I was a patient at WRH
Yes No
My family member was a patient at WRH
Yes No
My Name (optional)
Would you recommend WRH to you family and friends?
Yes No
Would you come back to WRH if you ever need rehabilitation services?
Yes No
Were your goals achieved during your stay?
Yes No
How can we improve?
The courteousness and helpfulness of the WRH Representative at your originating hospital.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Accuracy of the explanation of Whittier's services and expectations of your stay.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The helpfulness of the facility tour by you or a family member.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Welcomed and greeted with courtesy.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The usefulness of the information in your admissions folder (patient rights and responsibilities and privacy practices).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Attention given to your needs by the WRH staff.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Medications and specialized treatments provided as scheduled.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The effectiveness of your pain management.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The quality of your nursing staff in how well their did their jobs (skill).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The nursing staff in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
The quality of the respiratory staff in how well they did their jobs (skill).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The respiratory staff in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Gains made in your abilities during your stay.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The quality of your therapist(s) in how well their did their job (skill).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The therapist(s) in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
The variety of food choices.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The food quality (taste, temperature and appearance).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Please rate the dietary staff in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Please indicate what type of diet and texture you were on during the majority of your stay.
Diet Type:
Regular
Renal
Cardiac
Diabetic
Texture Type:
Regular
Pureed
Thickened Liquids
Tube Feedings
How can we improve?
Physician(s) kept you informed about your condition and treatment plan.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Physician(s) listened to your concerns and responded.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The quality of your physician(s) in how well they did their job (skill).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Physician(s) in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Arrangements were made for your privacy.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
WRH staff maintained confidentiality in regards to your medical and personal information.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Involved with planning of your discharge throughout your stay.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Home services / needs coordinated prior to leaving.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
The quality of case manager in how well they did their job (skill).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Case manager in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
You were an active participant in setting your rehab goals.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
You and your family were involved in making decisions in your care.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
The call light was answered to meet your needs.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Staff usage of proper safety techniques (such as gait belt, communication, checking wristband).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Staff utilization of proper infection control procedures such as handwashing and use of gowns/gloves.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
WRH and its staff made patient safety a priority.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
You were encouraged to 'Speak Up' regarding patient safety.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
The usefulness of the Patient/Visitor Information Packet provided in the room.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
All relevant services and programs were made available to you.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
All areas of the hospital were accessible.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
All areas of the hospital were properly labeled (signage).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
Cleanliness of your room.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Provided with a safe, friendly, and restful environment.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Provisions for visitors was adequate (visiting hours, visiting areas).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Housekeeping staff in how they treated you (sensitivity, dignity and respect).
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
You were educated on your physical disabilities and needs.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
You were kept informed about your medical condition and medications.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Whittier staff was willing and able to answer questions.
Select One:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
How can we improve?
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