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Survey Questions

Survey Questions

Use the links below to review the National Palliative Care Registry™ survey questions for each care setting. You will also find definitions for key measures and detailed guidance for specific questions.

  • Hospital [1]

    pdf-icon [2]

    Hospital Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care services in hospitals (both consultation services and on inpatient palliative care units), Cancer Centers, or Long-Term Acute Care (LTAC) Facilities.
    Download [2]

  • Home [1]

    pdf-icon [3]

    Home Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care in patients’ homes, wherever they may live. “Home” includes residential homes, nursing homes, assisted living facilities, and other long-term care facilities.

    If your palliative care program is integrated into a long-term care facility and provides care to the entire residential population that lives there, please use the long-term care survey. If your program sees patients at long-term care facilities because that’s where the patients live, but does not provide care to the entire residential population, please include these palliative care patients in the home survey.

    Download [3]

  • Office/Clinic [1]

    pdf-icon [4]

    Office/Clinic Palliative Care Survey

    For palliative care programs that provide non-hospice palliative care services at Clinics, Physician Offices, Federally Qualified Health Centers, End Stage Renal Disease (ESRD) Facilities, Outpatient Physical Therapy/Speech Pathology Facilities, Rural Health Clinics, Comprehensive Outpatient Rehabs, Ambulatory Surgical Centers or Community Mental Health Centers.

    *Only a shortened survey is available at this time.

    Download [4]

  • Long-term Care [1]

    pdf-icon [5]

    Long-term Care Palliative Care Survey

    For long-term care integrated palliative care programs that provide non-hospice palliative care services to Skilled Nursing Facilities (SNF), Nursing Homes, Rehab Facilities, or Assisted Living Facilities.

    If your palliative care program is integrated into a long-term care facility and provides care to the entire residential population that lives there, please use the long-term care survey. If your program sees patients at long-term care facilities because that’s where the patients live, but does not provide care to the entire residential population, please include these palliative care patients in the home survey.

    *Only a shortened survey is available at this time.

    Download [5]