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Appendix E; <br /> Community Health Opinion Survey <br /> (Also printed in Chinese, Burmese, Spanish, and Karen) <br /> OF <br /> o � <br /> � 9 <br /> U • m <br /> ORANGE COUNTY <br /> y W HEALTH DEPARTMENT <br /> �ja, �� Improving health.Inspiring change. <br /> 2019 Orange County Community Health Opinion Survey <br /> I Date COMMENTS I <br /> I <br /> I <br /> ❑ No One Home ADMIN ONLY <br /> Language Barrier(Interpreter not available) <br /> ❑ Spanish Follow Up? <br /> ❑ Karen <br /> ❑ Burmese Phone Number: <br /> ❑ Mandarin <br /> ❑ Other: <br /> (Call back to complete? Provide phone Address: <br /> number) <br /> ❑ Ended Before Survey Completed <br /> (Call back to complete? Provide phone <br /> number) <br /> ❑ No one in home eligible Email: <br /> ■ Under 18 years of age <br /> ■ Non-resident of Orange County <br /> Household Refusal <br /> ❑ Unoccupied/Vacant/Demolished <br /> House/Condemned House <br /> ❑ Selected Address Not a Household <br /> ❑ Survey Completed <br /> ❑ Yes <br /> ❑ No <br /> 52 2019 COMMUNITY HEALTH ASSESSMENT <br />