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* 1. Did staff introduce themselves to you before providing care?

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* 2. Did you feel that you were treated with respect and dignity during your outpatient visit?

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* 3. Did staff take your cultural values or personal preferences and those of your family or caregiver into account when making decisions about your care? 
These things may include, but are not limited to, accessibility needs, interpreter assistance, visits by clergy, elders, or spiritual leaders.

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* 4. If you had any questions or concerns regarding your condition or treatment, did the staff discuss them with you?

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* 5. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

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* 6. Did we address your anxiety and fears in a way that you felt cared for?

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* 7. Would you recommend Outpatient Withdrawal Services to family and friends based on the quality of care provided?

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* 8. Do you feel that coming to Outpatient Withdrawal Services helped you?

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* 9. What group topics did you find helpful during your stay?

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* 10. Were recreational activities and outings meaningful and enjoyable?

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* 11. Is there anyone you would like to recognize for the care he or she provided during your stay?

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* 12. Are there any general comments you would like to share?

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* 13. Is there any feedback for improvement that you would like to provide?

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