Outpatient and Ambulatory Surgery CAHPS Survey
To be Printed on Facility or Vendor Letterhead
«FirstName» «LastName»
«Address1» «Address2»
«City_Name», «State_Code» «Zip_Zip4»
Dear «FirstName» «LastName»:
[FACILITY] would like to learn more about the quality of health care that patients receive in our facility. [VENDOR], an independent research company, is helping us conduct this survey. Our records show that you had a surgery or procedure at [FACILITY]. The results of this survey will be used to help us understand more about patient experiences in our facility.
The enclosed survey asks for your experiences with the outpatient surgery or procedure you had on [DATE OF SURGERY]. We hope that you will take a few minutes to complete and return the questionnaire to [VENDOR] in the enclosed, postage-paid envelope.
When answering the questions, please consider your visit to [FACILITY] on [DATE OF SURGERY]. Do not answer questions based on any other surgeries or procedures you might have had at either this facility or another.
All information you provide will be confidential and is protected by the Privacy Act. Your answers to the survey will be grouped with answers from all other survey participants; your name and identifying information will not be linked to your answers when the data are analyzed. The overall survey results for [FACILITY NAME] and other facilities will be publicly reported on the Internet at https://www.medicare.gov/. These results will help people make more informed decisions when choosing an outpatient or ambulatory surgery facility. Your participation is voluntary and will not affect any health care benefits you currently receive or will receive in the future.
If you have any questions about the survey, please call NAME toll-free at 1-800-XXX-XXXX. If you need help in reading the questions or marking responses, a friend or family member can assist you. Thank you in advance for your participation. Si desea recibir la versión de la encuesta en español, por favor llame al 1-800-XXX-XXXX.
Sincerely,
NAME
Title
Enclosures [PRINT UNIQUE SAMPLE ID NUMBER HERE]
Outpatient and Ambulatory Surgery CAHPS Survey
To be Printed on Facility or Vendor Letterhead
«FirstName» «LastName»
«Address1» «Address2»
«City_Name», «State_Code» «Zip_Zip4»
Dear «FirstName» «LastName»:
Recently, we sent you a letter asking for your help on a survey to provide [FACILITY] with information about the quality of health care provided to patients who receive an outpatient surgery or procedure in our facility. As of today, we have not yet received your completed questionnaire. If you have already completed and returned the questionnaire, please accept our thanks. If you have not completed it, please take a few minutes to do so now. Then return the questionnaire in the enclosed, postage-paid envelope.
When answering the questions, please consider your visit to [FACILITY] on [DATE OF SURGERY]. Do not answer questions based on any other surgeries or procedures you might have had at either our facility or another.
The results of this survey will be used to help us understand more about patient experiences in our facility. All information you provide will be confidential and is protected by the Privacy Act. Your answers to the survey will be grouped with answers from all other survey participants; your name and identifying information will not be linked to your answers when the data are analyzed. Your participation is voluntary and will not affect any health care benefits you currently receive or will receive in the future.
If you have any questions about the survey, please call NAME toll-free at 1-800-XXX-XXXX. If you need help in reading the questions or marking responses, a friend or family member can assist you. Thank you in advance for your participation. Si desea recibir la versión de la encuesta en español, por favor llame al 1-800-XXX-XXXX.
Sincerely,
NAME
Title
Enclosures [PRINT UNIQUE SAMPLE ID NUMBER HERE]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | With, Sarah |
| File Modified | 0000-00-00 |
| File Created | 2021-08-02 |