HH CAHPS | QuestionPro

Enter Patient and Agency Information

Patient ID :
D.O.B. :
HHA Phone Number :
Home Health Agency :

1) According to our records, you recently received home health care from ______________. Is that right?

(As you answer the questions in this survey, think only about your experience with this agency)

Yes

No

2) When you first started getting home health care from this agency, did someone from the agency tell you what care and services you would get?

Yes

No

Do not remember

3) When you first started getting home health care from this agency, did someone from the agency talk with you about how to set up your home so you can move around safely?

Yes

No

Do not remember

4) When you started getting home health care from this agency. Did someone from the agency talk with you about all the prescription and over the counter medicines you were taking?

Yes

No

Do not remember

5) When you started getting home health from this agency, did someone ask to see all the prescription and over the counter medicines you were taking?

Yes

No

Do not remember

Your Care From Home Health Providers In The Last 2 Months
These next questions are about all the different staff, who gave you care in the last 2 months. Do not include care you got from staff from another home health care agency. Do not include care you got from family or friends.

6) In the last 2 months of care, was one of your home health providers from this agency a nurse?

Yes

No

7) In the last 2 months of care, was one of your home health providers from this agency a physical, occupational, speech therapy?

Yes

No

8) In the last 2 months of care, was one of your home health providers from this agency a home health or personal care aide?

Yes

No

9) In the last 2 months of care, how often did home health providers from this agency seem informed and up to date about all the care or treatment you got at home?