Mt. Sinai School of Health/Franklin Health, Inc. Communication Instrument
A one-page questionnaire with yes/no response for patients to evaluate their interest in end-of-life care.
Evaluation Tool - Satisfaction/Perception of Care
Mount Sinai School of Medicine/ Franklin Health, Inc.
Mount Sinai Medical Center
One Gustav L. Levy Place
New York, New York 10029-6574
How the grantee used this instrument:
Used to assess the patient's interest in discussing end-of-life care with their family and physicians, and in appointing a health care agent.
To use this tool:
You may print and copy this tool for your own use from the website. Please credit source.
Developed specifically for this project by the Franklin Health project team.
To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
PDF 14 KB / 1 page (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)
Posted September 2004
Mount Sinai overview page
# MS12, type:satisfaction/perception_of_care
Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.