Help us determine how well you understand your healthcare. Thank you for your time!

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* 1. When do you have a healthcare encounter (doctor’s appointment, surgery, hospital stay, ER visit, etc.)? Pick all that apply.

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* 2. How frequently do you leave a healthcare encounter feeling like you did not understand something?

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* 3. If “Always” or “Often,” why do you think that might be? (Pick all that apply.)

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* 4. I understand more during a healthcare encounter if the visit is for a loved one instead of myself, for example, taking my child or parent to the doctor.

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* 5. I understand the following:

  Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
How my medical or psychological conditions affect each other (co-morbidities)
What questions I should ask during a healthcare encounter
What is most important in my medical history
How my condition/treatment will affect my caregiver(s)
How to fix an error in my medical records

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* 6. Medication: When a new medication is prescribed, I understand the following: 

  Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Why I’m taking the medication
What the possible side effects are
If taking the medication may cause a problem because of anything in my medical history, for example, the drug has sugar and I have diabetes
The differences between the name brand drug and the generic version, including how the side effects may be different
How long I will be on the medication and when I may be able to stop taking it
What may happen to me if I don’t take the medication as prescribed

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* 7. Follow-up: After I’ve finished a healthcare encounter, I feel like I understand the following:

  Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
My discharge instructions and what I’m supposed to do
When I should call my doctor’s office to follow up, for example, about a new symptom
When I should expect to feel better after treatment
How to follow up about test results
When/how I should get a second opinion
Long-term, unexpected effects of my condition, for example, developing food allergies after cancer treatment

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* 8. Sepsis: I am familiar with the following:

  Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
What sepsis is
What the symptoms of sepsis are
What I should do if I think I may have sepsis

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* 9. How frequently during a healthcare encounter do you feel like the healthcare provider didn’t understand you?

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* 10. What else would you like to share?

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* 11. Do you think of yourself as:

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* 12. Do you think of yourself as:

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* 13. Do you think of yourself as:

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* 14. What is the highest level of educational completed?

0 of 14 answered
 

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