Loving & Caring Home

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Monday, 26 Jun 2017
Patient Satisfaction Survey
  1. Were you treated with respect and dignity by the Nurse?
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  2. ... by the Attendant Care
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  3. Were you included in your care plan?
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  4. Were your needs met?
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  5. Were the procedures explained to you?
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  6. Do you know how to voice a complaint?
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  7. Do you understand agency charges?
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  8. Do you understand your rights?
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  9. Would you recommend our services to friends and family?
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  10. Comments & Suggestions:
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  11. Survey completed by
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  12. Relationship:
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  13. Patient Name:
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  14. Phone:
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  15. Date/time phone call completed:
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  16. Call results
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  17. Name of Agency Representative:
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Loving and Caring Home, Inc.
6525 E. 82nd Street, Suite 216
Indianapolis, IN 46250
Ph: 317 841 5163
Fax: 317 841 5165
Office hours: Mon - Fri 8am - 4pm


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