Instrument comparison · F3 Patient
Paper questionnaire ↔ CAPI (CSEntry tablet)
Each section of the printed Patient (F3) questionnaire beside its CSEntry tablet screens.
The real printed pages
Pages 1–2 — the consent script and certificate of consent.
CSEntry (tablet)
Consent is recorded on screen as a Yes / No (shown) and gates the rest of the interview — a “No” ends it. The probe/script text is read from the device, not free-typed.
On paper
1. Are you the patient? · 2. What is your relationship to the patient? · 3. Do you live in the same house as the patient?
- Q1: Yes (→ skip to Q4) · No
- Q2: Spouse · Son · Daughter · Father · Mother · … 20 options incl. “Other” / “Refuse”
- Q3: Yes · No
On the tablet (CAPI)
Single-selects (shown) for Q1/Q2 and a Yes / No for Q3. If Q1 = Yes (the respondent is the patient), Q2–Q3 are skipped and the interview jumps to Q4.
On paper
4. Patient’s name (Last, First, MI, Ext.) · 5. Month & year of birth · 6. Age (in years, last birthday)
On the tablet (CAPI)
Q4 is a free-text name; Q5/Q6 are number-pad entries (shown). The app range-checks the age and birth year, and can cross-check age against the birth year.
On paper
7. Sex at birth · 8. Part of the LGBTQIA+ community? · 9. Which group? · 10. Civil status
- Q7: Male · Female
- Q8: Yes · No · Not comfortable · Don’t know · Refused
- Q10: Single · Married · Live-in · Widowed · Divorced · Separated · Annulled · Not reported
On the tablet (CAPI)
Single-selects (shown). Q9 (which group) opens only when Q8 = Yes; an “Other” choice opens a free-text box.
On paper
11. Identifies as a person with a disability? · 12. Specify the type? · 13. May we view the PWD ID card? · 14. Type indicated on the card
- Q13: Card presented & verified · Card not available · Refused to present
- Q14: Physical · Visual · Hearing · Speech · Intellectual · Psychosocial · Multiple · Other
On the tablet (CAPI)
Yes / No gates (shown) for Q11/Q12, then single-selects for Q13/Q14. The whole block opens only when Q11 = Yes, and Q14 only when the card is presented.
On paper
15. Highest education attained · 16. Employment status · 17. Main source of income · 18. Average monthly household income (amount & bracket)
- Q18 bracket: Under 50k · 50–99k · 100–149k · … · 500k+ · Don’t know (11 bands)
On the tablet (CAPI)
Single-selects (shown) for Q15–Q17 and the Q18 bracket; the Q18 amount is a number-pad peso entry. The app cross-checks the typed amount against the chosen bracket (and both against the Q29 socioeconomic class).
On paper
19. Total individuals living in the house · 20. Children under 18 · 21. Senior citizens
On the tablet (CAPI)
Three number-pad counts (shown). The app enforces that children (Q20) and seniors (Q21) can’t exceed the household total (Q19).
On paper
22. Electricity? · 23. Main water source · 24–25. Own or share faucet / tube? · 26–28. Own a refrigerator / television / washing machine?
- Q23: Faucet inside house · Tubed/piped well · Dug well · Other
- Q26–Q28: Yes, I/we have · No, I/we don’t
On the tablet (CAPI)
Yes / No for electricity (Q22) and asset ownership (Q26–Q28, shown); single-selects for water source (Q23) and own/share (Q24–Q25). The asset answers feed the socioeconomic-class question below.
On paper
29. Socioeconomic class · 30–31. Indigenous People member? Which group? · 32. 4Ps beneficiary? · 33–34. Main health-care decision-maker
- Q29: Class A/B · Class C · Class D/E · Don’t know
- Q33: Yes (patient decides) · No · The companion decides
On the tablet (CAPI)
Single-selects (shown) and Yes / No (Q30 IP, Q32 4Ps). Q31 (which IP group) opens only when Q30 = Yes; Q34 (who decides) opens only when Q33 ≠ “patient decides.”
The real printed pages
Pages 3–5 — Introduction/Consent (A) and the Patient Profile (B). Tap to open full size.
CSEntry (tablet)
Sections A & B run as single-selects, Yes/No gates and number-pad entries — the same controls shown row-by-row above.
On paper
35. Have you heard about UHC prior to this survey? · 36. Source of information about UHC? · 37. Your understanding of UHC?
- Q36: News · Legislation · Social media · Friends/family · Health facility · LGU/Barangay · Don’t know · Other
- Q37: Financial-risk protection · Access to quality care · Auto-enrollment to PhilHealth · A primary care provider for every Filipino · Don’t know · Other
On the tablet (CAPI)
Q35 is a Yes / No single-select; Q36 & Q37 are check-box multi-selects (tick all that apply). If Q35 = No, the section is skipped and the interview jumps to Q38. (Check-box control shown is a live tablet capture.)
On paper
38. Currently registered with PhilHealth? · 39. How did you find out how to register? · 40. Who assisted you?
- Q38: Yes · No (→ Q43) · Don’t know (→ Q43)
- Q39/Q40: PhilHealth rep · LGU · Primary care provider · Employer · Self-registered · BHW · Friends/family · … + Other
On the tablet (CAPI)
Single-selects (shown). Q38 is the gate: a “No” or “Don’t know” skips Q39–Q42 and jumps to Q43.
On paper
41. Any difficulties registering? · 42. What was difficult? · 43. Know where to seek assistance? · 44. Where would you go?
- Q42: Unclear process · Took long · Didn’t know where to ask · Travel · No valid ID · Didn’t know documents · … + Other
On the tablet (CAPI)
Yes / No gates (shown) for Q41/Q43, opening a check-box list of difficulties (Q42, only when Q41 = Yes) and a single-select place to seek help (Q44).
On paper
45. What category of member are you? · 46. Benefits of being a member? · 47. Awareness of packages (physician check-up · diagnostics · hospital confinement · outpatient drugs)
- Q45: Formal · Informal · Indigent · Sponsored · Lifetime · Senior citizen · OFW · Qualified dependent · … + Other
On the tablet (CAPI)
Q45 is a long single-select (shown); Q46 is a check-box benefits list; Q47 is four Yes / No awareness toggles, one per package.
On paper
48. Do you pay monthly premiums? · 49. Difficult to pay? · 50. Why? · 51. Registered with another health insurance plan? · 52. Which plan/s?
- Q48: Yes, I pay directly · Yes, my employer pays · No (→ Q51)
- Q52: GSIS · SSS · Private insurance · HMO · Pag-IBIG · Don’t know · Other
On the tablet (CAPI)
Q48 is a single-select; Q49/Q51 are Yes / No (shown), each opening a check-box list — why-difficult (Q50, when Q49 = Yes) and which-plans (Q52, when Q51 = Yes). A “No” on Q48 skips Q49–Q50.
The real printed pages
Pages 6–7 — UHC Awareness (C) and PhilHealth Registration (D). Tap to open full size.
CSEntry (tablet)
Sections C & D run as single-selects, Yes/No gates and check-box lists — the controls shown row-by-row above.
On paper
53. Do you have a primary care provider? · 54. Who is your main primary care provider? · 55. Is the location convenient? · 56. Are the clinic hours convenient? · 57. Is the usual wait for setting an appointment convenient?
- Q53, Q55, Q56, Q57: Yes · No
- Q54: General practitioner · Specialty Care Provider/Specialist · Both · Other (specify)
On the tablet (CAPI)
Q53 is the gate: Q53 = No (no PCP) skips Q54–Q62 and jumps to Q63. Q54 is a short single-select; its Other-specify text box opens only when Q54 = Other. Q55–Q57 are Yes/No.
On paper
58. Wait time to set an appointment (Days / Minutes) · 59. Mode/s of communication available when scheduling · 60. If teleconsult was available, did you succeed in using it (scheduling)? · 61. Mode/s of communication available when consulting · 62. If teleconsult was available, did you succeed in using it (consultation)?
- Q58: numeric — Days (000) and Minutes (0000)
- Q59 & Q61: Face-to-face · Teleconsultation · Landline · Cellphone · Video Conference
- Q60, Q62: Yes · No
On the tablet (CAPI)
Q58 captures Days and Minutes on number-pads. Q59 and Q61 are check-box multi-selects (tick all available modes). Q60 and Q62 are Yes/No follow-ups on whether teleconsult, if available, succeeded.
On paper
63. In the past 12 months, do you have a clinic/health center you usually go to? · 64. Name of the facility · 65. If none, why not? · 66. Is [facility] the one you usually go to? · 67. Why did you go to this facility instead of your usual?
- Q63, Q66: Yes · No
- Q64: free-text facility name
- Q65: I don't get sick · I recently moved · It's expensive · I can treat myself · I don't know where to go · I don't know · Other
- Q67: More accessible than usual · Service/specialist not available at usual · Recommended by friends/family … + Other
On the tablet (CAPI)
Q63 is Yes/No. Q65 is a check-box multi-select shown only when there is no usual facility (Q63 = No); Q67 is a check-box multi-select shown when Q66 = No (this is not the usual facility). Q64 is a free-text name; Q65 and Q67 each have an Other-specify text box gated on the Other tick.
On paper
68. Type of health facility you usually go to · 69. How long to travel there (Hours / Minutes) · 70. Mode/s of transportation used to get there
- Q68: YAKAP/Konsulta or primary care provider · Barangay Health Center/Station · Rural Health Unit/Urban Health Center · Public Hospital · Private Hospital · Private Clinic · Traditional Healer/Albularyo … + Other
- Q69: numeric — Hours (00) and Minutes (00)
- Q70: Walk · Bike · Public Bus · Jeepney · Tricycle · Car · Motorcycle … + Other
On the tablet (CAPI)
Q68 is a long single-select (9 facility types) with an Other-specify text box gated on Other. Q69 captures Hours and Minutes on number-pads. Q70 is a check-box multi-select (12 transport modes) with an Other-specify box gated on the Other tick.
On paper
71. Type of primary care facility nearest to your house · 72. How long to travel from your house to it (Hours / Minutes) · 73. Mode/s of transportation used to get to the nearest facility
- Q71: Barangay Health Center/Station · Rural Health Unit/Urban Health Center · Public Hospital · Private Hospital · Private Clinic · Traditional Healer/Albularyo … + Other
- Q72: numeric — Hours (00) and Minutes (00)
- Q73: Walk · Bike · Public Bus · Jeepney · Tricycle · Car · Motorcycle … + Other
On the tablet (CAPI)
Q71 is a long single-select (8 facility types) with an Other-specify text box gated on Other. Q72 captures Hours and Minutes on number-pads. Q73 is a check-box multi-select (12 transport modes) with an Other-specify box gated on the Other tick.
On paper
74. Have you heard of the term "YAKAP/Konsulta package"? · 75. Your sources of information about it · 76. Your understanding of the package
- Q74: Yes · No
- Q75: News · Legislation · Social Media · Friends/Family · Health center/facility · LGU/Barangay … + Other
- Q76: Free primary care consultation · Free health risk screening · Free selected labs/diagnostics · Free selected drugs/medicines … + Other
On the tablet (CAPI)
Q74 is the awareness gate: Q74 = No (never heard of it) skips the source/understanding/registration block and jumps to Q83. Q75 and Q76 are check-box multi-selects, each with an Other-specify box gated on the Other tick.
On paper
77. Are you registered with a YAKAP/Konsulta provider? · 78. When did you register? · 79. Since registering, have you had an appointment? · 80. Do you know how to book an appointment? · 81. Was that appointment a general check-up? · 82. Why are you NOT registered?
- Q77: Yes · No · I don't know
- Q78: Within past 6 months · 6 months–1 year ago · 1–2 years ago · 2 years ago or more
- Q79, Q80, Q81: Yes · No
- Q82: Don't know what a provider is · Don't trust PhilHealth · Don't know how to register · Registration is confusing … + Other
On the tablet (CAPI)
Q77 routes registration status: Q77 = No skips to Q82 (why not registered); Q77 = I don't know proceeds to Q83, so the registered block (Q78–Q81) opens only on Q77 = Yes. Q78 is a short single-select; Q79–Q81 are Yes/No. Q82 is a check-box multi-select (11 reasons) with an Other-specify box gated on the Other tick.
The real printed pages
Pages 8–10 — Primary Care Utilization. Tap to open full size.
CSEntry (tablet)
This section mixes Yes/No gates, short and long single-selects, number-pads for travel/wait time, and several check-box multi-selects for communication, transport, and YAKAP/Konsulta items.
On paper
83. What best describes why the patient visited a health facility (e.g. RHU, health center, clinic, hospital)? · 84. What type of service did the patient usually access?
- Q83: New problem · Follow-up · Tests/diagnostics only · General check-up · Health certificate/admin · Immunizations/vaccinations · Doctor transferred here · Other (Specify)
- Q84: Outpatient care · Inpatient care · Emergency care · Primary care consultation · Other (Specify)
On the tablet (CAPI)
Two single-select lists. Each "Other (Specify)" choice gates an alpha text field (Q83 / Q84 OTHER_TXT, 120 chars) — shown only when option 8 (Q83) / option 5 (Q84) is picked.
On paper
85. What condition/s do/es the patient usually visit the facility for?
- Q85: Upper respiratory infection · Hypertension · Immunization · Pregnancy or birth · Flu · Fever · Joint/muscle pain · Asthma or COPD · Diabetes · Heart problem · Kidney/Dialysis · Cancer · Gastro · Other infection · Accident/injury · Dental · ENT · Allergy · No condition – regular check-up · Other (Specify)
On the tablet (CAPI)
Check-box multi-select (tick all that apply). "Other (Specify)" gates an _OTHER_TXT alpha field shown only when Other is ticked.
On paper
86. Which of the following happened during the patient's most recent visit?
- Q86: Saw a doctor · Saw a nurse/midwife · Saw any other healthcare worker · Basic tests (BP, height/weight) · Laboratory tests · Imaging · Prescribed medication · Minor procedure/surgery · Picked up certificate/admin · Admitted for confinement · Other (Specify)
On the tablet (CAPI)
Check-box multi-select. "Other (Specify)" (code 99) is the none-of-the-above escape (e.g. came for a consult but couldn't see the doctor) and gates an _OTHER_TXT field.
On paper
87. Apart from this visit, has the patient done anything else to improve his/her health condition or address his/her health concern?
- Q87: Visited other healthcare facility · Sought alternative care · Sought telemedicine · Used home care · Bought medicine from a pharmacy · Did not seek other forms of care · Other (Specify)
On the tablet (CAPI)
Check-box multi-select. "Other (Specify)" gates an _OTHER_TXT alpha field; "Did not seek other forms of care" records the negative case.
The real printed page
Page 11 — Health-Seeking Behavior. Tap to open full size.
CSEntry (tablet)
Single-selects plus tick-all check-box grids, each with gated "Other (Specify)" text.
On paper
88. Why are you visiting [FACILITY] for consultation/advice or treatment? · 89. Were you advised for hospitalization / to be admitted? · 90. What were the reasons why you were not confined/admitted? · 91. Do you usually avail consultation services for outpatient care?
- Q88: Sick/Injured · Prenatal/Post-natal Check-up · Gave Birth · Dental check-up · Medical check-up · Medical requirement · NHTS/CCT/4Ps Requirement · Other (specify)
- Q89 / Q91: Yes · No
- Q90: Facility is far · No money · Worried about treatment cost · Home remedy is available · Not PhilHealth accredited · No need/regular check-up only · Other (specify)
On the tablet (CAPI)
Q88 single-select (Other reveals a 120-char text box); Q89/Q91 are Yes/No. Q90 is a check-box tick-all that only opens when Q89 = No (advised but not admitted), with its own Other-specify text gated on the Other tick.
On paper
92. Which of the following did you use to pay for the cost of consultation? (Tick all that apply.)
- Q92: Out-of-pocket · Donation · Free/no cost · Free, charge to PhilHealth · Free, charge to Private Insurance · Free, charge to HMO · In kind · Don't know
On the tablet (CAPI)
Q92 is a check-box tick-all of the 8 payment sources. The ticked sources feed a repeating roster (one row per source); only Out-of-pocket and Donation carry an amount box — the roster auto-protects and zeroes the amount for every other source code.
On paper
93. Did you have any of the following laboratory tests done during your outpatient care? · 94. Cost of laboratory test/s (by payment source).
- Q93: CBC w/ platelet · Urinalysis · Fecalysis · Sputum Microscopy · Fecal Occult Blood · Pap smear · Lipid profile · FBS · OGTT · ECG · Chest X-Ray · Creatinine · HbA1c · Abdominal ultrasound · Dental Services · Other (specify) · None
- Q94 sources: Out-of-pocket · Donation · Free/no cost · Free, charge to PhilHealth/Private Insurance/HMO · In kind · Don't know (Yes/No each)
On the tablet (CAPI)
Q93 is a check-box tick-all (Other reveals a text box; None routes past the lab-cost questions to Q95). Q94 is a per-source Yes/No matrix where only Out-of-pocket exposes an Amount-in-Pesos number-pad; all other sources are Yes/No only.
On paper
95. Were you prescribed medicine/s after your check-up? · 96. Amount spent for prescribed medicines (by payment source).
- Q95: Yes · No
- Q96 sources: Out-of-pocket · Free/no cost · Free, charge to PhilHealth/Private Insurance/HMO · In kind · Donation · Don't know
On the tablet (CAPI)
Q95 is Yes/No. Q96 is a per-source Yes/No matrix; only Out-of-pocket, In-kind and Donation expose an Amount-in-Pesos number-pad — the rest are Yes/No only.
On paper
97. What was the final amount you paid in cash for your outpatient care? · 97.1 Other items included in the bill. · 97.2 Other expenses during the OPD visit not in the bill.
- Q97.1: Consultation Fee · Medical equipment or supplies · Non-medical expenses (e.g. Hygiene kit) · Other expenses (Yes/No + Amount each)
- Q97.2: a) Consultation Fee · b) Diagnostic/laboratory procedure · c) Medical equipment or supplies · d) Medicines or drugs · e) Non-medical: travel · f) Other expenses (Yes/No + Amount each)
On the tablet (CAPI)
Q97 is a number-pad (Pesos). Q97.1 and Q97.2 each pair a per-item Yes/No with an Amount-in-Pesos number-pad, plus an Other-specify text box.
On paper
98. Which of the following did you use to pay for your medical costs? (15 sources, Yes/No + Amount each.)
- Q98: Salary/income · Loan/Mortgage · Savings · Donation/Charity (Private) · Malasakit Center · Other Donation/Charity (Government) · Sale of Assets · Paid by someone else · MAIFIP · PhilHealth · SSS · GSIS · Private Insurance · HMO · Other (specify)
On the tablet (CAPI)
A 15-source Yes/No matrix, each source pairing with an Amount-in-Pesos number-pad. Two free-text boxes follow: one for the government Other-Donation source, one for the generic Other payment source.
On paper
99. Have you heard about Bagong Urgent Care and Ambulatory Services (BUCAS) center? · 100. Sources of information about BUCAS. · 101. Your understanding of a BUCAS center. · 102. Have you accessed BUCAS services? · 103. Which service/s did you avail? · 104. Without a BUCAS center, where would you have gone?
- Q99 / Q102: Yes · No
- Q100: News · Legislation · Social Media · Friends/Family · Health center/facility · LGU/Barangay · I don't know · Other (specify)
- Q101: Provides urgent care for non-life-threatening conditions · Offers outpatient/ambulatory services · Helps reduce hospital overcrowding · Allows timely consultation/treatment · Other (specify)
- Q103: Medical consultation for urgent/minor conditions · Outpatient/ambulatory care · Basic diagnostics (lab, X-ray) · Minor procedures/treatments · Referral to higher-level facilities · I don't know · Other (specify)
- Q104: Another DOH hospital · Private clinic/hospital · LGU hospital · Rural Health Unit/Health Center · Would not seek care · Others
On the tablet (CAPI)
Q99/Q102 are Yes/No. Q100, Q101 and Q103 are check-box tick-all lists (each with an Other-specify text box); Q104 is single-select with its own Others text. Q100 is gated on Q99 = Yes, and Q103 is gated on Q102 = Yes (accessed BUCAS).
The real printed pages
Pages 12–14 — Outpatient Care. Tap to open full size.
CSEntry (tablet)
This section mixes single-select, Yes/No, check-box tick-all, payment-source matrices with conditional Amount-in-Pesos number-pads, and a repeating payment roster.
On paper
105. Why are you confined in the hospital? · 106. How long were you confined? (Nights / Days)
- Q105: Sick · Injured · Gave birth · Executive check-up · Other (specify)
On the tablet (CAPI)
Q105 is a 5-way single-select; picking Other (specify) gates a free-text box. Q106 is two number-pad fields (Nights, Days), each up to 3 digits.
On paper
107. Total bill for confinement — for each funding source, was it used, and how much (Amount in Pesos)?
- Q107 sources: Out-of-pocket · Free/no cost · Free, charge to PhilHealth · Free, charge to Private Insurance · Free, charge to HMO · Free, charge to MAIFIP · Donation · In kind · Don't know · Other
On the tablet (CAPI)
Per-source Yes/No matrix across 10 sources; each Yes exposes an Amount-in-Pesos number-pad (up to 9 digits). The Other source adds a specify free-text box.
On paper
108. Did the patient buy medicine/s from any pharmacy/facility outside the hospital? · 109. Amount paid for medicines outside (per-source) · 110. Did the patient pay for other service/s outside the hospital? · 111. If yes, what are those services? · 112. Amount paid for services outside (per-source)
- Q109 / Q112 sources: Out-of-pocket · Free/no cost · Free, charge to PhilHealth · Free, charge to Private Insurance · Free, charge to HMO · Free, charge to MAIFIP · In kind · Don't know · Other
On the tablet (CAPI)
Q108 and Q110 are Yes/No gates. Each opens a 9-source Yes/No payment matrix (Q109, Q112) where every Yes exposes an Amount-in-Pesos number-pad; Other adds a specify box. Q111 is a free-text field naming the outside services.
On paper
113. What did you use to pay for the hospital bill — for each source, was it used and how much (Amount in Pesos)?
- Q113 sources: Salary/income · Loan/Mortgage · Savings · Donation/Charity/Assistance from Private Organization · Malasakit Center · Other Donation/Charity/Assistance from Government Organization · MAIFIP · PhilHealth · SSS · GSIS · Private Insurance · HMO · Other (specify)
On the tablet (CAPI)
Per-source Yes/No matrix across all 13 funding sources; each Yes exposes an Amount-in-Pesos number-pad (up to 9 digits). The Other (specify) source adds a free-text box. This PhilHealth-used flag drives the Q114 gate below.
On paper
114. Why did you not avail of PhilHealth benefits? (asked only if PhilHealth was not availed in Q113)
- Q114: Not a PhilHealth member · PhilHealth member but not eligible for benefits · Probably used PhilHealth but cannot remember amount (deducted upon discharge) · Too many requirements to comply with · Limited hospitalization benefits · Claims processing too long · Other (specify)
On the tablet (CAPI)
Gated: shown only when PhilHealth was not used in Q113. A tick-all check-box multi-select (#694, converted from select-all); ticking Other reveals a specify free-text box.
On paper
115. Final amount paid in cash at the hospital cashier upon discharge (Amount in Pesos) · 115.1 Other items included in the bill (per-item amount) · 115.2 Other expenses during confinement not in the bill (per-item amount)
- Q115.1: Doctor's Professional Fee · Medical equipment or supplies · Non-medical expenses (e.g. Hygiene kit) · Diagnostic or laboratory procedure inside the facility · Medicines or drugs inside the facility · Other expenses
- Q115.2: Medical equipment or supplies bought outside · Payment made directly to doctor/s and their secretary · Food · Transportation · Donation to the facility · Allowance for caregiver · Other (specify)
On the tablet (CAPI)
Q115 is a single Amount-in-Pesos number-pad (up to 9 digits). Beneath it, Q115.1 (6 items) and Q115.2 (7 items) each run a per-item Yes/No matrix where every Yes exposes an Amount-in-Pesos number-pad; both end with an Other specify free-text box. Total precedes the breakdowns (#517), mirroring the outpatient Q97/Q97.1/Q97.2 pattern.
The real printed pages
Pages 15–16 — Inpatient Care. Tap to open full size.
CSEntry (tablet)
Inpatient Care renders as gated Yes/No payment matrices with conditional peso number-pads, one check-box multi-select (Q114), and free-text specify fields.
On paper
116. Have you heard of the No Balance Billing (NBB)? · 117. If yes, sources of information about NBB? · 118. What is your understanding about NBB?
- Q116: Yes · No · I don't know
- Q117 sources: News · Legislation · Social Media · Friends/Family · Health center/facility · LGU/Barangay · I don't know · Other (Specify)
- Q118: Patient pays no bill · PhilHealth covers cost · Medicine/service included · No cash on discharge · Only certain patients/hospitals · Settled hospital↔PhilHealth · No extra fees · I don't know · Other (Specify)
On the tablet (CAPI)
Q116 single-select. If "No" or "I don't know" → skip to Q119, bypassing Q117–Q118. Q117/Q118 are check-box multi-selects, each with a gated "Other (Specify)" text field.
On paper
119. Heard of Zero Balance Billing (ZBB)? · 120. Sources? · 121. Understanding of ZBB? · 122. Informed about ZBB upon admission? · 123. To what extent did ZBB reduce your financial burden?
- Q119: Yes · No · I don't know · Q122: Yes · No
- Q120 sources: News … + Other · Q121: same as Q118, but option 5 = "Only PhilHealth members and DOH-run hospitals" … + Other
- Q123: Significantly reduced burden · Lessened some costs but still OOP · Some relief, limited vs needs · No noticeable difference
On the tablet (CAPI)
Q119 single-select; if "No"/"I don't know" → skip to Q124, bypassing Q120–Q123. Q120/Q121 check-box multi-selects with gated "Other" text; Q122 Yes/No; Q123 single-select extent scale.
On paper
124. Heard of MAIFIP (Medical Assistance for Indigent and Financially Incapacitated Patients)? (SKIP IF ANSWERED MAIFIP IN Q113) · 125. Sources? · 126. Availed MAIFIP this confinement? · 127. Any out-of-pocket payment? · 128. Which items paid OOP? · 129. Why not avail MAIFIP?
- Q124: Yes · No · I don't know · Q126/Q127: Yes · No
- Q125 sources: News … + Other (no gated text) · Q128: Drugs · Laboratory · Professional Fees · Accommodation · None · Other (specify)
- Q129: Not eligible · Too complicated · Don't like basic ward · No available basic ward
On the tablet (CAPI)
Q124 single-select; if "No"/"I don't know" → skip to Q130. Q125/Q128/Q129 check-box multi-selects; Q128 "None" is exclusive and "Other (specify)" gates _OTHER_TXT. Q126/Q127 Yes/No gate the OOP follow-ups.
On paper
130. Have you or your household had to reduce spending on things you need (such as food, housing, or utilities) because of this health expenditure in the last 1 month?
- Q130: Yes · No · Don't know · Refused to answer
On the tablet (CAPI)
Single-select, always asked (no gate). Includes explicit "Don't know" and "Refused to answer" non-response codes.
The real printed page
Page 17 — Financial Risk Protection. Tap to open full size.
CSEntry (tablet)
Yes/No awareness gates branch past their source/understanding check-box blocks.
On paper
131–134. Satisfaction with cleanliness and comfort — Waiting areas · Bathrooms/toilets · Consultation Rooms · Rooms (inpatients only). · 135. Satisfied with overall time spent from registration to exiting the facility?
- Q131–Q135: Very Satisfied · Satisfied · Neither Satisfied nor Dissatisfied · Dissatisfied · Very Dissatisfied · Not applicable
On the tablet (CAPI)
Five single-select 5-point satisfaction rating scales (plus "Not applicable"). Q134 Rooms is for inpatients only — use "Not applicable" otherwise. Q135 is asked for all patients.
On paper
In most recent visit, how often did the staff… 136. treat you with courtesy and respect? · 137. listen carefully to what you say or ask? · 138. explain your condition and procedures understandably? · 139. give you the chance to make decisions about your treatment? · 140. ask for your consent before performing treatments or tests?
- Q136–Q140: Never · Sometimes · Usually · Always · I don't know
On the tablet (CAPI)
Five single-select 5-point frequency rating scales (Never→Always + "I don't know"). All always asked; no gating.
On paper
141. Did staff assure the patient's condition will be kept confidential? · 142. Did staff respect your privacy during the physical consultation? · 143. Overall, would you recommend [facility_name] to a friend or relative? · 144. How would the patient rate the quality of care received at [facility_name]?
- Q141–Q142: Yes · No · I don't know · Q143: Yes · No
- Q144: Very Satisfied · Satisfied · Neither · Dissatisfied · Very Dissatisfied · Not applicable
On the tablet (CAPI)
Q141/Q142 Yes/No/Don't-know single-selects; Q143 Yes/No; Q144 5-point satisfaction scale. Q143/Q144 prompts pipe the facility name via the [facility_name_input] fill. All always asked.
The real printed page
Page 18 — Satisfaction on Amenities & Medical Care. Tap to open full size.
CSEntry (tablet)
A column of 5-point satisfaction and frequency rating scales plus Yes/No items.
On paper
145. How often do you purchase or receive medicines? · 146. Was the most recent medicine purchased prescribed by a doctor or over-the-counter (OTC)? · 147. What are the medications that you usually take?
- Q145: Weekly · Bi-weekly · Monthly · Rarely · Never
- Q146: Prescribed by a doctor · Over-the-counter medicine · Purchased both · I don't know
- Q147: free-text list of medications
On the tablet (CAPI)
Q145/Q146 are single-select lists; Q147 is a free-text box (240 chars). No skip — all three always shown.
On paper
148. What are the medical conditions that you take the medicines for? · Which medicine(s) do you take for the condition(s) selected? · 149. Where do you usually buy or receive your medicines? (Select all that apply)
- Q148: Upper respiratory infection · Hypertension · Immunization · Pregnancy/birth · Flu · Fever · Joint/muscle pain · Asthma/COPD · Diabetes · Heart problem … + No condition (regular check-up) + Other (Specify)
- Q149: Public Hospital · Private Hospital · Chain Pharmacies (Mercury, Watsons, TGP, Generika) · Local pharmacies · Online stores (Shopee, Lazada) · Barangay Health Station · RHU/City Health Office · Other (specify)
On the tablet (CAPI)
Q148 is a one-screen check-box multi-select (tick all conditions). The Q148 medicines free-text is gated — skipped until at least one condition is ticked. Q149 is a check-box multi-select with an Other-specify text box.
On paper
150. Travel time from home to nearest pharmacy (hours HH, minutes MM) · 151. How easy is it for you to access a pharmacy or drugstore?
- Q150: numeric — hours (HH) + minutes (MM)
- Q151: Very difficult · Difficult · Neutral · Easy · Very easy
On the tablet (CAPI)
Q150 is two number-pad fields (HH, MM), each 2 digits. Q151 is a 5-point single-select ease scale. No skip — always shown.
On paper
152. Have you heard of the GAMOT Package (part of PhilHealth's YAKAP/Konsulta)? · 153. Sources of information for GAMOT · 154. Your understanding of GAMOT · 155. Did you get medicines from GAMOT in the past 6 months? · 156. Medications obtained from GAMOT · 157. Where did you get the rest of the medicines?
- Q152/Q155: Yes · No
- Q153: News · Legislation · Social Media · Friends/Family · Health center · LGU/Barangay · I don't know · Other (Specify)
- Q154: Free/affordable outpatient medicines · Continuous availability · Reduces out-of-pocket · Supports common/chronic illness treatment · I don't know · Other (specify)
- Q157: Pharmacy · Public/Private hospital · PCP (paid/free) · LGU free · None — got all from GAMOT · Other (Specify)
On the tablet (CAPI)
Q152 & Q155 are Yes/No. Q153/Q154/Q157 are check-box multi-selects with Other-specify text. Q153 is gated on Q152=Yes; Q156/Q157 follow from Q155=Yes. Q157 carries an exclusive "None — got all from GAMOT" option (code 90) that can't be ticked alongside a real source.
On paper
158. Do you know the difference between 'branded' and 'generic' medicine? · 159. Was/were the medicine/s bought outside GAMOT branded or generic? · 160. If generic, why? · 161. If branded, why?
- Q158: Yes · No
- Q159: Branded · Generic · Both · Don't know the difference · Not applicable
- Q160: Lower cost · Prescribed by doctor · Readily available · Given for free · More/as effective · I don't know · Other (Specify)
- Q161: Branded more effective · Not aware of generic · Prescribed by doctor · Given for free · Prefer branded · I don't know · Other (Specify)
On the tablet (CAPI)
Q158 is Yes/No; Q159 is single-select. Q160 & Q161 are check-box multi-selects with Other-specify, gated on the Q159 answer — Q160 shows for generic, Q161 for branded.
The real printed pages
Pages 19–20 — Access to Medicines. Tap to open full size.
CSEntry (tablet)
Mostly single-select and Yes/No lists, with check-box multi-selects for conditions, sources, and reasons — gated by GAMOT and branded/generic answers.
On paper
162. At your most recent visit, did a healthcare worker refer you to another facility/specialist? · 163. What type of care was the referral for? · 164. What kind of specialist did they recommend? · 165. How did they refer you?
- Q162: Yes · No
- Q163: Outpatient · Emergency · Inpatient · Dental · Other facility visits · Special therapy · Alternative care · Outreach/medical missions · Home healthcare · Telemedicine … + None of the above + Other (Specify)
- Q164: No specialty · Anesthesia · Dermatology · Emergency Medicine · Family Medicine … + I don't know + Other (Specify)
- Q165: Physical referral slip · E-referral · Phone call referring→receiving · I don't know · Other (Specify)
On the tablet (CAPI)
Q162 is Yes/No and gates the whole section — the referral questions only appear when Q162=Yes. Q163 is a check-box multi-select (with Other text); Q164 & Q165 are single-selects, each with an Other-specify text box.
On paper
166. Did they discuss the different places you could have gone? · 167. Did they help you make the appointment? · 168. Did they write down information for the specialist? · 169. Have you visited the referred facility? · 170. Did they follow up with you after the visit?
- Q166/Q167/Q168/Q170: Yes · No
- Q169: Yes · No, I'm not planning to · Not yet, but I'm planning to
On the tablet (CAPI)
Q166–Q168 and Q170 are Yes/No; Q169 is a 3-option single-select. Q170 (post-visit follow-up) applies after Q169 indicates a visit happened.
On paper
171. Why are you NOT planning to visit?
- Q171: Facility too far · Don't trust referred facility · No time · Worried about additional costs · Not needed · Don't know how to get there · Other (Specify)
On the tablet (CAPI)
Q171 is a check-box multi-select with an Other-specify text box. Gated — shown only when Q169 = "No, I'm not planning to" (declined the referral visit).
On paper
172. Was the visit a referral from your primary care facility? · 173. Does your PCP know you made the visit? · 174. Did your PCP discuss the different places you could have gone? · 175. Did your PCP (or staff) help make the appointment? · 176. Did your PCP write down info for the specialist? · 177. As it wasn't a referral, why did you decide to visit a hospital?
- Q172/Q174/Q175/Q176: Yes · No
- Q173: Yes · No · I don't know
- Q177: Referred by other specialist · Nearest facility · Usual source of care · Only place for a certain test · Referred by BHW/nurse/midwife · Referred by family/friends · Subsidized/free services · ZBB eligibility · I don't know · Other (Specify)
On the tablet (CAPI)
Q172 & Q174–Q176 are Yes/No; Q173 is a 3-option single-select. Q177 is a check-box multi-select with Other text. Q173–Q176 branch from Q172=Yes (PCP referral); Q177 applies when it was NOT a referral.
On paper
178. Overall, how would you rate your experience with the referral process?
- Q178: Very Satisfied · Satisfied · Neither Satisfied nor Dissatisfied · Dissatisfied · Very Dissatisfied
On the tablet (CAPI)
Q178 is a 5-point rating scale (single-select). No "Not applicable" option — it is only reached when a referral occurred (Q162=Yes gates Section L), so it always applies.
The real printed pages
Pages 21–23 — Experiences and Satisfaction on Referrals. Tap to open full size.
CSEntry (tablet)
A Q162=Yes-gated branch of Yes/No and single-select questions, check-box multi-selects for care type and reasons, ending in a 5-point satisfaction rating.