AIDET COMMUNICATION PROCESS

  • You should only fill out this survey if you were the patient during the clinic visit 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

þ         No èIf 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 1-24 in this survey are part of a national initiative to measure the quality   of care in the clinic. OMB #0938-0981

 

Please answer the questions in this survey about your clinic visit named on the cover letter. Do not include any other clinic visit in your answers.

 

YOUR CARE FROM NURSES

3.

 

4.

 

During this clinic visit, how often did nurses explain things in a way you could understand?

1o Never

2o Sometimes

3o Usually

4o Always

During this clinic visit, after you asked for help, how soon did you get the help you wanted?

1o Never

2o Sometimes

3o Usually

4o Always

9o I never pressed the call button

1.        During this clinic visit, how often did nurses treat you with courtesyand respect

1o Never

2o Sometimes

3o Usually

4o Always

 

2.        During this clinic visit, how often did nurses listen carefully to you?

1o Never

2o Sometimes

3o Usually

4o Always

March 2017                                                                                                                                                                                                1

 

 

 

           YOUR CARE FROM DOCTORS

  1. During this clinic visit, how often did doctors treat you with courtesyand respect?

[1]o Never

[2]o Sometimes

[3]o Usually

[4]o Always

 

  1. During this clinic visit, how often did doctors listen carefully to you?

[5]o Never

[6]o Sometimes

[7]o Usually

[8]o Always

 

  1. During this clinic visit, how often did doctors explain things in a way you could understand?

[9]o Never

[10]o Sometimes

[11]o Usually

[12]o Always

 

             THE CLINIC ENVIRONMENT

 

YOUR EXPERIENCES IN THIS CLINIC

 

 

 

  1. During this clinic visit, did you need medicine for pain?

1o Yes

2o No

 

  1. During this clinic visit, how often was your pain well controlled?

1o Never

2o Sometimes

3o Usually

4o Always

 

2                                                                                                                                                                                                              March 2017

 

 

  1. Before writing you any new medicine, how often did clinic staff tell you what the medicine was for?

1o Never

2o Sometimes

 

  1. Before giving you any new medicine, how often did Clinic staff describe possible side effects in a way you could understand?

1o Never

2o Sometimes

3o Usually

4o Always

 

            WHEN YOU LEFT THE CLINIC

  1. During this clinic visit, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the clinic?

1o Yes

2o No

 

  1. During this clinic visit, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

1o Yes

2oNo

 

       OVERALL RATING OF THE CLINIC

Please answer the following questions about your clinic visit named on the cover letter. Do not include any other clinic visits in your answers.

 0o 0 Worst hospital possible

 1o 1

 2o 2

 3o 3

 4o 4

 5o 5

 6o 6

 7o 7

 8o 8

 9o 9

10o10              Best hospital possible

 

  1. Would you recommend this clinic to your friends and family?

[13]o Definitely no

[14]o Probably no

[15]oProbably yes

[16]o Definitely yes

 

UNDERSTANDING YOUR CARE WHEN YOU LEFT THE CLINIC

  1. During this clinic visit, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.

1o Strongly disagree

2o Disagree

3o Agree

4ostrongly agree

 

  1. When I left the clinic, I had a good understanding of the things I was responsible for in managing my health.

1ostrongly disagree

2o Disagree

3o Agree

4ostrongly agree

 

  1. When I left the clinic, I clearly understood the purpose for taking each of my medications.

ABOUT YOU

There are only a few remaining items left.

 

  1. How would you rate your overall health?

1o Excellent

2o Very good

3o Good

4o Fair

[17]o Poor

 

  1. In general, how would you rate your overall mental or emotional health?

1o Excellent

[18]o Very good

[19]o Good

[20]o Fair

[21][22]o Poor

 

  1. What is the highest grade or level of school that you have completed?

1o 8th grade or less

 

[1]o Never

[2]o Sometimes

[3]o Usually

[4]o Always

 

  1. During this clinic visit, how often was the area around you kept silent?

[5]o Never

[6]o Sometimes

[7]o Usually

[8]o Always

P(5.m)       

Prime Essay Services , written from scratch, delivered on time, at affordable rates!

 

CategoriesUncategorized

Leave a Reply

Your email address will not be published. Required fields are marked *