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CARE PROVIDERS (...continued)
3.
How well the care provider informed you and your child about your child's
medication (if your child was prescribed medication)..........................................................
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Comments (describe good or bad experience): ------------------------
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THERAPIST(S)
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If you did not see a Therapist during this visit, please skip this section. Thank you.
1. Your trust in the skill of the therapist(s).....................................................................................
2. Therapist's concern for your child's questions and worries ...............................................
3. How well the therapist(s) understood your child and their needs ....................................
4. How well the therapist(s) kept you informed about your child's treatment ...................
Therapist(s) Section Comments_____________________________
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YOUR CHILD'S CARE
1. Staff's concern for your child's privacy ......................................................................................
2. How well the staff addressed your child's emotional needs ..............................................
3. Staff's response to concerns/complaints made during your child's care ......................
4. Staff's efforts to include you and your child in decisions about your child's care .......
5. Instructions on what to do if experiencing problems related to your child's
condition (when to seek help, who to call, etc.) .....................................................................
6. Degree of safety and security you felt in our facility .............................................................
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Comments (describe good or bad experience): ------------------------
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OVERALL ASSESSMENT
1. How well the staff worked together to care for your child ...................................................
2. Overall rating of care given at this facility................................................................................
3. Likelihood of your recommending this facility to others ......................................................
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Comments (describe good or bad experience): ________________________
Patient's Name: (optional)------------------------------Parent or Guardian's Name: (optional)___________________________
Telephone Number: (optional)------------------------------
© 2021 PRESS GANEY ASSOCIATES LLC.
All Rights Reserved.
CL#16028-OY0102-01-03/21
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| File Type | application/pdf |
| File Modified | 2021-03-08 |
| File Created | 2021-03-04 |