HOPDs/ASCs Patient Records

National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

OMB: 0938-1240

IC ID: 216391

Documents and Forms

Document Name Document Type
Form CMS-10500 HOPDs/ASCs Patient Records Form and Instruction
CMS-10500 OAS CAHPS (Mail Survey) OAS CAHPS Attachment A-Mail Questionnaire.pdf Form and Instruction
CMS-10500 OAS CAHPS (Telephone Script) OAS CAHPS Attachment B-CATI Questionnaire.pdf Form
CMS-10500 OAS CAHPS (Web Survey Screenshots) OAS CAHPS Attachment C-Web Questionnaire.pdf Form and Instruction
CMS-10500 OAS CAHPS - Spanish Attachment E1 - OAS CAHPS - Spanish Survey.pdf Form and Instruction
CMS-10500 OAS CAHPS - ChineseSimplified. Attachment E2 - OAS CAHPS - ChineseSimplified.pdf Form and Instruction
CMS-10500 OAS CAHPS - ChineseTraditional Attachment E3 - OAS CAHPS - ChineseTraditional.pdf Form and Instruction
CMS-10500 OAS CAHPS - Korean Attachment E4 - OAS CAHPS - Korean.pdf Form and Instruction
CMS-10500 OAS CAHPS - Russian Attachment E5 - OAS CAHPS - Russian.pdf Form and Instruction
OAS CAHPS Attachment D1-Mail Cover Letters.pdf Cover Letters IC Document
OAS CAHPS Attachment D2-Initial Web Survey Invitation Letter.pdf Letter Invitation for Web Survey IC Document
OAS CAHPS Attachment D3-Initial Web Survey Invitation Email.pdf E-mail Invitation for Web Survey (1st Contact) IC Document
OAS CAHPS Attachment D4-Followup Web Survey Invitation Letter.pdf Followup Web Survey Invitation Letter IC Document
OAS CAHPS Attachment D5-Followup Web Survey Invitation Email.pdf Follow up Web Survey Invitation Email IC Document
OAS CAHPS Attachment D6-Web with Mail Followup_Questionnaire Cover Letter.pdf Web with Mail Followup_Questionnaire Cover Letter IC Document
OAS CAHPS Attachment D7-Prenote Letter for Telephone Only.pdf Prenote Letter for Telephone Only IC Document