* 1. During this stay at the hospital, how often did nurses treat you with courtesy and respect?

* 2. During this stay at the hospital, how often did nurses listen carefully to you?

* 3. During this stay at the hospital, how often did nurses explain things in a way you could understand?

* 4. During this stay at the hospital, after you pressed the call button, how often did you get help as soon as you wanted it?

* 5. During this stay at the hospital, how often did doctors treat you with courtesy and respect?

* 6. During this stay at the hospital, how often did doctors listen carefully to you?

* 7. During this stay at the hospital, how often did doctors explain things in a way you could understand?

* 8. During this stay at the hospital, how often were your room and bathroom kept clean?

* 9. During this stay at the hospital, how often was the area around your room quiet at night?

* 10. During this stay at the hospital, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?

* 11. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

* 12. During this stay at the hospital, did you need medicine for pain?

* 13. During this stay at the hospital, how often was your pain well controlled?

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

* 15. During this stay at the hospital, were you given any medicine that you had not taken before?

* 16. Before giving you any new medicine, how often did hospital staff at the hospital tell you what the medicine was for?

* 17. Before giving you any new medicine, how often did hospital staff at the hospital describe possible side effects in a way you could understand?

* 18. After you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?

* 19. During this stay at the hospital, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?

* 20. During this stay at the hospital, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

* 21. Would you recommend the hospital you stayed in to your friends and family?

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