HCAHPS Survey (Patients via Hospital Data Collection)

National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)

OMB: 0938-0981

IC ID: 202110

Documents and Forms

Document Name Document Type
Form CMS-10102 HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction
CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials Attachment A - 2023_survey-instruments_english_mail.pdf Form and Instruction
CMS-10102 HCAHPS Survey Instrument (Telephone Script) Attachment B - 2023_HCAHPS Survey - English_telephone.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Spanish Attachment C - 2023_HCAHPS Survey Translation - Spanish.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Chinese Attachment D - 2023_HCAHPS Survey Translation - Chinese.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Russian Attachment E - 2023_HCAHPS Survey Translation - Russian.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Vietnamese Attachment F - 2023_HCAHPS Survey Translation - Vietnamese.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Portuguese Attachment G - 2023_HCAHPS Survey Translation - Portuguese.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - German Attachment H - 2023_HCAHPS Survey Translation - German.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Tagalog Attachment I - 2023_HCAHPS Survey Translation - Tagalog.pdf Form and Instruction
CMS-10102 HCAHPS Survey Translation - Arabic Attachment J - 2023_HCAHPS Survey Translation - Arabic.pdf Form and Instruction