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dv_personapproach


Doctor visits

Person approach

1. Person number ________

Record each date on which a doctor was visited in a separated question 2a of the doctor visits questions.
Earlier you told me that --had seen or talked to a doctor during the past 2 weeks
2a. On what dates during that 2 week period did --visit or talk to a doctor?

Month ________
Day ______

Ask and record the answer to question 2b on the last set of Doctor visit questions for each person.
b. Were there any other doctor visits for -- during that period?

[] Yes-reask Q 2a
[] No-ask Q3-5 for each visit

3. Where did -- see the doctor on the (date)? Mark one

01[] Home
10[] Telephone
20[] Doctor's office
30[] Pre-paid insurance group
40[] Hospital out-patient clinic
50[] Hospital emergency room
70[] Health department
80[] Company or industry
90[] Other-specify ________
XX[] While inpatient in hospital-stop

4. How much was the doctor's bill for that visit (call)?
If bill not received, ask:
How much do you expect the doctor's bill to be for that visit (call)?

Dollars ____
Cents ____

5. Is the doctor a general practitioner or a specialist?

[] General practitioner
[] Specialist
If (specialist) ask: what kind of specialist is he? ________

Doctor visit (2):

First visit: ____
Dum ____

1. Person number ____

Record each date on which a doctor was visited in a separate question 2a of the doctor visits questions.
2a. On what dates during that 2 week period did -- visit or talk to a doctor?

Month ____
Day ____

b. Were there any other doctor visits for --during that period?

[] Yes -reask Q2a.
[] No-ask Q 3-5 for each visit

3. Where did -- see the doctor on the (Date)? Mark one.

01[] Home
10[] Telephone
20[] Doctor's office
30[] Pre-paid insurance group
40[] Hospital outpatient clinic
50[] Hospital emergency room
70[] Health department
80[] Company or industry
90[] Other-specify ________
XX[] While inpatient in hospital - stop

4. How much was the doctor's bill for that visit (call)?
If bill not received, ask:
How much do you expect the doctor's bill to be for that visit (call)?

Dollars ____
Cents ____

5. Is the doctor a general practitioner or a specialist?

[] General practitioner
[] Specialist
If "specialist" ask: what kind of specialist is he? _____