Hardin Memorial Hospital. Here to heal.

Community Health Needs Survey

Question #1   How would you describe your overall health? Excellent Very good Good Fair Poor Question #2   Where do you go for routine healthcare? Physician’s office Health Department Emergency room Urgent care clinic Clinic in a grocery or drug store I do not receive routine healthcare Other Question #3   If you marked "other" in question 2, please list where you go for routine healthcare. Question #4   Are you able to visit a doctor when needed? Yes (Go to question 7 next) No Question #5   If you answered "No" to question 4, please choose all that apply. No appointment available Cannot afford it Cannot take time off from work No transportation No specialist in my community for my condition Other Question #6   If you marked "other" in question 5, please list why you are not able to visit a doctor when needed. Question #7   What type of healthcare coverage do you have? Medicare Medicaid/Passport Commercial health insurance (Examples: Humana, Anthem Blue Cross) No healthcare coverage Other Question #8   If you marked "other" in question 7, please list what type of healthcare coverage you have. Question #9   Please select the top 3 health challenges you face. Cancer Diabetes Overweight/obesity Lung disease High blood pressure Stroke Heart disease Joint pain or back pain Mental health issues Alcohol overuse Drug addiction I do not have any health challenges Other Question #10   If you marked "other" in question 9, please list health challenges you face. Question #11   What additional health services need to be offered to meet health challenges in your community? Question #12   Please choose all statements below that apply to you. I exercise at least 3 times per week. I eat at least 5 servings of fruits and vegetables each day. I eat fast food more than once per week. I smoke cigarettes. I chew tobacco. I use illegal drugs. I abuse or overuse prescription drugs. I consume more than 4 alcoholic drinks (if female) or 5 (if male) per day. I use sunscreen or protective clothing for planned time in the sun. I receive a flu shot each year. I have access to a wellness program through my employer. None of the above apply to me. Question #13   Which of the following preventive procedures have you had in the past 12 months? Mammogram (if woman) Pap smear (if woman) Prostate cancer screening (if man) Flu shot Colon/rectal exam Blood pressure check Blood sugar check Skin cancer screening Cholesterol screening Vision screening Hearing screening Cardiovascular screening Bone density test Dental cleaning/x-rays Physical exam None of the above Question #14   What is your gender? Female Male Question #15   What is your county of residence? Hardin LaRue Meade Other Question #16   If you marked "other" in question 15, please list what county you reside in. Question #17   What is your 5 digit zip code (Example 42701)? Question #18   What is your age? Question #19   What is your race? African American/Black Caucasian/White Asian American Indian/ Alaska Native Native Hawaiian/ Pacific Islander Other Question #20   What is your current employment status? Employed full-time Employed part-time Student Homemaker Unemployed Disabled Retired Question #21   What is your household income range? $0 - $24,999 $25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 or more Prefer not to answer Question #22   What is the highest level of education you have completed? Some high school High school graduate Some college College graduate Question #23   What can Hardin Memorial Health do to better meet the health needs of our community?