate your overall health?	Excellent		Y	Radio button, one-up vertical		ANHealth
				Very Good
				Good
				Fair
				Poor
			How did you hear about upgrading your Advanced to Premium Account?	Newsletter		Y	Radio button, one-up vertical		Referral
				VA Flyers, brochures
				Someone personally contacted me
				Health care team/provider
				Caregiver
				Family member
				My HealtheVet coordinator
				Other
				Not applicable
			How frequently do you visit the My HealtheVet web site?	First time		Y	Radio button, one-up vertical		ANMHVFreq
				Daily or more than once a day
				About once a week
				About once a month
				About every 6 months
				Less than every 6 months
				Not sure/Do not recall
	Accomplish		Did you accomplish what you wanted to in My HealtheVet?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	ANTaskAcc
				No	B
				Partially	B
		B	Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply)	Learn more about features that are available		Y	Checkbox, one-up vertical	Skip Logic Group*	NotAccomplished
				Request a prescription refill				Randomize
				Track the status of my prescription refill delivery
				View my medication history
				Use Secure Messaging to communicate with my VA health care team
				Access my VA health records/Use the Blue Button or VA Health Summary
				View my VA Appointments
				Look up information about a health condition or medication
				View my lab or other test results
				View my VA Notes (written by my health care team)
				Enter my personal information (emergency contacts, etc.)
				Enter data that I track myself such as weight, blood pressure, blood sugar, etc.
				Enter information about my non-VA medications or supplements
				Find a VA facility
				Find information about VA Health Benefits
				Find information about VA Benefits other than health benefits
				Use the Veterans Health Library
				Complete a HealtheLiving Assessment
				Other				Anchor Answer Choice
			What is the main improvement that you would suggest for the My HealtheVet web site?			N	Text area, no char limit		ENDRequest
			In which state do you receive medical care?	Do not have a primary medical center		Y	Drop down, select one	Skip Logic Group*	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
		A	Which Medical Center in Alaska do you visit?	Anchorage - Alaska VA Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Alaska
		B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Alabama
				Montgomery - Central Alabama Veterans Health Care System
				Tuscaloosa - Tuscaloosa VA Medical Center
				Tuskegee - Central Alabama Veterans Health Care System
		C	Which Medical Center in Arkansas do you visit?	Fayetteville - Veterans Health Care System of the Ozarks		Y	Radio button, one-up vertical	Skip Logic	Arkansas
				Little Rock - Central Arkansas Veterans Healthcare System
				North Little Rock - Central Arkansas Veterans Healthcare System
		D	Which Medical Center in Arizona do you visit?	Phoenix - Phoenix VA Health Care System		Y	Radio button, one-up vertical	Skip Logic	Arizona
				Prescott - Northern Arizona VA Health Care System
				Tucson - Southern Arizona VA Health Care System
		E	Which Medical Center in California do you visit?	Fresno - VA Central California Health Care System		Y	Radio button, one-up vertical	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
		F	Which Medical Center in Colorado do you visit?	Denver - VA Eastern Colorado Health Care System		Y	Radio button, one-up vertical	Skip Logic	Colorado
				Grand Junction - Grand Junction VA Medical Center
		G	Which Medical Center in Connecticut do you visit?	Newington - VA Connecticut Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Connecticut
				West Haven - VA Connecticut Healthcare System
		H	Which Medical Center in District of Columbia do you visit?	Washington DC - Washington DC VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	DC
		I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Delaware
		J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Y	Radio button, one-up vertical	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
		K	Which Medical Center in Georgia do you visit?	Augusta - Charlie Norwood VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Georgia
				Decatur - Atlanta VA Medical Center
				Dublin - Carl Vinson VA Medical Center
		L	Which Medical Center in Hawaii do you visit?	Honolulu - VA Pacific Islands Health Care System		Y	Radio button, one-up vertical	Skip Logic	Hawaii
		M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Y	Radio button, one-up vertical	Skip Logic	Iowa
				Iowa City - Iowa City VA Medical Center
		N	Which Medical Center in Idaho do you visit?	Boise VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Idaho
		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
		P	Which Medical Center in Indiana do you visit?	Fort Wayne - VA Northern Indiana Health Care System		Y	Radio button, one-up vertical	Skip Logic	Indiana
				Indianapolis - Richard L. Roudebush VA Medical Center
				Marion - VA Northern Indiana Health Care System
		Q	Which Medical Center in Kansas do you visit?	Leavenworth - VA Eastern Kansas Health Care System		Y	Radio button, one-up vertical	Skip Logic	Kansas
				Topeka - VA Eastern Kansas Health Care System
				Wichita - Robert J. Dole VA Medical Center
		R	Which Medical Center in Kentucky do you visit?	Lexington - Lexington VA Medical Center (Cooper Division)		Y	Radio button, one-up vertical	Skip Logic	Kentucky
				Lexington - Lexington VA Medical Center (Leestown Division)
				Louisville - Louisville VA Medical Center
		S	Which Medical Center in Louisiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Y	Radio button, one-up vertical	Skip Logic	Louisiana
				Pineville - Alexandria VA Medical Center
				Shreveport - Overton Brooks VA Medical Center
		T	Which Medical Center in Massachusetts do you visit?	Bedford - Edith Nourse Rogers Memorial Veterans Hospital		Y	Radio button, one-up vertical	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
		U	Which Medical Center in Maryland do you visit?	Baltimore - VA Maryland Health Care System		Y	Radio button, one-up vertical	Skip Logic	Maryland
				Perry Point - Perry Point VA Medical Center
		V	Which Medical Center in Maine do you visit?	Augusta - Togus VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Maine
		W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Y	Radio button, one-up vertical	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
		X	Which Medical Center in Minnesota do you visit?	Minneapolis - Minneapolis VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Minnesota
				St. Cloud - St. Cloud VA Medical Center
		Y	Which Medical Center in Missouri do you visit?	Columbia - Harry S. Truman Memorial VA Medical Center		Y	Radio button, one-up vertical	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)
		Z	Which Medical Center in Mississippi do you visit?	Biloxi - VA Gulf Coast Veterans Health Care System		Y	Radio button, one-up vertical	Skip Logic	Mississippi
				Jackson - G.V. (Sonny) Montgomery VA Medical Center
		AA	Which Medical Center in Montana do you visit?	Fort Harrison - VA Montana Health Care System		Y	Radio button, one-up vertical	Skip Logic	Montana
		BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	North Carolina
				Durham - Durham VA Medical Center
				Fayetteville - Fayetteville VA Medical Center
				Salisbury - W.G. (Bill) Hefner VA Medical Center
		CC	Which Medical Center in North Dakota do you visit?	Fargo - Fargo VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	North Dakota
		DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Y	Radio button, one-up vertical	Skip Logic	Nebraska
		EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	New Hampshire
		FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Y	Radio button, one-up vertical	Skip Logic	New Jersey
				Lyons - VA New Jersey Health Care System
		GG	Which Medical Center in New Mexico do you visit?	Albuquerque - New Mexico VA Health Care System		Y	Radio button, one-up vertical	Skip Logic	New Mexico
		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
		II	Which Medical Center in New York do you visit?	Albany - Samuel S. Stratton VA Medical Center		Y	Radio button, one-up vertical	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
		JJ	Which Medical Center in Ohio do you visit?	Chillicothe - Chillicothe VA Medical Center		Y	Radio button, one-up vertical	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
		KK	Which Medical Center in Oklahoma do you visit?	Muskogee - Jack C. Montgomery VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Oklahoma
				Oklahoma City - Oklahoma City VA Medical Center
		LL	Which Medical Center in Oregon do you visit?	Roseburg - VA Roseburg Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Oregon
				Portland - Portland VA Medical Center
		MM	Which Medical Center in Pennsylvania do you visit?	Altoona - James E. Van Zandt VA Medical Center		Y	Radio button, one-up vertical	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
		NN	Which Medical Center in Puerto Rico do you visit?	San Juan - VA Caribbean Healthcare System		Y	Radio button, one-up vertical	Skip Logic	Puerto Rico
		OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Rhode Island
		PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	South Carolina
				Columbia - Wm. Jennings Bryan Dorn VA Medical Center
		QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Y	Radio button, one-up vertical	Skip Logic	South Dakota
				Hot Springs - VA Black Hills Health Care System
				Sioux Falls - Sioux Falls VA Medical Center
		RR	Which Medical Center in Tennessee do you visit?	Memphis - Memphis VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Tennessee
				Mountain Home - Mountain Home VA Medical Center
				Murfreesboro - Tennessee Valley Healthcare System
				Nashville - Tennessee Valley Healthcare System
		SS	Which Medical Center in Texas do you visit?	Amarillo - Amarillo VA Health Care System		Y	Radio button, one-up vertical	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
		TT	Which Medical Center in Utah do you visit?	Salt Lake City - VA Salt Lake City Health Care System		Y	Radio button, one-up vertical	Skip Logic	Utah
		UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Virginia
				Richmond - Hunter Holmes McGuire VA Medical Center
				Salem - Salem VA Medical Center
		VV	Which Medical Center in Vermont do you visit?	White River Junction - White River Junction VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Vermont
		WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Y	Radio button, one-up vertical	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
		XX	Which Medical Center in Wisconsin do you visit?	Madison - William S. Middleton Memorial Veterans Hospital		Y	Radio button, one-up vertical	Skip Logic	Wisconsin
				Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center
				Tomah - Tomah VA Medical Center
		YY	Which Medical Center in West Virginia do you visit?	Beckley - Beckley VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	West Virginia
				Clarksburg - Louis A. Johnson VA Medical Center
				Huntington - Huntington VA Medical Center
				Martinsburg - Martinsburg VA Medical Center
		ZZ	Which Medical Center in Wyoming do you visit?	Cheyenne - Cheyenne VA Medical Center		Y	Radio button, one-up vertical	Skip Logic	Wyoming
				Sheridan - Sheridan VA Medical Center