Did you experience an unexpected negative outcome after undergoing surgery, receiving medical treatment, or taking medication?
Select your answer for question 1
Did a health care provider dismiss your symptoms or refuse to order tests to investigate your symptoms?
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Were there any delays regarding medical tests, diagnosis, or treatment?
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Did a doctor fail to refer you to a specialist when you reported symptoms of a condition beyond your doctor's area of expertise?
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Did your doctor fail to order additional tests or refer you to a specialist after an abnormal test result?
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Did your doctor withhold test results or delay informing you of them?
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At any time, did your doctor misdiagnose your condition?
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Was your child diagnosed with cerebral palsy or another disability in the days, months, or years following a complicated birth?
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Did you or a loved one suffer a bedsore, injuries from a fall, or other injuries in a hospital or a nursing home because of a lack of care or supervision?
Select your answer for question 9
Have you or your loved one experienced verbal, physical, or sexual abuse in a hospital, nursing home, or another medical facility?
Select your answer for question 10