CMS-10275 Consent to Share Question #35 (Traditional Chinese)

CAHPS Home Health Care Survey (CMS-10275)

HHCAHPS_Q35_Trad_Chinese consent to share question

HHCAHPS Survey

OMB: 0938-1066

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您的居家健康護理機構可能希望瞭解您的回答,以便他們可以確定如何解除您的顧慮。但
是,除非您同意,我們不會將您對此調查問卷的回答與您的姓名聯繫起來,并與您的居家
健康護理機構分享本資訊。
Q35. 您是否同意將您對此調查問卷的回答與您的姓名聯繫起來,并與您的居家健康護理
機構分享本資訊?

 

1

是,我同意將我的姓名及我對此調查問卷的回答提供給我的居家健康護理機構。

2

否,我不同意將我的姓名及我對此調查問卷的回答提供給我的居家健康護理機
構。


File Typeapplication/pdf
File TitleHOME HEALTH CARE CAHPS Consent to Share Response - Traditional Chinese
Subjecthome health CAHPS Survey, home health care, CMS, CAHPS, Survey, HHCAHPS, protocol, guideline, manual protocols and guidelines ma
AuthorCenters for Medicare & Medicaid Services
File Modified2013-01-07
File Created2011-12-01

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