| Rating Questions |
Excellent |
Good |
Average |
Fair |
Poor |
| (1.) Did nurse, therapist, and/or aide provide courteous service? |
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| (2.) Did staff members call prior to visit? |
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| (3.) Did you have the same staff member most of the time? |
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| (4.) Did the agency provide the service that you expected? |
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| (5.) Did you feel that you learned enough about your health problems and medicine? |
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| (6.) Were you told when service changed or was going to end? |
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| (7.) Your overall rating of the agency was: |
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