Opinion Suvery

Welcome to your OPINION SURVEY

Courtesy and respectfulness
Would you use St Rose of Lima Healthcare HHA again or recommend the Agency to others
Overall abilities in meeting needs and expectation
Was pain management instruction effective
Was the instruction of safety adequate
Discussing your discharge plan
Planning and carrying out your care
Discussing your visit schedule
Clear Emergency Management Instructions
Efficiency and competence

Your opinions are valuable in helping us improve the quality of our services. Kindly take a moment to fill out questions below by checking the appropriate boxes.


I and/ or my caregiver was contacted in a timely manner

Nurse = your RN or LVN     Aide = the person who helps you with your activities of daily living.    PT = your Physical Therapist  SC= Chaplain OT = your Occupational Therapist     ST = your Speech Therapist     MSW = your Social Worker

Effective instruction provided regarding management of my pain.

Please rate Care Provider (s) according to the following Safety instruction provided.

5=Excellent 4= Very Good 3=satisfactory 2=Fair 1=Unsatisfactory Please leave blank if the statement does not apply in your case.

My medications were reviewed and explanation was provided.
Home health services staff washed their hands or used hand sanitizer upon arrival and before and after treatments.
Home Health Services was explained to my satisfaction.
I was included in the planning of my care and treatments.
I was given information regarding advanced directives
I was informed about and given the 24 hour state hotline number in case of any problem with St. Rose of Lima Healthcare HHA services?
My rights and responsibilities were explained.

Still Have Questions?