Thinking about your last visit, how did you get there? [Interviewer; mark the one used for most of the travel distance.] - Private car or motorcycle - Public transport - Ambulance - Bicycle - Walked - Other
Thinking about your last visit, how much did you or your household pay for: [Health care provider's] fees
Thinking about your last visit, how much did you or your household pay for: Medicines
Thinking about your last visit, how much did you or your household pay for: Tests
Thinking about your last visit, how much did you or your household pay for: Transport
Thinking about your last visit, how much did you or your household pay for: Other
Did you or your household pay less than the normal health care fees because of a government discount or exemption?
For your [child’s] last visit, how would you rate the travelling time to the health care provider?
For your [child’s] last visit, how would you rate the amount of time you waited before being attended to?
For your [child’s] last visit, how would you rate your experience of being greeted and talked to respectfully?
For your [child’s] last visit, how would you rate the way your privacy was respected during physical examinations and treatments?
For you [child’s] last visit, how would you rate the experience of how clearly health care providers explained things to you?
For your [child’s] last visit, how would you rate your experience of getting enough time to ask questions about your health problem or treatment?
In the last 30 days, how much bodily discomfort did [name of person]have?
Overall in the last 30 days, how much difficulty did [name of person] have with personal relationships or participation in the community?
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