Supplemental Items for the CAHPS Clinician & Group Adult Survey 3.0: People With Mobility Impairments
Population version: Adult
Download these items: English (Word, 28 KB)
Learn more about the CAHPS People With Mobility Impairments Set.
Users of the CAHPS® Clinician & Group Survey are free to incorporate supplemental items in order to meet the needs of their organizations, local markets, and/or audiences. Some items cover events that occur with low frequency in the general population. You should include them only if your sample design is likely to yield a sufficient number of responses to those questions for statistical analysis and reporting.
| Questions |
Placement and Other Instructions |
C-IM1. In the last 6 months, when you visited this provider's office, how often were you examined on the examination table?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After core question 20 |
C-IM2. In the last 6 months, when you visited this provider's office, how often did someone weigh you?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After C-IM1 |
C-IM3. In the last 6 months, when you visited this provider's office, did you try to use the restroom?
1__ Yes
2__ No → If No, go to C-IM5 |
After C-IM2 |
C-IM4. In the last 6 months, how often was it easy to move around the restroom at this provider's office?
1__ Never
2__ Sometimes
3__ Usually
4__ Always |
After C-IM3
Note: Use with C-IM3
|
C-IM5. In the last 6 months, how often did pain limit your ability to do the things you needed to do?
1__ Never → If Never, go to C-IM7
2__ Sometimes
3__ Usually
4__ Always |
After C-IM4 |
C-IM6. In the last 6 months, did this provider ask about the impact of pain on your life?
1__ Yes
2__ No |
After C-IM5
Note: Use with C-IM5
|
C-IM7. In the last 6 months, how often did fatigue limit your ability to do the things you needed to do?
1__ Never → If Never, go to core question 21
2__ Sometimes
3__ Usually
4__ Always |
After C-IM6 |
C-IM8. In the last 6 months, did this provider ask about the impact of fatigue on your life?
1__ Yes
2__ No |
After C-IM7
Note: Use with C-IM7
|
C-IM9. A quarter mile is about 5 city blocks or 0.4 kilometers. In the last 6 months, were you able to walk that far?
1__ Yes
2__ No → If No, go to core question 25 |
After core question 24 |
C-IM10. In the last 6 months, did you have difficulty or need assistance walking that far?
1__ Yes
2__ No |
After C-IM9
Note: Use with C-IM9
|
