Readmission Reduction Program Survey
Help us improve our hospital's readmission reduction efforts by sharing your experiences and feedback.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Have you been readmitted to the hospital within the last 30 days after your most recent discharge?
*
Yes
No
Please rate the following aspects of your most recent hospital discharge process:
*
Rows
Clarity of discharge instructions
Support in arranging follow-up care
Access to prescribed medications
Communication with healthcare team
Very Poor
1
2
3
4
Poor
5
6
7
8
Average
9
10
11
12
Good
13
14
15
16
Excellent
17
18
19
20
How satisfied are you with the follow-up care you received after discharge?
*
1
2
3
4
5
What challenges, if any, did you face after being discharged from the hospital? (Select all that apply)
Difficulty understanding discharge instructions
Problems accessing medication
Lack of transportation to follow-up appointments
Financial barriers
Limited support at home
Other
In your opinion, how effective are the hospital's efforts to prevent unnecessary readmissions?
*
Not Effective
1
2
3
4
Very Effective
5
1 is Not Effective, 5 is Very Effective
Please provide any suggestions you have for improving our readmission reduction efforts.
Submit Survey
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