Medical
Hospice Survey Checklist
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Hospice Survey Checklist

1
Prepare Survey Materials
2
Set Schedule for Hospice Survey
3
Brief Survey Team on the Process
4
Visit the Hospice Facility
5
Conduct Survey of Staff Members
6
Review Policy Documents of Hospice
7
Tour the Facility for Physical Condition Check
8
Interview Patients about Care Received
9
Approval: Interview Data
10
Check Medical Equipment Condition
11
Evaluate Medical Care Procedures in Practice
12
Meet with Hospice Administrators
13
Approval: Evaluation of Medical Care Practices
14
Review Patients' Medical Records
15
Check End-of-Life Care Services
16
Conduct Follow-Up Interviews
17
Collate and Analyze Survey Findings
18
Approval: Preliminary Findings
19
Prepare Draft Report of Findings
20
Approval: Final Findings