CAA Healthy Families Questionnaire Question Title * 1. Please identify if you are: A Certified Application Assistant A family member reporting on an issue that directly affects your family Other (please specify) Question Title * 2. Name of Certified Application Assistant Question Title * 3. County of Service Del Norte Fresno Humboldt Kern Kings Los Angeles Marin Mendocino Merced Napa Orange Riverside/San Bernardino Sacramento San Francisco San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz San Joaquin Solano Sonoma Yolo Alameda Amador Butte Contra Costa Imperial Lake Lassen Mono Plumas San Benito San Diego Siskiyou Ventura Other (please specify) Question Title * 4. Family Configuration (How many children on Healthy Families/Medi-Cal)? One family per response. Question Title * 5. What is the question or concern? Question Title * 6. Was the issue resolved? Yes No Question Title * 7. If No, what was the result? Question Title * 8. What tool/resource did you use to resolve? FAQ Document Hotline MRMIB Local county DPSS center Health Plan Other Question Title * 9. Which was most helpful? Question Title * 10. Was there a call center available to assist with your question or concern? Yes No Question Title * 11. Were they able to help you? Yes No Question Title * 12. In your opinion, how would this issue best be resolved? Question Title * 13. CCHI, in conjunction with Community Health Councils (CHC), would like to periodically convene calls to discuss issues you are facing. Would you like to participate in these calls? If, yes, please add your email or phone number in the box below. (Please note, we will not share any of your personal information without your express consent.) Done