Q4 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您的性别</span>（单选题）

Q5 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您的年龄</span>（单选题）

Q7 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">离您居住地最近的公立医疗机构是</span>（单选题）

Q8 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您在最近一年到乡镇卫生院／社区卫生服务中心就诊的次数</span>（单选题）

Q9 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您到最近的乡镇卫生院或社区卫生服务中心需要步行多久才能到达</span>（单选题）

Q11 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您生病时，是否愿意首先前往乡镇卫生院或社区卫生服务中心就诊</span>（单选题）

Q13 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您若愿意首先到乡镇卫生院或社区卫生服务中心就诊的原因是</span>（多选题）

Q14 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您若不愿意首先到乡镇卫生院或社区卫生服务中心就诊的原因是</span>（多选题）

Q16 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您是否知道市政府出台的家庭医生签约制度</span>（单选题）

Q18 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您从哪些途径听说过家庭医生签约制度（多选题）</span>

Q19 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您是否了解签约家庭医生后有什么优惠政策？</span><span style="font-family: 宋体; font-size: 16px;">（多选题）</span>

Q20 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您对家庭医生签约制度的态度是</span><span style="font-family: 宋体; font-size: 16px;">（多选题）</span>

Q22 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您有签约家庭医生吗？（单选题）</span>

Q24 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">请问您是主动和家庭医生签约的吗？</span><span style="font-family: 宋体; font-size: 16px;">（单选题）</span>

Q25 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您签约家庭医生的原因有</span><span style="font-family: 宋体; font-size: 16px;">（多选题）</span><span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">：</span>

Q26 ：<span style="font-family: 宋体; font-size: 16px;">您对家庭医生技术能力及其诊疗过程和结果的信任度</span>（单选题）

Q27 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您对签约的家庭医生满意吗？</span>（单选题）

Q29 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您付出的签约费用与您得到的医疗服务比较，您觉得（单选题）</span>

Q30 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">如果您对您的家庭医生不满意，会选择以下哪个方式解决问题？</span><span style="font-family: 宋体; font-size: 16px;">（单选题）</span>

Q31 ：<span style="font-size:12.0pt;font-family:宋体;
mso-bidi-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:
ZH-CN;mso-bidi-language:AR-SA">您为什么不签约家庭医生（多选题）</span>