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I . <br /> Start time AM <br /> PM <br /> ©Or .III U NiliiY ©tJEartr[l©iN1In NII ;1E [ROM (NARVAIR <br /> BA$IC tw1NDCLa rANDiNgQF EMER E �MEL�I_' 'Ef�V �CM:5) <br /> 1. On a scale of 1 f.o•10, where 1 is little understanding and 10 is high understanding, <br /> how would you rate your understanding of the EMS system in Orange County? <br /> 1 2 3 • 4 5 G 7 8 9 10 <br /> LO-VI Kfr►o-t om <br /> 2. Have you ever used an ambulance service in Orange County? <br /> Yes No DK Ref, <br /> • <br /> 3. Have you ever used an ambulance service outside Orange County? <br /> 1 Yes Nf o DK Ref. <br /> L6+ 7ls � <br /> (Note: If No, DK or Ref., skip to question 7.) <br /> 4. On that occasion, did you pay for the service? (If more than one occasion, use most recent.) <br /> Yes No DK net, <br /> (Note: If No, DK, or Ref., skip to question 7,) <br /> 5. How did you pay for the service? 2 7 12 e_croitie_ti`rLs <br /> 40. 7 Xti 7su nc,e (Other than Medicare/Medicaid) <br /> t 1 ►0 . Paid out of pocket <br /> 7e 4 Medicare/Medicaid <br /> (4. a DK <br /> f�1 Refused <br /> t�� Other_,_ <br />