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* 1. During this stay at Cardiopulmonary Rehab, how often did the staff treat you with courtesy and respect?

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* 2. During this stay at Cardiopulmonary Rehab, how often did staff listen carefully to you?

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* 3. During this stay at Cardiopulmonary Rehab, how often did staff explain things in a way you could understand?

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* 4. During this stay at Cardiopulmonary Rehab , how often were the bathrooms kept clean?

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* 5. During this stay at Cardiopulmonary Rehab, how often did the  staff do everything they could to help you with your pain?

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* 6. During this stay at Cardiopulmonary Rehab, did the staff talk with you about whether you would have the information you needed when you left cardiopulmonary rehab to continue with exercise on your own?

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* 7. During this stay at Cardiopulmonary Rehab, did you get information in writing about what symptoms or health problems to look out for after you left cardiopulmonary Rehab?

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* 8. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate Cardiopulmonary Rehab?

  10 Best hospital possible 9 8 7 6 5 4 3 2 1 0 Worst hospital possible
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* 9. Would you recommend Cardiopulmonary Rehab to your friends and family?

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* 10. During this stay at Cardiopulmonary Rehab, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.

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* 11. When I left Cardiopulmonary Rehab, I had a good understanding of the things I was responsible for in managing my health.

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* 12. When I left Cardiopulmonary Rehab, I clearly understood the purpose for taking each of my medications.

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* 13. During this stay at Cardiopulmonary Rehab, did you have a visit to the Emergency Room?

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* 14. Exercise Program

  unacceptable needs improvement satisfactory good excellent
The exercise program has improved my ability to return to normal daily activity.
The exercise program was clearly explained.
The exercise program was progressed at an appropriate rate.
The exercise staff was knowledgeable and motivated me to exercise.

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* 15. Education Program

  unacceptable needs improvement satisfactory good excellent
The education given was effective in teaching me new information and reinforced information I already knew.
The staff presented the education material in a way which was easy for me to understand the information given.
The education covered all the necessary information and answered my questions.

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* 16. Self Management

  unacceptable needs improvement satisfactory good excellent N/A
The cardiopulmonary rehab staff encouraged me to take my medications as prescribed.
The cardiopulmonary rehab staff encouraged me to start or continue to exercise regularly.
The cardiopulmonary rehab staff encouraged me to follow an appropriate diet.
The cardiopulmonary rehab staff encouraged me to become or continue to remain a non-smoker.

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