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  1. Surveys
  2. 2013
  3. May
  4. R
  5. Readmission-Patient
0%
Questions marked with an * are required Exit Survey
 
 
* 1. In your opinion, did any of the following contribute to the patient visit today? (Select all that apply)
 
Progression of disease or medical condition
 
Missed doses or not taking prescribed medications
 
Not enough support at home
 
Fall or unsteadiness when walking
 
Side effect of current medication
 
Other
 

 
 
 
* 2. In your opinion, is your re-visit related to your last hospitalization?
 
Yes
 
No
 
 
 
* 3. In your opinion, would any of the following have reduced the likelihood of a re-visit? (Select all that apply)
 
Improved discharge care instructions
 
Review of medications
 
Home health visits
 
Follow up appointment with primary care doctor
 
Follow up appointment with specialist
 
Other
 
 
 
 
* 4. How old are you?
   
 
 
 
* 5. Describe your race:
 
Black/African American
 
Caucasian/White
 
Asian
 
American Indian/Alaska Native
 
Native Hawaiian/Pacific Islander
 
Bi/Multi-racial
 
 
 
* 6. What is the highest school level you completed?
 
Less than high school
 
High school graduate or GED
 
Some college
 
College graduate
 
Post-graduate work
 
Vocational
 
 
 
* 7. How would you describe your current relationship status?
 
Single
 
Married
 
Separated
 
Widowed
 
 
 
* 8. Whom do you live with?
 
Live by self
 
Live with one person
 
Live with multiple family members
 
Other