Confidential Information Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence by NORC at the University of Chicago and CDC, will be used only for purposes stated in this study, and will not be disclosed or released to anyone other than authorized staff of CDC without the consent of the individual or establishment in accordance with Section 308(d) of the Public Health Service Act (42 242) | SLAITS CHILDREN WITH SPECIAL HEALTH CARE NEEDS FLIPBOOK QUESTIONNAIRE MAIN INTERVIEW: VIETNAMESE November 20, 2007 Confidential Information Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence by NORC at the University of Chicago and CDC, will be used only for purposes stated in this study, and will not be disclosed or released to anyone other than authorized staff of CDC without the consent of the individual or establishment in accordance with Section 308(d) of the Public Health Service Act (42 242). Page 1 SLAITS SURVEY OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS FLIPBOOK QUESTIONNAIRE Section Subject Page Section 1. SLAITS ELIGIBILITY/SCREENING 3 Section 2. SPECIAL HEALTH CARE NEEDS SCREENING 7 Section 3. HEALTH AND FUNCTIONAL STATUS . 14 Section 4. ACCESS TO CARE: UTILIZATION AND UNMET NEEDS 24 Section 5. CARE COORDINATION . 48 Section 6A. FAMILY CENTERED CARE 52 Section 6B. TRANSITION ISSUES. 55 Section 6C. EASE OF SERVICE USE. 57 Section 6D. HURRICANE EVACUEE QUESTIONS 61 Section 7. HEALTH INSURANCE 66 Section 8. ADEQUACY OF HEALTH CARE .
