2013 Community Health Needs Assessment Report - Terrebonne ...

TGMC
2013 Community Health Needs Assessment Report
39
39b Which company provides your PRIMARY health insurance coverage?
[DO NOT READ - IF MORE THAN ONE, MAKE SURE RESPONDENT GIVES YOU
THE PRIMARY INSURER]
0=[DON'T KNOW/REFUSED]
3=United Healthcare
1=Blue Cross Blue Shield of LA
4=Aetna
2=CIGNA
5=Gilsbar
9=Other, specify:
_______________________
40 Which of the following best describes you?
0=[DO NOT KNOW/REFUSED]
1=never been married
2=currently married
3=previously married
41 What is the highest grade or year of school you completed?
0=[DO NOT KNOW/REFUSED] 3=some college (1-3
years)/vocational/technical
1=less than high school
4=college graduate/bachelor’s degree
2=grade 12 or GED (high school graduate) 5=postgraduate degree (Master’s,
M.D., Ph.D., J.D)
42 Please stop me when I reach your total family household income:
1=under $25,000 4=$75,000 to $99,999
2=$25,000 to $49,999 5=$100,000 and over
3=$50,000 to $74,999 0=[ REFUSED]
43a About how much do you weigh without shoes?
0=[DO NOT KNOW/REFUSED]
__________ pounds
43b About how tall are you without shoes? [RECORD FEET AND INCHES. THEN,
CONVERT TO INCHES]
0=[DO NOT KNOW/REFUSED]
_____ feet _____ inches __________ inches (convert
everything to inches)
44 Finally, which of the following best describes your race: Caucasian/White, African
descent/Black, Asian, Hispanic, or some other race?
0=[DO NOT KNOW/REFUSED]
3=Native American
1=White/Caucasian
4=Hispanic
2=Black/African
6=Asian