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Name
Label/Question

Agency case number

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ5 - Is agency part of a chain

AQ5 Is AGENCY part of a chain?

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ6 - Type of agency

AQ6 Is AGENCY a (home health/home care) agency, a hospice agency or does this agency serve both (home health/home care) and hospice patients? ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ7 - Number of home health admissions in 2006

AQ7 How many (home health/home care) admissions did AGENCY have during calendar year ? Only include this agency's home health patients for this location. NUMBER OF ADMISSIONS. ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ8 - Number of home health discharges in 2006

AQ8 How many (home health/home care) discharges did AGENCY have during calendar year? Only include this agency's home health discharges for this location. NUMBER OF DISCHARGES ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

Current number of patients receiving home health services (derived from PS5)

AQ9 What is the number of (home health/home care) patients currently being served by {AGENCY} at this location? ENTER NUMBER OF CURRENT PATIENTS ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ10 - Number of hospice admissions in 2006

AQ10 How many hospice admissions did (AGENCY} have during calendar year ? Only include this agency's hospice admissions for this location. ENTER NUMBER OF ADMISSIONS. ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ11 - Number of hospice discharges in 2006

AQ11 How many hospice discharges did {AGENCY} have during calendar year ? Only include this agency's hospice discharges for this location. ENTER NUMBER OF DISCHARGES ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ12 - Number of current hospice patients

AQ12 What is the number of hospice patients currently being served by {AGENCY} at this location? ENTER NUMBER OF CURRENT PATIENTS

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

Number of years been a hospice agency at time of interview (derived from AQ13)

AQ13 In what year was this agency established to provide hospice care? ENTER A 4-DIGIT YEAR.

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

Number of years from date of interview been a home health agency (derived from AQ14)

AQ14 In what year was this agency established to provide (home health/home care) services? ENTER A 4-DIGIT YEAR.

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

Type of ownership: profit or not-for-profit

AQ15 Which one of these categories on this card best describes the ownership of this agency?

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Hospital

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. HOSPITAL

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Nursing Home

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. NURSING HOME

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Assisted living facility

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. ASSISTED LIVING FACILITY ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Physician's office

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. PHYSICIAN?S OFFICE

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Outpatient medical/surgical center

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. OUTPATIENT MEDICAL/SURGICAL CENTER ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Rehabilitation facility

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. REHABILITATION FACILITY ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Patient/family/friend

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. PATIENT/FAMILY/FRIEND ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Other home health/hospice agency

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. OTHER HOME HEALTH/HOSPICE AGENCY ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Insurance provider/payer source

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. INSURANCE PROVIDER/PAYER SOURCE ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Community organization

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. COMMUNITY ORGANIZATION ... (view details)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16A - Home health patient referral source- Other

Q16A What are {AGENCY}?s patient referral sources for (home health/home/hospice) care? SELECT ALL THAT APPLY. OTHER (SPECIFY)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16B - Home health patient referral source-Other Specify 1

AQ16B What other referral source was used for care that? Enter other referral source(s)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

AQ16B - Home health patient referral source-Other Specify 2

AQ16B What other referral source was used for care that? Enter other referral source(s)

Taken from: National Home and Hospice Care Survey, 2007 - Agency Data.

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