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Kansas Health P260207

Please provide us with your First and Last Name

Please provide us with your email address.

Which of the following statements best describes who in your household is responsible for healthcare decisions for you and/or your family?

Which of the following statements best describes who in your household is responsible for healthcare decisions for you and/or your family?

A

I am the person most responsible

B

I share responsibility with someone else

C

Someone else is most responsible

D

Prefer not to answer

E

Don’t know / not sure

Thinking about healthcare systems or healthcare providers in your area, how familiar would you say you are with each of the following?

	Aware and Familiar	Aware, Not Familiar	Not Aware
The University of Kansas Health System
Allen County Regional Hospital
Coffeyville Regional Medical Center
Cox Barton County Hospital
Fredonia Regional Hospital
Freeman Health System
Girard Medical Center
Labette Health
Mercy Hospital Carthage
Mercy Hospital Columbus
Mercy Hospital Pittsburg
Mercy Specialty Hospital Southeast Kansas
Neosho Memorial Regional Medical Center
Sedan City Hospital
Wilson Medical Center

And thinking about your primary healthcare services provider, are they affiliated with any of the options below?

Not taking into account travel distance or time, are there any healthcare systems or healthcare providers that you would flatly reject going to if you were given the choice?