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* 1. Before your procedure, did a health professional explain what would happen to you in a way you could understand?    

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* 2. Did your doctor or anyone from the hospital give you easy to understand instructions about getting ready for your procedure?

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* 3. Did a health professional explain any risks and/or benefits of the procedure in a way you could understand?

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* 4. Before your procedure, did you know who to contact if your symptoms or condition got worse?

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* 5. Did you have enough time to talk about your health condition, worries or fears with the surgeon?

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* 6. Did the surgeon listen carefully to what you had to say?

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* 7. If you had questions to ask the surgeon, did you get answers that you could understand?

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* 8. If you had questions to ask the anesthesiologist, did you get answers that you could understand?

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* 9. Did team members treating and examining you introduce themselves?

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* 10. If your procedure did not start on time, how long did you have to wait?

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* 11. If you had to wait, were you told why?

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* 12. Were you involved as much as you wanted to be in decisions about your care and treatment?

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* 13. How much information about your condition or procedure was given to your family, caregiver or someone close to you?

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* 14. Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your procedure?

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* 15. Do you think the hospital team did everything they could to prepare you to manage your pain after you left the hospital?

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* 16. Before you left the hospital, were you told what would happen next (for example, did you need a follow-up appointment)?

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* 17. Did you receive information about what symptoms or health problems regarding your procedure to watch for at home?

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* 18. Did you receive enough information from hospital team members about what to do if you were worried about your condition or treatment after you left the hospital?

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* 19. Did doctors, nurses or other health professionals talk to you about whether you would have the help you needed at home after you left the hospital?

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* 20. Overall, did you feel you were treated with respect and dignity while you were at the hospital?

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* 21. Canadians come from different ethnic backgrounds, religious beliefs and gender identifications. At our hospital we strive to treat everyone equally, fairly and appropriately. Have you experienced any challenges in these areas? If so, your input would be appreciated.

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* 22. Did you have any difficulty getting your needs met for mobility, hearing, vision or any other challenges you may have?

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* 23. Overall, at this visit, I had a very:

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* 24. Is there anything else you would like to say about your experience or is there a team member or group that you would like to recognize for providing exceptional care or service? Please specify below.

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