Comment Card Survey

Texas Health & Human Services Commission - Long-Term Care Regulatory Division

Our goal at HHSC is to provide efficient, educational, and accurate regulatory inspection of our Long-Term Care Providers and Facilities. Please take a few moments to let us know about the recent HHSC Regulatory Services visit to your facility.

If you have questions, concerns, or compliments about the visit please call:
1-800-458-9858(Voice)
1-888-425-6889 (TDD)

	Always	Most of the time	Sometimes	Never
The conduct of the surveyor(s) during the visit was professional and courteous to staff.	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Always	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Most of the time	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Sometimes	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Never
The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers.	The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Always	The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Most of the time	The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Sometimes	The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Never
The surveyor(s) followed regulatory protocols.	The surveyor(s) followed regulatory protocols. Always	The surveyor(s) followed regulatory protocols. Most of the time	The surveyor(s) followed regulatory protocols. Sometimes	The surveyor(s) followed regulatory protocols. Never
The surveyor(s) considered all pertinent evidence.	The surveyor(s) considered all pertinent evidence. Always	The surveyor(s) considered all pertinent evidence. Most of the time	The surveyor(s) considered all pertinent evidence. Sometimes	The surveyor(s) considered all pertinent evidence. Never
The surveyor(s) kept you informed of the progress of the survey during the course of the survey.	The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Always	The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Most of the time	The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Sometimes	The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Never
The surveyor(s) explained the survey findings or deficiencies.	The surveyor(s) explained the survey findings or deficiencies. Always	The surveyor(s) explained the survey findings or deficiencies. Most of the time	The surveyor(s) explained the survey findings or deficiencies. Sometimes	The surveyor(s) explained the survey findings or deficiencies. Never
The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit.	The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Always	The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Most of the time	The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Sometimes	The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Never

Always

Most of the time

Sometimes

Never

The conduct of the surveyor(s) during the visit was professional and courteous to staff.

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Always

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Most of the time

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Sometimes

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Never

The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers.

The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Always

The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Most of the time

The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Sometimes

The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers. Never

The surveyor(s) followed regulatory protocols.

The surveyor(s) followed regulatory protocols. Always

The surveyor(s) followed regulatory protocols. Most of the time

The surveyor(s) followed regulatory protocols. Sometimes

The surveyor(s) followed regulatory protocols. Never

The surveyor(s) considered all pertinent evidence.

The surveyor(s) considered all pertinent evidence. Always

The surveyor(s) considered all pertinent evidence. Most of the time

The surveyor(s) considered all pertinent evidence. Sometimes

The surveyor(s) considered all pertinent evidence. Never

The surveyor(s) kept you informed of the progress of the survey during the course of the survey.

The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Always

The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Most of the time

The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Sometimes

The surveyor(s) kept you informed of the progress of the survey during the course of the survey. Never

The surveyor(s) explained the survey findings or deficiencies.

The surveyor(s) explained the survey findings or deficiencies. Always

The surveyor(s) explained the survey findings or deficiencies. Most of the time

The surveyor(s) explained the survey findings or deficiencies. Sometimes

The surveyor(s) explained the survey findings or deficiencies. Never

The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit.

The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Always

The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Most of the time

The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Sometimes

The surveyor(s) considered all evidence presented to refute deficiencies / violations prior to exit. Never

Comment Card Survey

Question Title

* Facility or Agency Name

Question Title

* Demographic Information

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* Region #? Please choose in which HHSC Administrative Region your facility is located. If you do not know in which region your facility is located, click here.

Question Title

* Facility Type

Question Title

* Date of Exit for visit?

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* Type of Visit (You may check as many as required)

Question Title

* Professionalism and Courtesy are our Goals

Question Title

* Additional comments: