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<body lang=EN-US style='tab-interval:.5in'>

<div class=WordSection1>

<h2>CCHT Patient Satisfaction Survey</h2>

<p class=MsoBodyText><o:p>&nbsp;</o:p></p>

<p class=MsoBodyText>“It is important that we know what you think about the
value of our Care Coordination program. It will help us learn how we can
improve care to all veterans. We would greatly appreciate your taking a few
minutes to answer eight questions.</p>

<p class=MsoBodyText>Before you get started on the survey, we would like to
clear up a few things:</p>

<p class=MsoBodyText>You may know the Care Coordination program as the Home
Telehealth program. It is the program that provided you with this device. </p>

<p class=MsoBodyText>The Care Coordinator is the person that calls you as
follow-up to your answers on this device.</p>

<p class=MsoBodyText>Now let’s begin the survey. Please enter ‘continue’.”</p>

<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><a
name="_Toc101264440"><span style='mso-spacerun:yes'> </span></a>**Notes: </p>

<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:1.0in;text-indent:-.25in;mso-list:l0 level1 lfo3;tab-stops:list 1.0in'><![if !supportLists]><span
style='mso-list:Ignore'>1.<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span><![endif]>All of the following questions and answers are on the
OMB approved questions list.</p>

<p class=MsoNormal style='margin-left:1.0in;text-indent:-.25in;mso-list:l0 level1 lfo3;
tab-stops:list 1.0in'><![if !supportLists]><span style='mso-list:Ignore'>2.<span
style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><![endif]>The
numbers in parentheses are how the response will be scored in the database.</p>

<p class=MsoBodyText style='margin:0in;margin-bottom:.0001pt'><span lang=ES
style='font-family:"Garamond","serif";mso-ansi-language:ES'><o:p>&nbsp;</o:p></span></p>

<p class=MsoBodyText style='margin:0in;margin-bottom:.0001pt'><span lang=ES
style='font-family:"Garamond","serif";mso-ansi-language:ES'><o:p>&nbsp;</o:p></span></p>

<h3><a name="_Toc121723983"></a><a name="_Toc121722662"></a><a
name="_Toc121722249"><span style='mso-bookmark:_Toc121722662'><span
style='mso-bookmark:_Toc121723983'><span style='font-size:16.0pt;mso-bidi-font-weight:
normal'>Questionnaire Content</span></span></span></a><span style='font-size:
16.0pt;mso-bidi-font-weight:normal'><o:p></o:p></span></h3>

<p class=MsoNormal style='margin-left:.25in'>1. The following statement is
related to your feelings about the Care Coordination staff. The staff is
helpful.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span><span
style='mso-spacerun:yes'> </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:1'>   </span><span
style='mso-tab-count:1'>            </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree <span
style='mso-spacerun:yes'>  </span>(1) </p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>2. The following statement refers
to the health care you receive from the Care Coordination program. Information
given to me about my health is clear and adequate.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree<span
style='mso-spacerun:yes'>  </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal style='margin-left:.5in'><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>3. Your Care Coordinator has a
thorough understanding of the things that are wrong with you.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree<span
style='mso-spacerun:yes'>  </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>4. Please rate the following aspects
of the health care you received from Care Coordinators in the past 12 months.
Advice the Care Coordinator gives you about ways to avoid illness and stay
healthy.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Excellent <span style='mso-tab-count:2'>              </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Very Good <span style='mso-tab-count:1'>           </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Good <span style='mso-tab-count:2'>                    </span>(3)
</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Fair) <span style='mso-tab-count:2'>                      </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Poor<span style='mso-tab-count:2'>                       </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo2;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]><span style='mso-spacerun:yes'> </span>No
experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>5. How much do you agree or
disagree with the following statement about the Care Coordination care you have
received in the past 12 months? I would recommend this type of care to my
family or friends who have chronic diseases.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree<span
style='mso-spacerun:yes'>  </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>6. Think about the care you
receive from your Care Coordinator. You often have health problems that should
be discussed but are not.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree (5) </p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>7. The following statement refers
to your Care Coordinator. It is easy to understand what the Care Coordinator is
talking about.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:1'>       </span><span
style='mso-tab-count:1'>            </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree <span style='mso-tab-count:
1'> </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

<p class=MsoNormal style='margin-left:.25in'>8. The information given by the Care
Coordinator about my medical problems helps me to adjust to my condition.</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly agree <span style='mso-tab-count:1'>      </span>(5)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Agree <span style='mso-tab-count:2'>                   </span>(4)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No opinion <span style='mso-tab-count:1'>           </span>(3)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Disagree <span style='mso-tab-count:2'>               </span>(2)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Strongly disagree <span style='mso-tab-count:
1'> </span>(1)</p>

<p class=MsoNormal style='margin-left:.75in;text-indent:-.25in;mso-list:l2 level1 lfo1;
tab-stops:list .75in'><![if !supportLists]><span style='font-family:Symbol;
mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>No experience</p>

<p class=MsoNormal><o:p>&nbsp;</o:p></p>

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