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Date: ____/____/____ Time: ________ AM/PM Patient group: ___________________________________________ Facilitator: ______________________________________________ Facilitator Title: __________________________________________ |
| 1. What were the most important events during your hospital stay? |
| 2. What were the most positive? |
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3. Where there any negative events during your hospital stay?
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4. Did you receive enough information to make informed decisions?
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| 5. How much of their time is down time and how would they rather use it? |
| 6. What type of issues/events during the patient's stay could be categorized as redundant or repetitive and how this affected the stay? |
| 7. How the patient may want to be engaged in the process of care? |
| 8. What types of information would you like to have access to, that would improve your stay? |
| 9. How would the patient like to use technology such as E-mail? |
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10. Do you or your family wish to take part in your care? How would you like to participate?
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Non-English speaking question:
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If your care provider spoke your native language would you trust them more or less than someone who needs a translator? |
| Notes: |


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