QUESTIONS REGARDING HOSPITAL STAFF 

**If a question does not apply to your visit, please choose N/A as your answer**

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* 1. Department(s) accessed during this visit

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* 2. In terms of friendliness and respect, how would you rate the staff that you saw?

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* 3. Please rate how you felt about the communication between yourself, nurses, and other hospital staff.

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* 4. Please share how you felt about the amount of information you received from the hospital staff regarding what to do if you were worried about your condition or treatment after you left the hospital

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* 5. How do you feel the health team member explained your care plan to you and answered any questions you may have had?

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* 6. Were you informed (verbally or in writing) of any follow-up or discharge instructions?

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* 7. Did you see the staff wash their hands upon entering and leaving the room, and before and after administering treatment? 

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* 8. Was your sensitive health information treated in a respectful and confidential manner?

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* 9. Did staff confirm your name and date of birth prior to initiating assessment/treatment?

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* 10. Did you see a Physician/ Physiatrist today?

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