CMS-10102 HCAHPS Survey Instrument (Telephone Script)

HCAHPS
Standard Telephone Script (English)
Overview
This telephone interview script is provided to assist interviewers while attempting to reach the
patient. The script explains the purpose of the survey and confirms necessary information about
the patient. Interviewers must not conduct the survey with a proxy.
Note: No proxy respondents are permitted in the administration of the HCAHPS Survey.
However, an individual may assist the patient by repeating questions or with translation of the
survey -- but only the patient may provide answers to the survey.
General Interviewing Conventions and Instructions
 The telephone introduction script and HCAHPS questions must be read verbatim
 Practice pronouncing the patient’s name before initiating the call
 It is optional to include the day of the week, e.g., Monday, with the discharge date
(mm/dd/yyyy)
 All text that appears in lowercase letters must be read out loud
 Text in UPPERCASE letters must not be read out loud
o However, YES and NO response options are to be read if necessary
 All questions and all answer categories must be read exactly as they are worded
o During the course of the survey, the use of neutral acknowledgment words such as
the following is permitted:
 Thank you
 Alright
 Okay
 I understand, or I see
 Yes, Ma’am
 Yes, Sir
 Read the scripts from the interviewer screens (reciting the survey from memory can lead
to unnecessary errors and missed updates to the scripts)
 Adjust the pace of the HCAHPS Survey interview to be conducive to the needs of the
respondent
 No changes are permitted to the order of the HCAHPS Survey (Questions 1-29)
 No changes are permitted to the order of the answer categories for the HCAHPS
questions
 All transitional phrases must be read
 Text that is underlined must be emphasized
 Characters in < > brackets must not be read
 [Square brackets] are used to show programming instructions that must not actually
appear on electronic telephone interviewing system screens
 Only one language (i.e., English, Spanish, Chinese, or Russian) must appear on the
electronic interviewing system screen
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



MISSING/DON’T KNOW (DK) is a valid response option for each item in the electronic
telephone interviewing system script; however, this option must not be read out loud to
the patient. MISSING/DK response options allow the telephone interviewer to go to the
next question if a patient is unable to provide a response for a given question (or refuses
to provide a response). In the survey file layouts, a value of MISSING/DK is coded as
“M - Missing/Don't know.”
Skip patterns should be programmed into the electronic telephone interviewing system
o Appropriately skipped questions should be coded as “8 - Not applicable.” For
example, if a patient answers “No” to Question 10 of the HCAHPS Survey, the
program should skip Question 11, and go to Question 12. Question 11 must then be
coded as “8 - Not applicable.” Coding may be done automatically by the telephone
interviewing system or later during data preparation.
o When a response to a screener question is not obtained, the screener question and any
questions in the skip pattern should be coded as “M - Missing/Don't know.” For
example, if the patient does not provide an answer to Question 10 of the HCAHPS
Survey and the interviewer selects “MISSING/DON’T KNOW” to Question 10, then
the telephone interviewing system should be programmed to skip Question 11, and go
to Question 12. Question 11 must then be coded as “M - Missing/Don't know.”
Coding may be done automatically by the telephone interviewing system or later
during data preparation.

NOTE: SEE INTERVIEWING GUIDELINES IN APPENDIX N FOR GUIDELINES ON
HOW TO HANDLE DIFFICULT TO REACH PATIENTS.
INITIATING CONTACT
START Hello, may I please speak to [SAMPLED PATIENT NAME]?
OPTIONAL START
Hello, my name is [INTERVIEWER NAME], may I speak to
[SAMPLED PATIENT NAME]?
<1> YES [GO TO INTRO]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING:
This is [INTERVIEWER NAME] calling from [DATA COLLECTION
CONTRACTOR] on behalf of [HOSPITAL NAME]. We are conducting a survey
about healthcare. Is [SAMPLED PATIENT NAME] available?
IF ASKED WHETHER PERSON CAN SERVE AS PROXY FOR SAMPLED
PATIENT:
For this survey, we need to speak directly to [SAMPLED PATIENT NAME]. Is
[SAMPLED PATIENT NAME] available?
IF THE SAMPLED PATIENT IS NOT AVAILABLE:
Can you tell me a convenient time to call back to speak with (him/her)?

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IF THE SAMPLED PATIENT SAYS THIS IS NOT A GOOD TIME:
If you don’t have the time now, when is a more convenient time to call you back?
IF ASKED IF YOU WOULD LIKE TO SPEAK TO “SR.” OR “JR”:
I would like to speak with [PATIENT NAME] who is approximately [AGE
RANGE].
IF SOMEONE OTHER THAN THE SAMPLED PATIENT ANSWERS THE PHONE
RECONFIRM THAT YOU ARE SPEAKING WITH THE SAMPLED PATIENT WHEN HE
OR SHE PICKS UP.
CALL BACK TO COMPLETE A PREVIOUSLY STARTED SURVEY
START: Hello, may I please speak to [SAMPLED PATIENT NAME]?
<1> YES [GO TO CONFIRM PATIENT]
<2> NO [REFUSAL]
<3> NO, NOT AVAILABLE RIGHT NOW [SET CALLBACK]
IF ASKED WHO IS CALLING: This is [INTERVIEWER NAME] calling from [DATA
COLLECTION CONTRACTOR] on behalf of [HOSPITAL NAME]. Is [SAMPLED
PATIENT NAME] available to complete a survey that [HE/SHE] started at an earlier date?
CONFIRM PATIENT: This is [INTERVIEWER NAME] calling from [DATA
COLLECTION CONTRACTOR] on behalf of [HOSPITAL NAME]. I would like to confirm
that I am speaking with [SAMPLED PATIENT NAME]. I am calling to continue the survey
started on an earlier date. CONTINUE SURVEY WHERE PREVIOUSLY LEFT OFF.
SPEAKING WITH SAMPLED PATIENT
INTRO

Hi, this is [INTERVIEWER NAME], calling (OPTIONAL TO STATE from
[DATA COLLECTION CONTRACTOR]) on behalf of [HOSPITAL NAME].
[HOSPITAL NAME] is participating in a survey about the care people receive in
the hospital. This survey is part of a national initiative to measure the quality of
care in hospitals. Survey results can be used by people to choose a hospital. Your
answers may be shared with the hospital for purposes of quality improvement.
Participation in the survey is completely voluntary and will not affect your health
care or your benefits. It should take about 7 minutes [OR HOSPITAL/SURVEY
VENDOR SPECIFY] to answer.
This call may be monitored (OPTIONAL TO STATE and/or recorded) for quality
improvement purposes.
OPTIONAL QUESTION TO INCLUDE:
I’d like to begin the survey now, is this a good time for us to continue?

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NOTE: THE STATED NUMBER OF MINUTES TO COMPLETE THE SURVEY
MUST BE AT LEAST 7 MINUTES. IF SUPPLEMENTAL ITEMS ARE ADDED
TO THE SURVEY, THIS NUMBER SHOULD BE INCREASED ACCORDINGLY.
S1:

Our records show that you were discharged from [HOSPITAL NAME] on or
about [DISCHARGE DATE (mm/dd/yyyy)]. Is that right?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>
<3>
<4>

YES
NO
DON’T KNOW
REFUSAL

[GO TO Q1_INTRO]
[GO TO INEL1]
[GO TO INEL1]
[GO TO INEL1]

CONFIRMING INELIGIBLE PATIENTS
INEL1:

Were you ever at this hospital?
<1> YES [GO TO INEL2]
<2> NO
[GO TO INEL_END]

INEL2:

Were you a patient at this hospital in the last year?
<1> YES [GO TO INEL3]
<2> NO
[GO TO INEL_END]

INEL3:

When was this?
IF ANY DATE WAS WITHIN TWO WEEKS OF [DISCHARGE DATE
(mm/dd/yyyy)], GO TO Q1_INTRO; OTHERWISE, GO TO INEL_END.

INEL_END: Thank you for your time. It looks like we made a mistake. Have a good
(day/evening).
BEGIN HCAHPS QUESTIONS
Q1_INTRO

Please answer the questions in this survey about this stay at [HOSPITAL NAME].
When thinking about your answers, do not include any other hospital stays. The
first questions are about the care you received from nurses during this hospital
stay.
BE PREPARED TO PROBE IF THE PATIENT ANSWERS OUTSIDE OF
THE ANSWER CATEGORIES PROVIDED. PROBE BY REPEATING
THE ANSWER CATEGORIES ONLY; DO NOT INTERPRET FOR THE
PATIENT.

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Q1

During this hospital stay, how often did nurses treat you with courtesy and
respect? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q2

During this hospital stay, how often did nurses listen carefully to you? Would you
say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q3

During this hospital stay, how often did nurses explain things in a way you could
understand? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q4

During this hospital stay, after you pressed the call button, how often did you get
help as soon as you wanted it? Would you say…
<1>
<2>
<3>
<4>
<9>

Never,
Sometimes,
Usually,
Always, or
I never pressed the call button?

MISSING/DK

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Q5_INTRO

The next questions are about the care you received from doctors during this hospital
stay.

Q5

During this hospital stay, how often did doctors treat you with courtesy and
respect? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q6

During this hospital stay, how often did doctors listen carefully to you? Would
you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q7

During this hospital stay, how often did doctors explain things in a way you could
understand? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q8_INTRO

The next set of questions is about the hospital environment.

Q8

During this hospital stay, how often were your room and bathroom kept clean?
Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK

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Q9

During this hospital stay, how often was the area around your room quiet at night?
Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

MISSING/DK
Q10_INTRO The next questions are about your experiences in this hospital.
Q10

During this hospital stay, did you need help from nurses or other hospital staff in
getting to the bathroom or in using a bedpan?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>

YES
NO

[GO TO Q12]

MISSING/DK [GO TO Q12]
Q11

How often did you get help in getting to the bathroom or in using a bedpan as
soon as you wanted? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

[<8> NOT APPLICABLE]
MISSING/DK
[NOTE: IF Q10 = “2 - NO” THEN Q11 = “8 - NOT APPLICABLE” OR IF Q10
= “M - MISSING/DK” THEN Q11 = “MISSING/DK”]
Q12

During this hospital stay, were you given any medicine that you had not taken
before?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>

YES
NO

[GO TO Q15_INTRO]

MISSING/DK [GO TO Q15_INTRO]

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Q13

Before giving you any new medicine, how often did hospital staff tell you what
the medicine was for? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

[<8> NOT APPLICABLE]
MISSING/DK
[NOTE: IF Q12 = “2 - NO” THEN Q13 = “8 - NOT APPLICABLE” OR IF Q12
= “M - MISSING/DK” THEN Q13 = “M - MISSING/DK”]
Q14

Before giving you any new medicine, how often did hospital staff describe
possible side effects in a way you could understand? Would you say…
<1>
<2>
<3>
<4>

Never,
Sometimes,
Usually, or
Always?

[<8> NOT APPLICABLE]
MISSING/DK
[NOTE: IF Q12 = “2 - NO” THEN Q14 = “8 - NOT APPLICABLE” OR IF Q12
= “M - MISSING/DK” THEN Q14 = “M - MISSING/DK”]
Q15_INTRO The next questions are about when you left the hospital.
Q15

After you left the hospital, did you go directly to your own home, to someone
else’s home, or to another health facility?
READ RESPONSE CHOICES 1, 2 AND 3 ONLY IF NECESSARY
<1>
<2>
<3>

OWN HOME
SOMEONE ELSE’S HOME
ANOTHER HEALTH FACILITY [GO TO Q18]

MISSING/DK [GO TO Q18]

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Q16

During this hospital stay, did doctors, nurses, or other hospital staff talk with you
about whether you would have the help you needed when you left the hospital?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>

YES
NO

[<8> NOT APPLICABLE]
MISSING/DK
[NOTE: IF Q15 = “3 - ANOTHER HEALTH FACILITY” THEN Q16 = “8 - NOT
APPLICABLE” IF Q15 = “M - MISSING/DK” THEN Q16 = “M - MISSING/DK”]
Q17

During this hospital stay, did you get information in writing about what symptoms
or health problems to look out for after you left the hospital?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1>
<2>

YES
NO

[<8> NOT APPLICABLE]
MISSING/DK
[NOTE: IF Q15 = “3 - ANOTHER HEALTH FACILITY” THEN Q17 = “8 - NOT
APPLICABLE” IF Q15 = “M - MISSING/DK” THEN Q17 = “M - MISSING/DK”]

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Q18

We want to know your overall rating of your stay at [FACILITY NAME]. This is
the stay that ended around [DISCHARGE DATE (mm/dd/yyyy)]. Please do not
include any other hospital stays in your answer.
Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the
best hospital possible, what number would you use to rate this hospital during your
stay?
IF THE PATIENT DOES NOT PROVIDE AN APPROPRIATE
RESPONSE, PROBE BY REPEATING: “Using any number from 0 to 10,
where 0 is the worst hospital possible and 10 is the best hospital possible, what
number would you use to rate this hospital during your stay?”
<0>
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<8>
<9>
<10>

0
1
2
3
4
5
6
7
8
9
10

MISSING/DK
Q19

Would you recommend this hospital to your friends and family? Would you say…
<1>
<2>
<3>
<4>

Definitely no,
Probably no,
Probably yes, or
Definitely yes?

MISSING/DK

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Q20_INTRO We have a few more questions about this hospital stay.
Q20

During this hospital stay, staff took my preferences and those of my family or
caregiver into account in deciding what my health care needs would be when I
left. Would you say…
<1>
<2>
<3>
<4>

Strongly disagree,
Disagree,
Agree, or
Strongly agree?

MISSING/DK
Q21

When I left the hospital, I had a good understanding of the things I was
responsible for in managing my health. Would you say...
<1>
<2>
<3>
<4>

Strongly disagree,
Disagree,
Agree, or
Strongly agree?

MISSING/DK
Q22

When I left the hospital, I clearly understood the purpose for taking each of my
medications. Would you say…
<1>
<2>
<3>
<4>
<5>

Strongly disagree,
Disagree,
Agree,
Strongly agree, or
I was not given any medication when I left the hospital?

MISSING/DK
IF THE PATIENT SEEMS CONFUSED BECAUSE HE/SHE RECEIVED A
PRESCRIPTION INSTEAD OF MEDICATION, THEN PROBE BY READING
THE FOLLOWING: “If you left the hospital with a prescription for a medication
rather than an actual medication, please answer the question based on your
understanding of the purpose for taking the prescription.”

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Q23_INTRO This next set of questions is about you.
Q23

During this hospital stay, were you admitted to this hospital through the
Emergency Room?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY
<1> YES
<2> NO
MISSING/DK

Q24

In general, how would you rate your overall health? Would you say that it is…
<1>
<2>
<3>
<4>
<5>

Excellent,
Very good,
Good,
Fair, or
Poor?

MISSING/DK
Q25

In general, how would you rate your overall mental or emotional health? Would
you say that it is…
<1>
<2>
<3>
<4>
<5>

Excellent,
Very good,
Good,
Fair, or
Poor?

MISSING/DK

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Q26

What is the highest grade or level of school that you have completed? Please
listen to all six response choices before you answer. Did you…
<1>
<2>
<3>
<4>
<5>
<6>

Complete the 8th grade or less,
Complete some high school, but did not graduate,
Graduate from high school or earn a GED,
Complete some college or earn a 2-year degree,
Graduate from a 4-year college, or
Complete more than a 4-year college degree?

MISSING/DK
ACADEMIC TRAINING BEYOND A HIGH SCHOOL DIPLOMA THAT
DOES NOT LEAD TO A BACHELORS DEGREE SHOULD BE CODED AS 4.
IF THE PATIENT DESCRIBES NON-ACADEMIC TRAINING, SUCH AS
TRADE SCHOOL, PROBE TO FIND OUT IF HE/SHE HAS A HIGH SCHOOL
DIPLOMA AND CODE 2 OR 3, AS APPROPRIATE.
Q27

Are you of Spanish, Hispanic or Latino origin or descent?
READ YES/NO RESPONSE CHOICES ONLY IF NECESSARY

<1>

YES
NO

MISSING/DK
IF YES: Would you say you are… (READ ALL RESPONSE CHOICES)
<2>
<3>
<4>
<5>

Puerto Rican,
Mexican, Mexican American, Chicano,
Cuban, or
Other Spanish/Hispanic/Latino?

MISSING/DK

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[FOR TELEPHONE INTERVIEWING, QUESTION 28 IS BROKEN INTO PARTS A-E]
READ ALL RACE CATEGORIES, PAUSING AT EACH RACE CATEGORY TO ALLOW
PATIENT TO REPLY TO EACH RACE CATEGORY.
IF THE PATIENT REPLIES, “WHY ARE YOU ASKING MY RACE?”:
We ask about your race for demographic purposes. We want to be sure that the people we survey
accurately represent the racial diversity in this country.
IF THE PATIENT REPLIES, “I ALREADY TOLD YOU MY RACE”:
I understand, however the survey requires me to ask about all races so results can include people
who are multiracial. If the race does not apply to you please answer “No.” Thanks for your
patience.
Q28

When I read the following, please tell me if the category describes your race. I am
required to read all five categories. Please answer “Yes” or “No” to each of the
categories.

Q28A

Are you White?
<1>
<0>

YES/WHITE
NO/NOT WHITE

MISSING/DK
Q28B

Are you Black or African American?
<1>
<0>

YES/BLACK OR AFRICAN AMERICAN
NO/NOT BLACK OR AFRICAN AMERICAN

MISSING/DK
Q28C

Are you Asian?
<1>
<0>

YES/ASIAN
NO/NOT ASIAN

MISSING/DK
Q28D

Are you Native Hawaiian or other Pacific Islander?
<1>
<0>

YES/NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
NO/NOT NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

MISSING/DK
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Q28E

Are you American Indian or Alaska Native?
<1>
<0>

YES/AMERICAN INDIAN OR ALASKA NATIVE
NO/NOT AMERICAN INDIAN OR ALASKA NATIVE

MISSING/DK
Q29

What language do you mainly speak at home? Please listen to all eight response
choices before you answer. Would you say that you mainly speak…
<1>
<2>
<3>
<4>
<5>
<6>
<7>
<9>

English,
Spanish,
Chinese,
Russian,
Vietnamese,
Portuguese,
German, or
Some other language?

MISSING/DK

[GO TO END]
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO END]
[GO TO Q29A]
[GO TO END]

IF THE PATIENT REPLIES WITH MULTIPLE LANGUAGES, PROBE:
Would you say that you mainly speak [LANGUAGE A] or [LANGUAGE B]?
IF THE PATIENT REPLIES THAT THEY SPEAK AMERICAN PLEASE
CODE AS 1 – ENGLISH.
Q29A

What other language do you mainly speak at home?
[NOTE: PLEASE DOCUMENT THE OTHER LANGUAGE AND MAINTAIN
IN YOUR INTERNAL RECORDS.]

SUPPL_INTRO
Questions 1-29 in this survey are from the U.S. Department of Health and
Human Services (HHS) for use in quality measurement. The following
questions are from [NAME OF HOSPITAL] to gather additional feedback
about your hospital stay and will not be shared with HHS.
NOTE: IF HOSPITAL-SPECIFIC SUPPLEMENTAL QUESTION(S) ARE
ADDED, THE STATEMENT ABOVE MUST BE PLACED IMMEDIATELY
BEFORE THE SUPPLEMENTAL QUESTION(S).
END:

Those are all the questions I have. Thank you for your time. Have a good
(day/evening).

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