Exceptional Patient/Staff Stories

Please complete this short informational survey to help us document the numerous ways we are providing EXCEPTIONAL care to our patients, families and referral sources. We want to spread the word about the wonderful things that members of the HPA team do every day. Thank you!!

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* 1. Agency:

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* 2. Please indicate Individual / Agency Team involved in story:

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* 3. Date

Date

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* 4. My story demonstrates we were EXCEPTIONAL in helping:
(check all that apply)

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* 5. The Story:

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* 6. What was the response/reaction of those impacted by actions taken?

T