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  2. 2012
  3. October
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  5. DoNotUse UKB HHS and Grants 2012

DoNotUse UKB HHS and Grants 2012

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Hello:
You are invited to participate in our survey for UKB Health and Human Services and UKB Gov't Services. In this survey, approximately 400 people will be asked to complete a survey that asks questions about general health questions and opinions. It will take approximately 3 minutes or less to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions to better serve you.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact the Director of Health and Human Services Carrie Haney at 918-772-4323 or by email at [email protected].

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
Have you ever been seen or visited by a Community Health Representative?
 
Yes
 
No
 
I don’t know what that is
 
 
 
Was your experience with the Community Health Representative helpful?
 
Yes
 
No
 
Don't know
 
 
 
If a Community Health Representative was accessible either through home visits or through free educational seminars or through personal appointments to help you understand your health needs would you use him/her?
 
Probably
 
Probably not
 
I don’t know
 
 
 
When I use Indian Health Service I am
 
Satisfied
 
Unsatisfied
 
Neutral
 
 
 
Are you unsatisfied with
 
Doctors or staff
 
Lab
 
Pharmacy
 
Registration
 
Contract Health
 
One of the clinics (Dental, Surgery, etc.)
 
Emergency
 
Other
 
 
 
 
When using Indian Health Service, have you ever used Contract Health Services?
 
Yes
 
No
 
I don’t know what that is
 
 
 
When using Indian Health Service have you ever been sent to a doctor outside of the hospital (referred to a private doctor through Contract Health Service)?
 
Yes
 
No
 
 
 
Were you satisfied with the Contract Health Services
 
Satisfied
 
Neutral
 
Unsatisfied
 
 
 
Why were you unsatisfied with the Indian Health Service Contract Health Service?
 
The appointment date was too far away
 
The location of the appointment was too far away
 
I was turned down for a referral to a private doctor or hospital.
 
None of the above
 
 
 
If you were turned down for IHS Contract Health Services, what was the reason?
 
I was not qualified
 
Funding ran out
 
I was not a priority
 
I don’t know
 
 
 
How many times have you been denied a referral through IHS Contract Health Services?
 
Once
 
More than once
 
 
 
If you were denied a referral through HIS Contract Health Services did you
 
Eventually get a referral after some time
 
Go to a private doctor on your private insurance
 
Go to another Indian Health Service outside your usual hospital
 
Still waiting for a referral
 
 
The following questions are required for an Indian Community Block Grant the United Keetoowah Band is applying for. All responses are anonymous and confidental.
*
Which county do you live in?
 
Cherokee,Adair,Craig,Delaware,Sequoyah,Muskogee,McIntosh,Wagoner,Ottawa
 
Tulsa
 
Nowata
 
Mayes,Rogers
 
Washington
 
 
 
* How many people in your household?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
 
 
* How many people in your household?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
 
 
* How many people in your household?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
 
 
* How many people in your household?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
 
 
* How many people in your household?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
 
Is your household above or below the following income?
Above Below
* $27,750
 
 
Is your income above or below the following:
Above Below
* $31,700
 
 
Is your income above or below the following:
Above Below
* $35,650
 
 
Is your household above or below the following income?
Above Below
* $39,600
 
 
Is your household above or below the following income?
Above Below
* $42,800
 
 
Is your household above or below the following income?
Above Below
* $45,950
 
 
Is your household above or below the following income?
Above Below
* $49,150
 
 
Is your household above or below the following income?
Above Below
* $52,300
 
 
Is your household above or below the following income?
Above Below
* $33,850
 
 
Is your household above or below the following income?
Above Below
* $38,650
 
 
Is your household above or below the following income?
Above Below
* $43,500
 
 
Is your household above or below the following income?
Above Below
* $48,300
 
 
Is your household above or below the following income?
Above Below
* $52,200
 
 
Is your household above or below the following income?
Above Below
* $56,050
 
 
Is your household above or below the following income?
Above Below
* $59,900
 
 
Is your household above or below the following income?
Above Below
* $63,800
 
 
Is your household above or below the following income?
Above Below
* $27,850
 
 
Is your household above or below the following income?
Above Below
* $31,800
 
 
Is your household above or below the following income?
Above Below
* $35,800
 
 
Is your household above or below the following income?
Above Below
* $39,750
 
 
Is your household above or below the following income?
Above Below
* $42,950
 
 
Is your household above or below the following income?
Above Below
* $46,150
 
 
Is your household above or below the following income?
Above Below
* $49,300
 
 
Is your household above or below the following income?
Above Below
* $52,500
 
 
Is your household above or below the following income?
Above Below
* $28,500
 
 
Is your household above or below the following income?
Above Below
* $32,600
 
 
Is your household above or below the following income?
Above Below
* $36,650
 
 
Is your household above or below the following income?
Above Below
* $40,700
 
 
Is your household above or below the following income?
Above Below
* $44,000
 
 
Is your household above or below the following income?
Above Below
* $47,250
 
 
Is your household above or below the following income?
Above Below
* $50,500
 
 
Is your household above or below the following income?
Above Below
* $53,750
 
 
Is your household above or below the following income?
Above Below
* $32,100
 
 
Is your household above or below the following income?
Above Below
* $36,700
 
 
Is your household above or below the following income?
Above Below
* $41,300
 
 
Is your household above or below the following income?
Above Below
* $45,850
 
 
Is your household above or below the following income?
Above Below
* $49,550
 
 
Is your household above or below the following income?
Above Below
* $53,200
 
 
Is your household above or below the following income?
Above Below
* $56,900
 
 
Is your household above or below the following income?
Above Below
* $60,550
 
 
 
* Are you male or female?
 
Male
 
Female
 
Prefer not to say
 
 
 
* Are you a senior (over 55)?
 
Yes
 
No
 
I prefer not to say
 
 
 
* Which district do you live in?
 
Canadian
 
Cooweescoowee
 
Delaware
 
Flint
 
Goingsnake
 
Illinois
 
Saline
 
Sequoyah
 
Tahlequah
 
Outside of UKB nine districts
 
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