H CAHPS Results for End of Sept 2010 Dec 2010

Size: px
Start display at page:

Download "H CAHPS Results for End of Sept 2010 Dec 2010"

Transcription

1 H CAHPS Results for End of Sept 2010 Dec patients to be contacted 23 successfully contacted 11 could not be reached (never answered phone) Note: Intracranial pts and non elective admissions excluded Of those who were successfully contacted (23): 3 were deemed to be ineligible 2 refused to participate 18 completed the surveys (response rate for those eligible = 18/20 = 90%) How often did nurses treat you with courtesy and respect? ( = 3.78) Frequency Percent Percent Percent Usually Always How often did nurses follow up on your concerns and observations? ( = 3.72) Frequency Percent Percent Percent Never Usually Always How often did nurses explain things in a way you could understand? ( = 3.50) Frequency Percent Percent Percent Never Sometimes Usually Always How often did nurses follow up on your concerns and observations? ( = 3.61) Frequency Percent Percent Percent Never Sometimes Usually Always

2 After you pressed the call button, how often did you get help as soon as you wanted it? Frequency Percent Percent Percent Always Don't Know\ What number would you give the care you got from all the nurses who treated you? ( = 9.00) Frequency Percent Percent Percent How often did doctors treat you with courtesy and respect? ( = 4.0) Frequency Percent Percent Percent Always How often did doctors listen carefully to you? ( = 3.89) Frequency Percent Percent Percent Usually Always How often did doctors explain things in a way you could understand? ( = 3.67) Frequency Percent Percent Percent Usually Always How often did doctors follow up on your concerns and observations? ( = 3.67) Frequency Percent Percent Percent Usually Always

3 What number would you give the care you got from all the doctors who treated you? ( = 9.19) Frequency Percent Percent Percent **How often was the area around your room kept quiet at night? ( = 3.50) Frequency Percent Percent Percent Sometimes Usually Always How often were your room and bathroom kept clean? ( = 3.61) Frequency Percent Percent Percent Never Sometimes Usually Always Did you need medicine for pain? Frequency Percent Percent Percent No Yes Don't Know Total Missing How often was your pain well controlled? ( = 3.38) Frequency Percent Percent Percent Sometimes Usually Always Total Missing

4 How often did the hospital staff do everything they could to help with your pain? ( = 4.00) Frequency Percent Percent Percent Always Missing Were you given any medicine that you had not taken before? Frequency Percent Percent Percent No Yes Don't Know Before giving you any medicine, how often did hospital staff tell you what the medicine was for? Frequency Percent Percent Percent Always Missing Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Frequency Percent Percent Percent Never Always Total Missing Did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? Frequency Percent Percent Percent No Yes **Did you get information, in writing, about what symptoms or health problems to look out for after you left the hospital? Frequency Percent Percent Percent No Yes Not Applicable Don't know

5 What number would you use to rate this hospital during your stay? ( = 8.89) Frequency Percent Percent Percent Would you recommend this hospital to your friends and family? ( = 3.94) Frequency Percent Percent Percent Probably Yes Definitely Yes What Language Do You Mainly Speak at Home? Frequency Percent Percent Percent English Other Language Were you born in Canada? Frequency Percent Percent Percent No Yes What is the highest level of education that you have acheived so far? Frequency Percent Percent Percent Elementary or Junior High Senior High- Incomplete Senior High- Complete College or Technical School-Incomplete College or Technical School-Incomplete University-Complete

6 What is your current marital status? Frequency Percent Percent Percent Single (Never Married) Married Common Law/Living With Partner Divorced Separated In general, how would you rate your overall physical health? Frequency Percent Percent Percent Excellent Very Good Good Fair Poor In general, how would you rate your overall mental or emotional health? Frequency Percent Percent Percent Excellent Very Good Good Fair Poor Refused

Calculating CAHPS Hospice Survey Top-Box Scores

Calculating CAHPS Hospice Survey Top-Box Scores Calculating CAHPS Hospice Survey Top-Box Scores This document summarizes the steps that the Centers for Medicare & Medicaid Services (CMS) uses to calculate top-box CAHPS Hospice Survey measure scores.

More information

Calculating CAHPS Hospice Survey Top-Box Scores

Calculating CAHPS Hospice Survey Top-Box Scores Calculating CAHPS Hospice Survey Top-Box Scores This document summarizes the steps that the Centers for Medicare & Medicaid Services (CMS) uses to calculate top-box CAHPS Hospice Survey measure scores.

More information

Case-Mix Adjustments for Q Q Publicly Reported CAHPS Hospice Survey Results

Case-Mix Adjustments for Q Q Publicly Reported CAHPS Hospice Survey Results Case-Mix Adjustments for Q2 2015 Q1 2016 Publicly Reported CAHPS Hospice Survey Results Overview Prior to public reporting, hospices CAHPS Hospice Survey results are adjusted for the effects of both mode

More information

Understanding dementia. people with learning disabilities finding out and raising awareness together

Understanding dementia. people with learning disabilities finding out and raising awareness together Understanding dementia people with learning disabilities finding out and raising awareness together About this booklet This booklet will tell you about dementia. It will also help you to understand what

More information

Learn about Delirium. Information for patients and families

Learn about Delirium. Information for patients and families Learn about Delirium Information for patients and families In this document you will find information about: What is delirium Signs Causes Treatment What you can do What is delirium? Delirium is sudden

More information

Public Attitudes and Knowledge about HIV/AIDS in Georgia Kaiser Family Foundation

Public Attitudes and Knowledge about HIV/AIDS in Georgia Kaiser Family Foundation Public Attitudes and Knowledge about HIV/AIDS in Georgia Kaiser Family Foundation Chart Pack November 2015 Methodology Public Attitudes and Knowledge about HIV/AIDS in Georgia is a representative, statewide

More information

UCA Speech-Language Hearing Center UCA Box Donaghey Avenue Conway, AR Phone: Fax: APHASIA CASE HISTORY

UCA Speech-Language Hearing Center UCA Box Donaghey Avenue Conway, AR Phone: Fax: APHASIA CASE HISTORY UCA Speech-Language Hearing Center UCA Box 4985 201 Donaghey Avenue Conway, AR 72035-0001 Phone: 501-450-3176 Fax: 501-450-5474 APHASIA CASE HISTORY General Information Name: Birthdate Gender Address:

More information

Case-Mix Adjustments for Q Q Publicly Reported CAHPS Hospice Survey Results

Case-Mix Adjustments for Q Q Publicly Reported CAHPS Hospice Survey Results Case-Mix Adjustments for Q2 2017 - Q3 2017 Publicly Reported CAHPS Hospice Survey Results Overview Prior to public reporting, hospices CAHPS Hospice Survey results are adjusted for the effects of both

More information

San Diego Center for the Treatment of Mood Disorders 1

San Diego Center for the Treatment of Mood Disorders 1 San Diego Center for the Treatment of Mood Disorders 1 DATE NAME Last Middle First REFERRAL HISTORY: How did you find us (via a referral, web search, recommendation)? Please provide the name and phone

More information

Overseen by: Prof. Judy Freedman Fask, College of the Holy Cross

Overseen by: Prof. Judy Freedman Fask, College of the Holy Cross Interviewee:Dennise Scott Interviewer: Lauren Spadaro Interpretors: Rebecca Blusenheim, Bethany Bertrand, Northeastern University Date of Interview: May 8, 2007 Location: College of the Holy Cross Overseen

More information

What is a clinical psychologist?

What is a clinical psychologist? What is a clinical psychologist? Easy read information leaflet www.bps.org.uk/dcp The Picture Communication Symbols 1981 2011 by Mayer-Johnson LLC. All Rights Reserved Worldwide. What is a clinical psychologist?

More information

NHS SERVICES TO MEET YOUR NEEDS THE STANDARDS OF CARE YOU CAN EXPECT

NHS SERVICES TO MEET YOUR NEEDS THE STANDARDS OF CARE YOU CAN EXPECT NHS SERVICES TO MEET YOUR NEEDS Meeting these unique needs requires special knowledge and skills, so NHS England has stated that there should be cancer services especially for teenagers and young adults

More information

2016 Children and young people s inpatient and day case survey

2016 Children and young people s inpatient and day case survey NHS Patient Survey Programme 2016 Children and young people s inpatient and day case survey Technical details for analysing trust-level results Published November 2017 CQC publication Contents 1. Introduction...

More information

Sleep & Relaxation. Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique

Sleep & Relaxation. Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique Sleep & Relaxation Sleep & Relaxation Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique Session 2 Dealing with unhelpful thoughts Putting these techniques together for better

More information

National Cancer Information Center

National Cancer Information Center National Cancer Information Center The American Cancer Society s National Cancer Information Center (NCIC) is a nationwide cancer help line open 24 hours a day, 7 days a week. The NCIC has trained Cancer

More information

Improving Your Sleep During Your Hospital Stay

Improving Your Sleep During Your Hospital Stay PATIENT & CAREGIVER EDUCATION Improving Your Sleep During Your Hospital Stay This information will help you improve your sleep during your hospital stay. Sleeping well at night can make you feel better

More information

To learn more, visit the website and see the Find Out More section at the end of this booklet.

To learn more, visit the website  and see the Find Out More section at the end of this booklet. Loving Your Child, Learning How to Help Congratulations! As a parent of a precious baby or young child, you have a wonderful journey ahead. The fact that your child has a hearing loss is only one part

More information

How to apply for Access to Work (AtW) online: (Correct as of September 2018)

How to apply for Access to Work (AtW) online: (Correct as of September 2018) This is information to help you apply for AtW. It is worth reading all of this before you start applying because it will help you be prepared with your answers, and gives you suggestions about how to explain

More information

Client Information Form

Client Information Form Client Information Form General Information Date: Name: Date of Birth: Age: Current Address: Home Phone: Cell Phone: Best number and time to reach you directly: Can I leave a message at either or both

More information

Testimony of Dana Godfrey

Testimony of Dana Godfrey Testimony of Dana Godfrey DIRECT EXAMINATION 18 19 BY MR. CURTIS GLOVER: 20 Q. Dana, tell the jury what you do. 21 A. I'm a housewife and I also work with 22 my husband part-time now in electronics. 23

More information

Our Pledge to Children in Care and Care Leavers

Our Pledge to Children in Care and Care Leavers Our Pledge to Children in Care and Care Leavers 1 Designed and printed by Bristol City Council, Bristol Design OCTOBER 15 BD7047 Bristol Corporate Parenting Strategy The Bristol Pledge The pledge is a

More information

Moving Forward. Support for you after a diagnosis of breast cancer. The breast cancer support charity

Moving Forward. Support for you after a diagnosis of breast cancer. The breast cancer support charity Moving Forward Support for you after a diagnosis of breast cancer The breast cancer support charity We understand breast cancer changes everything. If you ve had treatment for breast cancer and are looking

More information

New Patient Intake. Boynton Health Mental Health Clinic. If you are new to the mental health clinic or have not been seen in over one year:

New Patient Intake. Boynton Health Mental Health Clinic. If you are new to the mental health clinic or have not been seen in over one year: New Patient Intake Boynton Health Mental Health Clinic Welcome to the Boynton Health Mental Health Clinic The Mental Health Clinic is open to degree-seeking University of Minnesota Twin Cities campus students

More information

WORKER ASSIGNMENT SHEET

WORKER ASSIGNMENT SHEET CHAPTER 4 PERSONAL AND PROFESSIONAL. QUALITIES OF A HEALTH CARE WORKER ASSIGNMENT SHEET Grade Name INTRODUCTION: Certain personal characteristics, attitudes, and rules of appearance apply to all health

More information

NORC AmeriSpeak Omnibus Survey: 41% of Americans Do Not Intend to Get a Flu Shot this Season

NORC AmeriSpeak Omnibus Survey: 41% of Americans Do Not Intend to Get a Flu Shot this Season Omnibus Survey: 41% of Americans Do Intend to Get a Flu Shot this Season Interview Dates: November 14-19, 2018 Nationally representative sample of 1,202 English-speaking adults age 18 and over, conducted

More information

The Phoenix ESTLR/STAR Pre-Screening Form

The Phoenix ESTLR/STAR Pre-Screening Form 1 The Phoenix ESTLR/STAR Pre-Screening Form INTERVIEWER NAME: *******DATE: yyyy mmm dd Applicant Data Applicant Name Age D.O.B MMM DD YYYY PHN: S.I.N Tel: Length of abstinence as of today? or Clean Date:

More information

2017 Medicare CAHPS At-A-Glance Report

2017 Medicare CAHPS At-A-Glance Report 2017 Medicare CAHPS At-A-Glance Report CMS MA PD Contract: H9207 Project Number(s): 30120117 and 10123759 Current data as of: 07/10/2017 1965 Evergreen Boulevard Suite 100, Duluth, Georgia 30096 2017 At-A-Glance

More information

Information Session. What is Dementia? People with dementia need to be understood and supported in their communities.

Information Session. What is Dementia? People with dementia need to be understood and supported in their communities. Information Session People with dementia need to be understood and supported in their communities. You can help by becoming a Dementia Friend. Visit www.actonalz.org/dementia-friends to learn more! Dementia

More information

DECISION QUALITY WORKSHEET TREATMENTS FOR DEPRESSION

DECISION QUALITY WORKSHEET TREATMENTS FOR DEPRESSION DECISION QUALITY WORKSHEET TREATMENTS FOR DEPRESSION Instructions This survey has questions about what it is like for you to make decisions about treating your depression. Please check the box or circle

More information

Date: / / Hello, my name is [interviewer name], and I'm calling to speak with [participant name]. Is [participant name] available?

Date: / / Hello, my name is [interviewer name], and I'm calling to speak with [participant name]. Is [participant name] available? Multi-Ethnic Study of Atherosclerosis Follow-up Phone Call 16 Participant Id#: Acrostic: General Health Date: / / Day INTRODUCTION Hello, my name is [interviewer name], and I'm calling to speak with [participant

More information

Helping you understand the care and support you can ask for in Wales.

Helping you understand the care and support you can ask for in Wales. Helping you understand the care and support you can ask for in Wales. Contents About this leaflet What type of support can I ask for? What type of information can I ask for? What questions can I ask my

More information

Sleep Health Center. You have been scheduled for an Insomnia Treatment Program consultation to further discuss your

Sleep Health Center. You have been scheduled for an Insomnia Treatment Program consultation to further discuss your Sleep Health Center You have been scheduled for an Insomnia Treatment Program consultation to further discuss your sleep. In the week preceding your appointment, please take the time to complete the enclosed

More information

CHINO VALLEY UNIFIED SCHOOL DISTRICT INSTRUCTIONAL GUIDE AMERICAN SIGN LANGUAGE 1

CHINO VALLEY UNIFIED SCHOOL DISTRICT INSTRUCTIONAL GUIDE AMERICAN SIGN LANGUAGE 1 CHINO VALLEY UNIFIED SCHOOL DISTRICT INSTRUCTIONAL GUIDE AMERICAN SIGN LANGUAGE 1 Course Number 5716 Department Elective Length of Course One (1) year/two (2) semesters Grade Level 9-12 Prerequisite None

More information

Harvard Opinion Research Program Harvard School of Public Health SWINE FLU (H1N1 VIRUS) SURVEY. April 29, 2009

Harvard Opinion Research Program Harvard School of Public Health SWINE FLU (H1N1 VIRUS) SURVEY. April 29, 2009 Harvard Opinion Research Program Harvard School of Public Health SWINE FLU (H1N1 VIRUS) SURVEY April 29, 2009 Research Team: Robert J. Blendon, Harvard School of Public Health, Project Director Gillian

More information

American Cancer Society National Cancer Information Center (NCIC)

American Cancer Society National Cancer Information Center (NCIC) American Cancer Society National Cancer Information Center (NCIC) The American Cancer Society s National Cancer Information Center (NCIC) is a nationwide cancer help line open 24 hours a day, 7 days a

More information

SAMMY BEAR S MUMMY IS IN HOSPITAL

SAMMY BEAR S MUMMY IS IN HOSPITAL SAMMY BEAR S MUMMY IS IN HOSPITAL A story for children aged 3 6 to be read with an adult 2 Notes for adults We hope this rhyming story will be useful for family, carers, social workers and teachers who

More information

Research has long suggested that 21 days is all it takes to start a new habit.

Research has long suggested that 21 days is all it takes to start a new habit. Research has long suggested that 21 days is all it takes to start a new habit. 2 Introduction It s normal to feel a tad stressed from time to time. Life can be stressful. We all worry about things like

More information

Universal Newborn. Your baby has referred for another Hearing Screening or Diagnostic Hearing Test

Universal Newborn. Your baby has referred for another Hearing Screening or Diagnostic Hearing Test Parents are important partners. They have the greatest impact upon their young child and their active participation is crucial. Mark Ross (1975) Universal Newborn HEARING SCREENING Your baby has referred

More information

Supporting You to Speak Up

Supporting You to Speak Up 10093 Cheshire Booklet 2:Layout 1 04/09/2009 12:02 Page 1 Your Complaints & Feedback are Welcome Supporting You to Speak Up An information booklet for people receiving a Cheshire service, their family

More information

3. They complete the gaps of transcript with the correct verbs.

3. They complete the gaps of transcript with the correct verbs. Lesson Plan 1. Identify pictures, put Christina s day in order. 2. Listen 3. They complete the gaps of transcript with the correct verbs. 4. Clarify what 1 st person and 3 rd person is on the board above

More information

My handbook. Easy English

My handbook. Easy English My handbook Easy English Wellways National Consumer and Carer Advisory Committee 2017 helped write your handbook. Thank you! Wellways Australia Limited 2018 In your handbook We are Wellways...5 Who is

More information

P2P Mentor Program Application (Parent to Parent Mentor Program)

P2P Mentor Program Application (Parent to Parent Mentor Program) P2P Mentor Program Application (Parent to Parent Mentor Program) Thank you for your interest in volunteering with us in the P2P Program Pilot! Autism Edmonton has consulted potential mentees in a survey

More information

[H1N1 New Mother Poll] Weighted Topline March 24, 2010

[H1N1 New Mother Poll] Weighted Topline March 24, 2010 H1N1 New Poll Topline Summary [H1N1 New Poll] Weighted Topline March 24, 2010 Knowledge Networks fielded this study on behalf of the Harvard School of Public Health. Interviews were collected from January

More information

Testimony of Dana Routier

Testimony of Dana Routier Testimony of Dana Routier DIRECT EXAMINATION 12 13 BY MR. DOUGLAS MULDER: 14 Q. Dana, will you tell the jury where you 15 were born and raised? 16 A. I was born in Nashville, Tennessee. 17 And I was raised

More information

NAMI In Our Own Voice Presenter Screening Tool

NAMI In Our Own Voice Presenter Screening Tool NAMI In Our Own Voice Presenter Screening Tool This tool has been developed by individuals who are currently involved in recruiting and evaluating consumers for NAMI programs. It is offered as a relevant

More information

APPENDICES. In the following pages you will find:

APPENDICES. In the following pages you will find: APPENDICES This guide was developed to assist you in organizing your loved one s care. The following appendices can be used to help you organize yourself. Pick the ones that fit your needs, and adapt them

More information

Moving Forward. Support for you after a diagnosis of breast cancer. The breast cancer support charity

Moving Forward. Support for you after a diagnosis of breast cancer. The breast cancer support charity Moving Forward Support for you after a diagnosis of breast cancer The breast cancer support charity We understand breast cancer changes everything. If you ve had treatment for breast cancer and are looking

More information

handouts for women 1. Self-test for depression symptoms in pregnancy and postpartum Edinburgh postnatal depression scale (epds) 2

handouts for women 1. Self-test for depression symptoms in pregnancy and postpartum Edinburgh postnatal depression scale (epds) 2 handouts for women 1. Self-test for depression symptoms in pregnancy and postpartum Edinburgh postnatal depression scale (epds) 2 2. The Cognitive-Behaviour Therapy model of depression 4 3. Goal setting

More information

Xs4 t5 Pauktuutit wkw5 x3nw5 vnbu INUIT WOMEN OF CANADA. Getting Ready. for Hepatitis C Treatment A GUIDE. This booklet will help you prepare.

Xs4 t5 Pauktuutit wkw5 x3nw5 vnbu INUIT WOMEN OF CANADA. Getting Ready. for Hepatitis C Treatment A GUIDE. This booklet will help you prepare. Xs4 t5 Pauktuutit wkw5 x3nw5 vnbu INUIT WOMEN OF CANADA Getting Ready for Hepatitis C Treatment A GUIDE This booklet will help you prepare. Design EarthLore Communications Photos: front cover main and

More information

Life After A Heart Attack

Life After A Heart Attack Life After A Heart Attack A heart attack changes the lives of both seniors and their caregivers. If your loved one has had a heart attack, it's essential to understand the medications and lifestyle changes

More information

REGION 9 ASSEMBLY 2013 ABSTINENCE WORKSHOP REPORT

REGION 9 ASSEMBLY 2013 ABSTINENCE WORKSHOP REPORT APPENDIX J Group Let's look more closely - What do you understand from refrain What does compulsive food behaviors means to you What does the word obsession mean to you What does the word compulsion mean

More information

Messages of hope and support

Messages of hope and support Messages of hope and support Italian English i About us Breast Cancer Network Australia (BCNA) is the peak organisation for all people affected by breast cancer in Australia. We provide a range of free

More information

Safeguarding adults: mediation and family group conferences: Information for people who use services

Safeguarding adults: mediation and family group conferences: Information for people who use services Safeguarding adults: mediation and family group conferences: Information for people who use services The Social Care Institute for Excellence (SCIE) was established by Government in 2001 to improve social

More information

[H1N1 Pregnant Women Poll] Weighted Topline March 24, 2010

[H1N1 Pregnant Women Poll] Weighted Topline March 24, 2010 H1N1 Women Poll Topline Summary [H1N1 Women Poll] Weighted Topline March 24, 2010 Knowledge Networks fielded this study on behalf of the Harvard School of Public Health. Interviews were collected from

More information

Your solution to medical uncertainty members.bestdoctors.com

Your solution to medical uncertainty members.bestdoctors.com Your solution to medical uncertainty My experience was very positive; Best Doctors gave me the reassurance to go forward with the proper medical care I needed. What is Best Doctors? Best Doctors is an

More information

Thank you for reading this.

Thank you for reading this. Can we Reduce Asthma Attacks in Children using Exhaled Nitric Oxide measurements? (RAACENO) We would like to invite you to take part in a study which will see if taking a breathing test every three months

More information

Smoking Among Pregnant Women in the Baffin Region of Nunavut. Chantal Nelson PhD Candidate, Population Health University of Ottawa

Smoking Among Pregnant Women in the Baffin Region of Nunavut. Chantal Nelson PhD Candidate, Population Health University of Ottawa Smoking Among Pregnant Women in the Baffin Region of Nunavut Chantal Nelson PhD Candidate, Population Health University of Ottawa Background 80% of pregnant women in Nunavut smoke compared to the national

More information

HEDIS CAHPS 4.0H Member Survey

HEDIS CAHPS 4.0H Member Survey Helping you turn insight into action HEDIS - CAHPS 4.0H Member Survey Adult - HMO prepared for ANTHEM BLUE CROSS BLUE SHIELD - INDIA June 800.989.5150 dssresearch.com Table of Contents Background and Objectives

More information

Equality Scheme. Our plan about how we are going to treat people fairly and make things better for staff and people who use our services

Equality Scheme. Our plan about how we are going to treat people fairly and make things better for staff and people who use our services Northern Ireland Blood Transfusion Service Equality Scheme Our plan about how we are going to treat people fairly and make things better for staff and people who use our services September 2011 Northern

More information

Breathe Easy. Tips for controlling your Asthma

Breathe Easy. Tips for controlling your Asthma Breathe Easy Tips for controlling your Asthma Have you or a family member been told you have asthma? Are you or a family member coughing or wheezing? Do you or a family member have tightness in your chest?

More information

Co-Production Agreement for Health and Social Care in Hackney and the City of London

Co-Production Agreement for Health and Social Care in Hackney and the City of London Co-Production Agreement for Health and Social Care in Hackney and the City of London Co-Production is about organisations working together with people to improve services. This is an Agreement about working

More information

Cy-Fair Hearing Aids Case History Form. Brandy R Jacobson Au.D. PERSONAL INFORMATION. Patient Name: Appointment Date: Date of Birth: Age: Gender: Male

Cy-Fair Hearing Aids Case History Form. Brandy R Jacobson Au.D. PERSONAL INFORMATION. Patient Name: Appointment Date: Date of Birth: Age: Gender: Male Cy-Fair Hearing Aids Case History Form Brandy R Jacobson Au.D. PERSONAL INFORMATION Patient Name: Appointment Date: Date of Birth: Age: Gender: Male Female Marital Status: Single Married Divorced Widowed

More information

Patient Follow-up Form - Version 1.1

Patient Follow-up Form - Version 1.1 Physician: [Last Name GO PROJECT Patient Follow-up Form - Version 1.1 Thank you for participating in the Glioma Outcomes Project. To continue participating in this important project, complete or correct

More information

Simonside Primary School ASTHMA POLICY

Simonside Primary School ASTHMA POLICY Simonside Primary School ASTHMA POLICY 1 These named staff members have volunteered to be responsible for maintaining the emergency inhaler kit (Minimum of 2 staff) Name 1 Julie Parnaby Name 2 Lisa Pegman

More information

ELDER ABUSE In THE SHUSWAP

ELDER ABUSE In THE SHUSWAP ELDER ABUSE In THE SHUSWAP Booklet #3 of 4 PREVENTION ELDER ABUSE AWARENESS PROGRAM 2016 An Immigrant Services Shuswap Program 2016 Funded by New Horizons for Seniors Project, Government of Canada BOOKLETS

More information

HELPING YOU HAVE A CONVERSATION ABOUT PROSTATE CANCER

HELPING YOU HAVE A CONVERSATION ABOUT PROSTATE CANCER HELPING YOU HAVE A CONVERSATION ABOUT PROSTATE CANCER The Manversation campaign has been developed in consultation with leading prostate cancer charities Orchid Male Cancer and Tackle Prostate Cancer.

More information

Questions for the Table Group

Questions for the Table Group Clinical Research Study Study 1 Natalie and her daughter, Sarah I am 40 years old. I am HIV negative. My daughter s name is Sarah. She has AIDS. She is 12 years old. I have many fights with my daughter

More information

Self-directed support

Self-directed support Self-directed support Mental health and self-directed support Self- directed support is for everyone who is eligible for social care funding. This answers some of the most commonly heard questions about

More information

2016 Medicaid Adult CAHPS 5.0H. At-A-Glance Report

2016 Medicaid Adult CAHPS 5.0H. At-A-Glance Report 2016 Medicaid Adult CAHPS 5.0H At-A-Glance Report Health Partners Plans Project Number(s): 4109174 Current data as of: 06/16/2016 1965 Evergreen Boulevard Suite 100, Duluth, Georgia 30096 2016 At-A-Glance

More information

MEDICAL MALE CIRCUMCISION. A discussion tool

MEDICAL MALE CIRCUMCISION. A discussion tool MEDICAL MALE CIRCUMCISION A discussion tool About the MMC Discussion Tool Learn and talk about Medical Male Circumcision with this exciting learning tool. It consists of a 15-minute DVD, which tells the

More information

Date: / / Hello, my name is [interviewer name], and I'm calling to speak with [participant name]. Is [participant name] available?

Date: / / Hello, my name is [interviewer name], and I'm calling to speak with [participant name]. Is [participant name] available? Multi-Ethnic Study of Atherosclerosis Follow-up Phone Call 17 Participant Id#: Acrostic: General Health Date: / / Day INTRODUCTION Hello, my name is [interviewer name], and I'm calling to speak with [participant

More information

Science Leads. By: Brooke Jahner and Rachel Wagner. PHEOCS Investigation

Science Leads. By: Brooke Jahner and Rachel Wagner. PHEOCS Investigation Science Leads By: Brooke Jahner and Rachel Wagner PHEOCS Investigation There is an old saying Music sooths the savage beast. Does it also affect the heart rate of a person? Will the heart rate of a person

More information

ACS 106 LANGUAGE LEADER / PRE-INTERMEDIATE

ACS 106 LANGUAGE LEADER / PRE-INTERMEDIATE ACS 106 LANGUAGE LEADER / PRE-INTERMEDIATE 8.1. SLEEP TIGHT! http://www.youtube.com/watch?v=3elfn7ewx_s 8.1. SLEEP TIGHT! SPEAKING & VOCABULARY What kind of a sleeper are you? 8.1. SLEEP TIGHT! READING

More information

Diabetes services in Leicester - Have your say

Diabetes services in Leicester - Have your say Diabetes services in Leicester - Have your say We are reviewing two existing diabetes services in Leicester so that we can potentially make changes of improvement for patients. These are: 1. The Integrated

More information

Oliver Figgat A Birth Story

Oliver Figgat A Birth Story Oliver Figgat A Birth Story Dear Oliver, I feel like writing this in letter format will be easiest, because let's face it. This is all about your birthday! In the days leading up to your birth, I was incredibly

More information

CBT Intake Form. Patient Name: Preferred Name: Last. First. Best contact phone number: address: Address:

CBT Intake Form. Patient Name: Preferred Name: Last. First. Best contact phone number:  address: Address: Patient Information CBT Intake Form Patient Name: Preferred Name: Last Date of Birth: _// Age: _ First MM DD YYYY Gender: Best contact phone number: Email address: _ Address: _ Primary Care Physician:

More information

2 Franklin Street, Belfast, BT2 8DQ Equality Scheme

2 Franklin Street, Belfast, BT2 8DQ Equality Scheme 2 Franklin Street, Belfast, BT2 8DQ Equality Scheme Our plan about how we are going to treat people fairly and make things better for staff and people who use our services September 2011 This is a shorter

More information

National Stroke Association s Guide to Choosing Stroke. Rehabilitation Services

National Stroke Association s Guide to Choosing Stroke. Rehabilitation Services National Stroke Association s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills

More information

ANNUAL FOLLOW-UP FORM

ANNUAL FOLLOW-UP FORM Public reporting burden for this collection of information is estimated to average 6-15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and

More information

CA: Hi, my name is Camille, and I will be interviewing you today. Would you please introduce yourself?

CA: Hi, my name is Camille, and I will be interviewing you today. Would you please introduce yourself? Interviewee: Ying Li Interviewer: Camille Alvarado Date of Interview: April 17, 2007 Location: Worcester, Massachusetts Transcriber: Randylin Bourassa, The Salter School Interpreters: Nicole Heart and

More information

Housing Needs Assessment Survey Tool

Housing Needs Assessment Survey Tool Appendix II -Year Chicago Area HIV/AIDS Housing Plan A-9 Housing Needs Assessment Survey Tool Appendix II consists of the English Housing Needs Assessment Survey tool (the Spanish-language survey is not

More information

PATIENT SURVEY FOR ADMINISTRATIVE USE ONLY. TO BE COMPLETED BY STUDY COORDINATOR.

PATIENT SURVEY FOR ADMINISTRATIVE USE ONLY. TO BE COMPLETED BY STUDY COORDINATOR. PATIENT SURVEY FOR ADMINISTRATIVE USE ONLY. TO BE COMPLETED BY STUDY COORDINATOR. DATE OF VISIT: / / PATIENT ID: REGULAR PROVIDER: SITE OF VISIT: Cleveland Houston Manhattan Pittsburgh Thank you for agreeing

More information

Letter to the teachers

Letter to the teachers Letter to the teachers Hello my name is Sasha Jacombs I m 12 years old and I have had Type 1 Diabetes since I was four years old. Some of the people reading this may not know what that is, so I had better

More information

OUTCOMES AND DATA 2016

OUTCOMES AND DATA 2016 AND DATA 2016 SERVED BY REHAB IMPAIRMENT CATEGORY 20 patients 5.1% MAJOR MULTIPLE TRAUMA W/BRAIN OR SPINAL CORD INJURY 24 patients 6.2% TRAUMATIC 39 patients 10.0% AMPUTATION LOWER EXTREMITY 26 patients

More information

National Inspection of services that support looked after children and care leavers

National Inspection of services that support looked after children and care leavers National Inspection of services that support looked after children and care leavers Introduction Children and young people that are looked after and those leaving care need the best support possible. Support

More information

Participant Information Sheet

Participant Information Sheet Appendix A Participant Information Sheet for Young People Participant Information Sheet Exploring experiences of disclosure and non-disclosure amongst young adolescents who hear voices Hi. My name is Rachel

More information

Healthy bladder and bowel habits. Continence Foundation of Australia

Healthy bladder and bowel habits. Continence Foundation of Australia Healthy bladder and bowel habits Continence Foundation of Australia Easy English 2016 Healthy bladder and bowel habits This factsheet is about how to keep your bladder and bowel healthy. This factsheet

More information

What happens to people with dementia when they move between care homes and hospitals?

What happens to people with dementia when they move between care homes and hospitals? What happens to people with dementia when they move between care homes and hospitals? A report by CQC saying what we found out This is an EasyRead version of: Cracks in the Pathway People s experiences

More information

Children with cochlear implants: parental perspectives. Parents points of view

Children with cochlear implants: parental perspectives. Parents points of view : parental perspectives Parents points of view Introduction In this booklet, we summarise the views of parents of children with cochlear implants. These parents completed a lengthy questionnaire about

More information

Angie s Marriage Column July 15, Dealing with a Mentally Abusive Alcoholic

Angie s Marriage Column July 15, Dealing with a Mentally Abusive Alcoholic Angie s Marriage Column July 15, 2009 Dealing with a Mentally Abusive Alcoholic Marriage Questions: I have a question - what if you're in a position where the only place your spouse can safely drink is

More information

Notes from filming at White River VA-February 5, 2008

Notes from filming at White River VA-February 5, 2008 Notes from filming at White River VA-February 5, 2008 Wellness Tools Go fishing Shut down and think, what to do and what not to do Get into a good book Drawing Focus on something other than negatives Be

More information

Under the Supervision of: Prof. Judy Freedman Fask, College of the Holy Cross

Under the Supervision of: Prof. Judy Freedman Fask, College of the Holy Cross Interviewee: Lillian MacWhinnie Interviewees: Chelsea Vanacore and Brittany Michelson College of the Holy Cross Interpreters: Sarah Clinkenbeard and Tyler Nelson Northeastern University Date of Interview:

More information

Funding Health and Long-Term Care: A Survey on Increasing North Carolina's Cigarette and Alcohol Taxes

Funding Health and Long-Term Care: A Survey on Increasing North Carolina's Cigarette and Alcohol Taxes Funding Health and Long-Term Care: A Survey on Increasing North Carolina's Cigarette and Alcohol Taxes Data Collected by Southeastern Institute of Research, Inc. Report Prepared by Rachelle Cummins Copyright

More information

Initial Patient Self Assessment Demographics:

Initial Patient Self Assessment Demographics: Initial Patient Self Assessment Demographics: Name: Address: E mail: Phone Number: Date of Birth: Gender: Male Female Other Primary Language: English Spanish Other Occupation: Education: Clerical Skilled

More information

LISTEN A MINUTE.com. Fear. Focus on new words, grammar and pronunciation in this short text.

LISTEN A MINUTE.com. Fear.   Focus on new words, grammar and pronunciation in this short text. LISTEN A MINUTE.com Fear http://www.listenaminute.com/f/fear.html One minute a day is all you need to improve your listening skills. Focus on new words, grammar and pronunciation in this short text. Doing

More information

The table below includes the quality measures an ACO is required to submit to CMS as a participant in an MSSP Track 3 ACO

The table below includes the quality measures an ACO is required to submit to CMS as a participant in an MSSP Track 3 ACO The table below includes the quality measures an ACO is required to submit to CMS as a participant in an MSSP Track 3 ACO ACO-1 ACO-2 Getting Timely Care, Appointments, and Information How Well Your Providers

More information

General Fall Prevention

General Fall Prevention Slide 1 General Fall Prevention Determining Risk, Implementing Interventions and Managing Falls Senior Vice President of Patient Care Services Hello, I am Anne Panik, Senior Vice President of Patient Care

More information

Internship notes 5/13/13 (7:45-12:15)

Internship notes 5/13/13 (7:45-12:15) 5/13/13 (7:45-12:15) Started at 7:45am this morning with going over projects that I will be completely throughout my stay with Midwest Physical therapy. I will be updating the facebook page, website, and

More information

Participant Self-Assessment of Diabetes Management

Participant Self-Assessment of Diabetes Management Participant Self-Assessment of Diabetes Management Name: Date: Date of Birth: Age: Gender: F M Ethnic Background: White/Caucasian Black/African American Hispanic Native American-Alaska Asian/Pacific Islander

More information

Child s Information (Please print) Name Birth Date Age Home Address City State Zip Code

Child s Information (Please print) Name Birth Date Age Home Address City State Zip Code The following questions are asked so that we can best understand your child. Please fill out this questionnaire before the child is evaluated. Please read the questions carefully and answer them as fully

More information