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Get it on time: Personal Testimonial

1. GIOT Personal Testimony

Did hospital/facility staff have an understanding of Parkinson's? Did you get your medication on time-every time? Do you want to share your experience?

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* 1. I am a:

Person living with Parkinson's

Spouse/Family Member/Carepartner completing this survey on behalf of a Person Living with Parkinson's

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* 2. While you were in the hospital/long term care facility did you get your Parkinson's medication on time?

Very rarely

Some of the time

Most of the time

Every time

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* 3. Please indicate your level of agreement with the following statements about the hospital/long term care facility:

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Staff had a strong general understanding of Parkinson's	Staff had a strong general understanding of Parkinson's Strongly Disagree	Staff had a strong general understanding of Parkinson's Disagree	Staff had a strong general understanding of Parkinson's Neither Agree nor Disagree	Staff had a strong general understanding of Parkinson's Agree	Staff had a strong general understanding of Parkinson's Strongly Agree
Staff treated me with respect and dignity	Staff treated me with respect and dignity Strongly Disagree	Staff treated me with respect and dignity Disagree	Staff treated me with respect and dignity Neither Agree nor Disagree	Staff treated me with respect and dignity Agree	Staff treated me with respect and dignity Strongly Agree
Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.)	Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.) Strongly Disagree	Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.) Disagree	Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.) Neither Agree nor Disagree	Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.) Agree	Staff were willing to listen to me, and help with Parkinson specific requests (medication timing, managing rigidity, swallowing issues, etc.) Strongly Agree

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* 4. Tell us about your experience getting your Parkinson's medication when you needed it during your stay. Did staff understand the importance of getting it on time? Did they talk about it? Did you have to mention it first?

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* 5. Did hospital/facility staff contact your prescribing specialist about your Parkinson's and medication timing?

Yes

No

Comments

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* 6. Tell us about your experience in being able to manage your own Parkinson's medication during your stay. Were you permitted to? Did you ask about self administration? What was the response?

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* 7. Please share any other comments about your experience.