Assessment of the Emergency Department from a Sensory Perspective

Assessment tool for autistic patients

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* 1. Does the information you will be providing relate to a visit to the Emergency Department at Leeds Teaching Hospitals in the 12 months?

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* 2. Please confirm the date and time you are completing this form?

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* 3. Are you Autistic?

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* 4. Are you completing this about your own experience?

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* 5. Are you completing this on behalf of someone Autistic?

For each area please give a rating of
1 - Unacceptable
2 - Poor
3 - Fair
4 - Good
5 - Excellent

If you are able to give additional comments these will be helpful for service improvement.

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* 13. Comments - In relation to the Car Park both positive and negative comments are appreciated?

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* 21. Comments - In relation to the Entrance both positive and negative comments are appreciated?

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* 29. Comments - In relation to the Reception Area both positive and negative comments are appreciated?

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* 37. Comments - In relation to the Waiting Area both positive and negative comments are appreciated?

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* 45. Comments - In relation to the Treatment Room both positive and negative comments are appreciated?

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* 46. If you found the environment unsuitable how helpful were the staff at offering adaptations?

0 of 46 answered
 

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