1. What is your current citizenship/membership number and, if applicable, what was your. citizenship/membership number before compacting with IHS?

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1 Survey Questions Page 1 1. What is your current citizenship/membership number and, if applicable, what was your citizenship/membership number before compacting with IHS? 2. What was your annual patient registry/user population before compacting with Indian Health Service (IHS) and what is it currently? 3. What was the average patient wait-time in your health care facility (reception area) before compacting with IHS and what is it currently? 4. What was the health care provider vacancy rate within your facilities before compacting with IHS and what is it currently? 5. Since assuming operations from IHS, have you expanded the types of health care services your facilities provide? 5a. If so, approximately how many services have you added? 5b. If so, what types of services have you added? (Mark all that apply) Dental Behavioral Health Special Diabetes Cardiovascular Physical Therapy Optometry Podiatry

2 Survey Questions Page 2 Orthopedics Pediatrics Urgent Care Prevention/Education Programs 6. When (year) and why did you decide to compact your health care facility? 7. Overall, how has the quality of health care provided changed since entering into Self- Governance? 8. Does your health care facility incorporate culturally relevant/appropriate practices into the health care provided and patient care plans? 8a. If so, how has doing that impacted the health of your patients? 8b. Has Self-Governance played a role in helping you have the flexibility to do so? 9. What are some innovative ways your health care facilities are using to address the many challenges, such as health care provider vacancy and turnover rates, access to care, continuity of care, etc., that Indian health care faces? (Check all that apply) Scholarship Programs Incentives for Health Care Providers Partnership with: Other Health Care Facilities

3 Survey Questions Page 3 Tribal Colleges/Universities Non-Tribal Colleges/Universities Outside Health Care Providers Tribally Operated Primary Schools Non-Tribal Primary Schools Insurance Sponsorships Tribally Operated Insurance Plans/Programs Mobile Health Care Clinics Tribally Operated Medical Schools/Programs Transportation Programs Mail Order Pharmacies Prevention/Education Programs Health Care Clinics/Programs in Primary Schools 9b. How has Self-Governance played a role in developing and utilizing the above strategies? 10. Have you been able to extend health care access beyond your Tribal citizens/members? 10a. If so, what are some ways you have done that? (Check all that apply) Partnerships with: Local Communities Local Facilities Federal Agencies

4 Survey Questions Page 4 Other Tribal Facilities Other Tribal Communities Local Health Care Providers Mobile Clinics Tribally Operated Insurance Plans 11. Do you believe Self-Governance has played a role in your ability to provide quality health care and why? 12. What is/are the biggest health care challenge(s) your Tribal community faces? (Mark all that apply) Access to Quality Care Continuity of Care Staffing Administration Technology Integration Training Infrastructure Funding Capturing Third-Party Revenue Regulations Accreditation Specialty Services

5 Survey Questions Page 5 Capacity 12b. How have you been able to address those challenges since compacting your health care facilities? 13. Finally, is there anything else about your health care facilities/system you would like to share?

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