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STATE OF WISCONSIN Page 1 of 3DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F00338 (11×10)SURVEY GUIDE HOSPICE DIRECT INPATIENT UNIT SURVEY DateSurveyor NumberAgency Names OM 2084A:
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How to fill out the survey guide-hospice direct inpatient:

01
Read through the survey guide carefully to familiarize yourself with the questions and instructions.
02
Gather all necessary information and documents related to the hospice direct inpatient care you received.
03
Start by providing your personal information, such as your name, address, and contact details.
04
Answer each question thoroughly and accurately. Take your time to ensure you provide the most detailed and correct information.
05
If you encounter any questions that you are unsure about or require additional information, consult the guide or contact the relevant authorities for clarification.
06
Double-check your answers before submitting the survey to ensure accuracy.
07
Review any additional instructions or requirements for submission provided in the survey guide.
08
Submit the completed survey according to the specified method outlined in the guide.

Who needs the survey guide-hospice direct inpatient:

01
Individuals who have received hospice direct inpatient care and have been requested to provide feedback or complete a survey.
02
Hospice care providers who want to gather valuable insights and feedback from their direct inpatient care recipients for quality improvement purposes.
03
Researchers or organizations interested in understanding the experiences and satisfaction levels of individuals who have received hospice direct inpatient care to enhance the overall care delivery in this setting.
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Survey guide-hospice direct inpatient is a tool used to assess the quality of care provided by hospice facilities to inpatient clients.
Hospice facilities that provide direct inpatient care are required to file the survey guide.
The survey guide must be filled out by gathering information on the care provided and outcomes achieved for inpatient clients.
The purpose of the survey guide is to ensure that hospice facilities are providing high-quality care to inpatient clients.
Information such as client demographics, care provided, and outcomes achieved must be reported on the survey guide.
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