Patient Interview/readmission Chart Review Page 3

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Comments:
2. Did you have a clear understanding of the purpose of taking each of your medications?
Yes
No
Comments:
3. Did you receive written documentation of the symptoms, warning signs, or health problems to be
aware of after you left the hospital?
Yes
No
Comments:
4. Did the staff explain your discharge instructions in a way you could understand?
Yes
No
Comments:
When you were in the hospital the last time were you kept informed about your diagnoses during your
stay?
No
Yes
Most of the time
Some of the time
At the time of discharge did someone talk to you about?
Discharge diagnosis (what was wrong with you)
Yes
NO
Not sure
Tests or lab work to be done once you left the hospital
Yes
No
Not sure
What to watch out for regarding worsening of your disease
Yes
No
Not sure
What were you told to do if you were experiencing worsening of your disease
Yes
No
Not sure

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Parent category: Medical