SURVEY INSTRUCTIONS

March 2017 1

 

HCAHPS Survey

 

SURVEY INSTRUCTIONS

 You should only fill out this survey if you were the patient during the hospital stay named in the cover letter. Do not fill out this survey if you were not the patient.

 Answer all the questions by checking the box to the left of your answer.

 You are sometimes told to skip over some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this:

 Yes  No  If No, Go to Question 1

 

You may notice a number on the survey. This number is used to let us know if you returned your survey so we don’t have to send you reminders. Please note: Questions 1-25 in this survey are part of a national initiative to measure the quality of care in hospitals. OMB #0938-0981

 

 

Please answer the questions in this survey

about your stay at the hospital named on

the cover letter. Do not include any other

hospital stays in your answers.

 

YOUR CARE FROM NURSES

1. During this hospital stay, how often

did nurses treat you with courtesy

and respect?

1  Never

2  Sometimes

3  Usually

4  Always

 

2. During this hospital stay, how often

did nurses listen carefully to you?

1  Never

2  Sometimes

3  Usually

4  Always

3. During this hospital stay, how often

did nurses explain things in a way

you could understand?

1  Never

2  Sometimes

3  Usually

4  Always

 

4. During this hospital stay, after you

pressed the call button, how often did

you get help as soon as you wanted

it?

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