HCAHPS Survey
Form Template
This HCAHPS Survey has been turned into a mobile application.
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Please answer the following questions about your stay at the hospital named on the cover letter. Do not include any other hospital stays in your answers. Questions asked include: During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan? During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? After you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?
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