CAHPS® Health Plan Survey 5.0 - Child Commercial Survey
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  • 1. Our records show that your child is now in {INSERT HEALTH PLAN NAME}. Is that right?
  • 2. What is the name of your child’s health plan?
  • 3. In the last 12 months, did your child have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor’s office?
  • 4. In the last 12 months, when your child needed care right away, how often did your child get care as soon as he or she needed?
  • 5. In the last 12 months, did you make any appointments for a check-up or routine care for your child at a doctor’s office or clinic?
  • 6. In the last 12 months, how often did you get an appointment for a check-up or routine care for your child at a doctor’s office or clinic as soon as your child needed?
  • 7. In the last 12 months, not counting the times your child went to an emergency room, how many times did he or she go to a doctor’s office or clinic to get health care?
  • 8. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your child’s health care in the last 12 months?
  • 9. In the last 12 months, how often was it easy to get the care, tests, or treatment your child needed?
  • 10. A personal doctor is the one your child would see if he or she needs a check-up, has a health problem, or gets sick or hurt. Does your child have a personal doctor?
  • 11. In the last 12 months, how many times did your child visit his or her personal doctor for care?
  • 12. In the last 12 months, how often did your child’s personal doctor explain things about your child’s health in a way that was easy to understand?
  • 13. In the last 12 months, how often did your child’s personal doctor listen carefully to you?
  • 14. In the last 12 months, how often did your child’s personal doctor show respect for what you had to say?
  • 15. Is your child able to talk with doctors about his or her health care?
  • 16. In the last 12 months, how often did your child’s personal doctor explain things in a way that was easy for your child to understand?
  • 17. In the last 12 months, how often did your child’s personal doctor spend enough time with your child?
  • 18. In the last 12 months, did your child’s personal doctor talk with you about how your child is feeling, growing, or behaving?
  • 19. Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your child’s personal doctor?
  • 20. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 12 months, did you make any appointments for your child to see a specialist?
  • 21. In the last 12 months, how often did you get appointments for your child to see a specialist as soon as he or she needed?
  • 22. How many specialists has your child seen in the last 12 months?
  • 23. We want to know your rating of the specialist your child saw most often in the last 12 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?
  • 24. In the last 12 months, did you get information or help from customer service at your child’s health plan?
  • 25. In the last 12 months, how often did customer service at your child’s health plan give you the information or help you needed?
  • 26. In the last 12 months, how often did customer service staff at your child’s health plan treat you with courtesy and respect?
  • 27. In the last 12 months, did your child’s health plan give you any forms to fill out?
  • 28. In the last 12 months, how often were the forms from your child’s health plan easy to fill out?
  • 29. Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your child’s health plan?
  • 30. In general, how would you rate your child’s overall health?
  • 31. In general, how would you rate your child’s overall mental or emotional health?
  • 32. What is your child’s age?
  • 33. Is your child male or female?
  • 34. Is your child of Hispanic or Latino origin or descent?
  • 35. What is your child’s race? Mark one or more.
  • 36. What is your age?
  • 37. Are you male or female?
  • 38. What is the highest grade or level of school that you have completed?
  • 39. How are you related to the child?
  • 40. Did someone help you complete this survey?
  • 41. How did that person help you? Mark one or more.

Supplemental Item Sets Hide Numbering

Click on items or set of items that you want to add.

    Access to Urgent Care
    • AC1. In the last 12 months, how many days did you usually have to wait for an appointment when your child needed care right away?
    Access to Routine Care
    • AC2. In the last 12 months, how many days did you usually have to wait for an appointment for a check-up or routine care for your child?
    Access to After Hours Care
    • AC3. In the last 12 months, did your child need care during evenings, weekends, or holidays?
    • AC4. In the last 12 months, how often were you able to get the care your child needed from a doctor’s office or clinic during evenings, weekends, or holidays?
    Access to After Hours Care
    • AC5. In the last 12 months, did your child need to visit a doctor's office or clinic after regular office hours?
    • AC6. In the last 12 months, how often were you able to get the care your child needed from a doctor's office or clinic after regular office hours?
    Access to After Hours Care
    • AC7. In the last 12 months, did your child need care from his or her personal doctor during evenings, weekends, or holidays?
    • AC8. In the last 12 months, how often were you able to get the care your child needed from his or her personal doctor’s office or clinic during evenings, weekends, or holidays?
    Wait Time for Appointment to Start
    • AC9. Wait time includes time spent in the waiting room and exam room. In the last 12 months, how often did your child see his or her personal doctor within 15 minutes of your child's appointment time?
    • AC10. In the last 12 months, after you checked in for an appointment at your child’s personal doctor’s office, how often were you kept informed about how long you would need to wait for your child's appointment to start?
    Contacting Doctor's Office With a Medical Question
    • AC11. In the last 12 months, did you contact your child’s personal doctor's office or clinic with a medical question during regular office hours?
    • AC12. In the last 12 months, when you contacted your child’s personal doctor's office or clinic during regular office hours, how often did you get an answer to your medical question that same day?
    Contacting Doctor's Office With a Medical Question
    • AC13. In the last 12 months, did you contact your child’s personal doctor's office or clinic with a medical question after regular office hours?
    • AC14. In the last 12 months, when you contacted your child’s personal doctor's office or clinic after regular office hours, how often did you get an answer to your medical question as soon as you needed?
    • P-IC1. Please tell us how your child’s personal doctor and the office staff could have improved the care and services your child received in the last 12 months.
    Personal doctor had child's medical records or other information about care
    • P-CR1. In the last 12 months, when you visited your child’s personal doctor, how often did he or she have your child’s medical records or other information about your child’s care?
    Personal doctor ordered a blood test, x-ray, or other test
    • P-CR2. In the last 12 months, did your child’s personal doctor order a blood test, x-ray, or other test for your child?
    • P-CR3. In the last 12 months, when your child’s personal doctor ordered a blood test, x-ray, or other test, how often did someone from your child’s personal doctor’s office follow up to give you those results?
    • P-CR4. In the last 12 months, when your child’s personal doctor ordered a blood test, x-ray, or other test, how often did you get those results as soon as you needed them?
    Child saw specialist for a particular health problem
    • P-CR5. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. In the last 12 months, did your child see a specialist for a particular health problem?
    • P-CR6. In the last 12 months, how often did your child’s personal doctor seem informed and up-to-date about the care your child got from specialists?
    Child took prescription medicine
    • P-CR7. In the last 12 months, did your child take any prescription medicine?
    • P-CR8. In the last 12 months, how often did you and someone from your child’s personal doctor’s office talk about all the prescription medicines your child was taking?
    Child got care from more than one kind of health care provider or used more than one kind of health care service
    • P-CR9. In the last 12 months, did your child get care from more than one kind of health care provider or use more than one kind of health care service?
    • P-CR10. In the last 12 months, did you need help from anyone in your child’s personal doctor’s office to manage your child’s care among these different providers and services?
    • P-CR11. In the last 12 months, did you get the help you needed from your child’s personal doctor’s office to manage your child’s care among these different providers and services?
    • P-IN13. What language would you like to talk to your personal doctor in?
    Respondent needed interpreter at child's personal doctor's office
    • P-IN1. An interpreter is someone who helps you talk with others who do not speak your language. In the last 12 months, did you need an interpreter at your child’s personal doctor’s office?
    • P-IN2. In the last 12 months, during visits to your child’s personal doctor’s office, how often did you get an interpreter when you needed one?
    • P-IN3. In the last 12 months, how often did this interpreter treat you with courtesy and respect?
    • P-IN4. Using any number from 0 to 10, where 0 is the worst interpreter possible and 10 is the best interpreter possible, what number would you use to rate this interpreter?
    Respondent used friend or family member as interpreter at child's personal doctor's office
    • P-IN1B. An interpreter is someone who helps you talk with others who do not speak your language. In the last 12 months, did you need an interpreter at your child’s personal doctor’s office?
    • P-IN5. In the last 12 months, how often did you use a friend or family member as an interpreter when you talked with someone from your child’s personal doctor’s office?
    • P-IN6. In the last 12 months, did you use a child younger than 18 to help you talk with someone from your child’s personal doctor’s office?
    Respondent needed interpreter to talk with child's health plan
    • P-IN7. An interpreter is someone who helps you talk with others who do not speak your language. In the last 12 months, did you need an interpreter to talk with someone from your child’s health plan?
    • P-IN8. In the last 12 months, how often did you get an interpreter to talk with someone from your child’s health plan when you needed one?
    • P-IN9. In the last 12 months, how often did this interpreter treat you with courtesy and respect?
    • P-IN10. Using any number from 0 to 10, where 0 is the worst interpreter possible and 10 is the best interpreter possible, what number would you use to rate this interpreter?
    Respondent used friend or family member as interpreter with child's health plan
    • P-IN7B. An interpreter is someone who helps you talk with others who do not speak your language. In the last 12 months, did you need an interpreter to talk with someone from your child’s health plan?
    • P-IN11. In the last 12 months, how often did you use a friend or family member as an interpreter when you talked with someone from your child’s health plan?
    • P-IN12. In the last 12 months, did you use a child younger than 18 to help you talk with someone from your child’s health plan?
    Provider and respondent talked about starting or stopping a prescription medicine for child
    • P-SD1. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else your child would see for health care. In the last 12 months, did you and a health provider talk about starting or stopping a prescription medicine for your child?
    • P-SD2. Did you and a health provider talk about the reasons you might want your child to take the medicine?
    • P-SD3. Did you and a health provider talk about the reasons you might not want your child to take the medicine?
    • P-SD4. When you talked about starting or stopping a prescription medicine for your child, did the health provider ask what you thought was best for your child?
    Provider and respondent talked about child having surgery or any type of procedure
    • P-SD5. In the last 12 months, did you and a health provider talk about your child having surgery or any type of procedure?
    • P-SD6. Did you and a health provider talk about the reasons you might want your child to have the surgery or procedure?
    • P-SD7. Did you and a health provider talk about the reasons you might not want your child to have the surgery or procedure?
    • P-SD8. When you and a health provider talked about your child having surgery or a procedure, did the health provider ask what you thought was best for your child?
    • P-UT1. In the last 12 months, how many times did your child go to an emergency room for care?