Survey Text

2012
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2012
Survey form view entire document:  text  image

QuestionID: ALT.553_00.000

Instrument Variable Name: TP1_DS1 Adult CAM
QuestionText:
[fill1: Not including the practitioner you saw for] [fill2: modality] DURING THE PAST 12 MONTHS, did you let your personal health care provider know about your use of [fill3: modality]?
*If practitioner for therapy is the same person as personal health care provider, enter '1'.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have used first of top three modalities and has a personal health care provider
SkipInstructions:
(1,R,D) [goto TP1_INF1]
(2) [goto TP1_DS2]

Survey form view entire document:  text  image

Question ID: CAL.553_00.000

Instrument Variable Name: CTP1DS1
QuestionText:
[fill1: Not including the practitioner [fill: S.C. name] saw for] [fill2: modality] DURING THE PAST 12 MONTHS, did you let [fill S.C. name]'s personal health care provider know about [fill: his/her] use of [fill3: modality]?
*If practitioner for therapy is the same person as personal health care provider, enter '1'.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4+ who have used first of top three modalities and has a personal health care provider
SkipInstructions:
(1,R,D) [goto CTP1INF1]
(2) [goto CTP1DS2]