Download:
pdf |
pdf ve�
ve�
poor poor fair good good
CARE PROVIDERS (...continued)
3.
How well the care provider informed you about your medication (if you were
prescribed medication)...................................................................................................................
1
2
3
4
5
0
0
0
0
0
Comments (describe good or bad experience): ------------------------
ve�
ve�
poor poor fair good good
THERAPIST(S)
If you did not see a Therapist during this visit, please skip this section. Thank you.
1. Your trust in the skill of the therapist(s).....................................................................................
2. Therapist's concern for your questions and worries .............................................................
3. How well the therapist(s) understood you and your needs ................................................
4. How well the therapist(s) kept you informed about your treatment .................................
1
2
3
4
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Therapist(s) Section Comments_____________________________
ve�
ve�
poor poor fair good good
YOUR CARE
1. Staff's concern for your privacy ...................................................................................................
2. How well the staff addressed your emotional needs ............................................................
3. Staff's response to concerns/complaints made during your care ....................................
4. Staff's efforts to include you in decisions about your care .................................................
5. Instructions on what to do if experiencing problems related to your condition
(when to seek help, who to call, etc.) ........................................................................................
6. Degree of safety and security you felt in our facility .............................................................
1
2
3
4
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Comments (describe good or bad experience): ------------------------
ve�
ve�
poor poor fair good good
OVERALL ASSESSMENT
1. How well the staff worked together to care for you .............................................................. .
2. Overall rating of care given at this facility................................................................................
3. Likelihood of your recommending this facility to others ......................................................
1
2
3
4
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Comments (describe good or bad experience): ________________________
Patient's Name: (optional)------------------------------TeIephone Number: (optional)______________________________
© 2021 PRESS GANEY ASSOCIATES LLC.
All Rights Reserved.
CL#16028-OY0101-01-03/21
C p R E s s GA N E y•
�'
�
Ol
co
r--
| File Type | application/pdf |
| File Modified | 2021-03-08 |
| File Created | 2021-03-04 |