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Nursing Physical Therapy
Occupational Therapy Speech Therapy
Aide Medical Social Worker
Questions Excellent Good Average Poor N/A
Were your Home health Services initiated in a timely manner? 5 4 3 1
Did nurse provide courteous and helpful service? 5 4 3 1
Did therapy provide courteous and helpful service? 5 4 3 1
Did aide provide courteous and helpful service? 5 4 3 1
Did the staff explain the care being provides and ask your needs? 5 4 3 1
Do you feel staff members met your needs? 5 4 3 1
Did the agency provide the service and care that you expected? 5 4 3 1
Was the staff responsive to your pain and did They attempt to keep it at an acceptable level? 5 4 3 1
Were you told when service changed or was goind to end? 5 4 3 1
Your overall rating of the agency. 5 4 3 1
YesNo
YesNo