CAHPS® Clinician & Group Survey 3.0 - Child
Create and Download Survey
Core Questions
- 1. Our records show that your child got care from the provider named below in the last 6 months. Name of provider label goes here Is that right?
- 2. Is this the provider you usually see if your child needs a check-up, has a health problem, or gets sick or hurt?
- 3. How long has your child been going to this provider?
- 4. In the last 6 months, how many times did your child visit this provider for care?
- 5. In the last 6 months, did you ever stay in the exam room with your child during a visit to this provider?
- 6. Did this provider give you enough information about what was discussed during the visit when you were not there?
- 7. Is your child able to talk with providers about his or her health care?
- 8. In the last 6 months, how often did this provider explain things in a way that was easy for your child to understand?
- 9. In the last 6 months, how often did this provider listen carefully to your child?
- 10. Did this provider tell you that you needed to do anything to follow up on the care your child got during the visit?
- 11. Did this provider give you enough information about what you needed to do to follow up on your child’s care?
- 12. In the last 6 months, did you contact this provider’s office to get an appointment for your child for an illness, injury, or condition that needed care right away?
- 13. In the last 6 months, when you contacted this provider’s office to get an appointment for care your child needed right away, how often did you get an appointment as soon as your child needed?
- 14. In the last 6 months, did you make any appointments for a check-up or routine care for your child with this provider?
- 15. In the last 6 months, when you made an appointment for a check-up or routine care for your child with this provider, how often did you get an appointment as soon as your child needed?
- 16. In the last 6 months, did you contact this provider’s office with a medical question about your child during regular office hours?
- 17. In the last 6 months, when you contacted this provider’s office during regular office hours, how often did you get an answer to your medical question that same day?
- 18. In the last 6 months, how often did this provider explain things about your child’s health in a way that was easy to understand?
- 19. In the last 6 months, how often did this provider listen carefully to you?
- 20. In the last 6 months, how often did this provider seem to know the important information about your child’s medical history?
- 21. In the last 6 months, how often did this provider show respect for what you had to say?
- 22. In the last 6 months, how often did this provider spend enough time with your child?
- 23. In the last 6 months, did this provider order a blood test, x-ray, or other test for your child?
- 24. In the last 6 months, when this provider ordered a blood test, x-ray, or other test for your child, how often did someone from this provider’s office follow up to give you those results?
- 25. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
- 26. In the last 6 months, how often were clerks and receptionists at this provider’s office as helpful as you thought they should be?
- 27. In the last 6 months, how often did clerks and receptionists at this provider’s office treat you with courtesy and respect?
- 28. In general, how would you rate your child’s overall health?
- 29. In general, how would you rate your child’s overall mental or emotional health?
- 30. What is your child’s age?
- 31. Is your child male or female?
- 32. Is your child of Hispanic or Latino origin or descent?
- 33. What is your child’s race? Mark one or more.
- 34. What is your age?
- 35. Are you male or female?
- 36. What is the highest grade or level of school that you have completed?
- 37. How are you related to the child?
- 38. Did someone help you complete this survey?
- 39. 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 (AC)
Access to Urgent Care
- AC1. In the last 6 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 6 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 6 months, did your child need care during evenings, weekends, or holidays?
- AC4. In the last 6 months, how often were you able to get the care your child needed from this provider’s office during evenings, weekends, or holidays?
Access to After Hours Care- AC5. In the last 6 months, did you contact this provider’s office with a medical question about your child after regular office hours?
- AC6. In the last 6 months, when you contacted this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?
Access to After Hours Care- AC7. In the last 6 months, did your child need to visit this provider's office after regular office hours?
- AC8. In the last 6 months, how often were you able to get the care your child needed from this provider's office after regular office hours?
Wait Time for Appointment to Start- AC9. Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did your child see this provider within 15 minutes of your child’s appointment time?
- AC10. In the last 6 months, after you checked in for your child’s appointment at this provider's office, how often were you kept informed about how long you would need to wait for your child’s appointment to start?
-
Shared Decisionmaking (C-SD)
Provider and respondent talked about starting or stopping a prescription medicine for child
- C-SD1. In the last 6 months, did you and this provider talk about starting or stopping a prescription medicine for your child?
- C-SD2. Did you and this provider talk about the reasons you might want your child to take the medicine?
- C-SD3. Did you and this provider talk about the reasons you might not want your child to take the medicine?
- C-SD4. When you talked about starting or stopping a prescription medicine for your child, did this provider ask what you thought was best for your child?
Provider and respondent talked about child having surgery or procedure- C-SD5. In the last 6 months, did you and this provider talk about your child having surgery or any type of procedure?
- C-SD6. Did you and this provider talk about the reasons you might want your child to have the surgery or procedure?
- C-SD7. Did you and this provider talk about the reasons you might not want your child to have the surgery or procedure?
- C-SD8. When you and this provider talked about your child having surgery or a procedure, did this provider ask what you thought was best for your child?
-
Narrative Comments (C-PN)
- C-PN1. What are the most important things that you look for in your child’s healthcare provider and their staff?
- C-PN2. When you think about the things that are most important to you, how do your child’s provider and their staff measure up?
- C-PN3. What has gone well in your experiences with this provider and their staff in the last 6 months? Please explain what happened, how it happened, and how it felt to you.
- C-PN4. Was there anything you wish had gone differently in your experiences with this provider and their staff in the last 6 months? If so, please explain what happened, how it happened, and how it felt to you.
- C-PN5. Please describe your interactions with your child's provider and how you get along.
- C-PN6. Please describe your child’s interactions with this provider and how they get along.
-
Improving Care and Services (C-IC)
- C-IC1. Please tell us how this provider and the office staff could have improved the care and services your child received in the last 6 months.
-
Coordination of Care (C-CR)
- C-CR1. In the last 6 months, when you visited this provider, how often did he or she have your child’s medical records or other information about your child's care?
- C-CR2. In the last 6 months, when this provider ordered a blood test, x-ray, or other test for your child, how often did you get those results as soon as you needed them?
Child saw specialist for a particular health problem- C-CR3. 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 6 months, did your child see a specialist for a particular health problem?
- C-CR4. In the last 6 months, how often did the provider named in Question 1 seem informed and up-to-date about the care your child got from specialists?
Child took prescription medicine- C-CR5. In the last 6 months, did your child take any prescription medicine?
- C-CR6. In the last 6 months, how often did you and someone from this provider’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- C-CR7. In the last 6 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?
- C-CR8. In the last 6 months, did you need help from anyone in this provider's office to manage your child’s care among these different providers and services?
- C-CR9. In the last 6 months, did you get the help you needed from this provider's office to manage your child’s care among these different providers and services?
-
Patient-Centered Medical Home (PCMH)
- PCMH1. Did this provider’s office give you information about what to do if your child needed care during evenings, weekends, or holidays?
- PCMH4. Please answer these questions about the provider named in Question 1 of this survey. In the last 6 months, did you and someone from this provider’s office talk about the kinds of behaviors that are normal for your child at this age?
- PCMH5. In the last 6 months, did you and someone from this provider’s office talk about how your child’s body is growing?
- PCMH6. In the last 6 months, did you and someone from this provider’s office talk about your child’s moods and emotions?
- PCMH7. In the last 6 months, did you and someone from this provider’s office talk about things you can do to keep your child from getting injured?
- PCMH8. In the last 6 months, did you and someone from this provider’s office talk about how much or what kind of food your child eats?
- PCMH9. In the last 6 months, did you and someone from this provider’s office talk about how much or what kind of exercise your child gets?
- PCMH10. In the last 6 months, did you and someone from this provider’s office talk about how your child gets along with others?
Child saw a specialist for a particular health problem- PCMH2. 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 6 months, did your child see a specialist for a particular health problem?
- PCMH3. In the last 6 months, how often did the provider named in Question 1 seem informed and up-to-date about the care your child got from specialists?
-
Interpreter Services (C-IN)
- C-IN7. What language would you like to talk to your child’s provider in?
Interpreter Services- C-IN1. An interpreter is someone who helps you talk with others who do not speak your language. In the last 6 months, did you need an interpreter at this provider's office?
- C-IN2. In the last 6 months, during visits to this provider's office, how often did you get an interpreter when you needed one?
- C-IN3. In the last 6 months, how often did this interpreter treat you with courtesy and respect?
- C-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?
Interpreter Services- C-IN1b. An interpreter is someone who helps you talk with others who do not speak your language. In the last 6 months, did you need an interpreter at this provider's office?
- C-IN5. In the last 6 months, how often did you use a friend or family member as an interpreter when you talked with this provider?
- C-IN6. In the last 6 months, did you use a child younger than 18 to help you talk with this provider?