CAHPS Hospital Survey

H-CAHPS
STUDER GROUP TOOLKIT
Aligning Actions to Improve Patients Perception
of Care with the New H-CAHPS Initiative

Consumer
Assessment of
Healthcare
Providers and
Systems
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WHY WE CREATED THIS TOOLKIT
AND HOW WE HOPE IT WILL HELP YOUR ORGANIZATION
M
any organizations have asked us how they can be better prepared to implement the new CAHPS

Hospital Survey.* (H-CAHPS) These organizations want to make sure that their employees are
ready to utilize the new process in ways that are consistent with the organizations goal of ensuring high
quality patient care.
We have found that many of the organizations we work with are very well prepared for implementing
H-CAHPS, regardless of the measurement tool they use. What is often needed is an adjustment to specic
actionssuch as the key words that they are using with their patients.
In this toolkit we have identied actions that have proven successful with hundreds of hospitals, and we
have linked those actions to the H-CAHPS questions and categories.
At Studer Group, we use the Healthcare Flywheel

as a foundation for our work. The Healthcare Flywheel

is based on the premise that the good always want to get better. It shows how organizations can create
momentum for change by engaging the passion of their employees to apply prescriptive actions in order
to achieve excellent results. Our hope is that by using the recommended actions in this toolkit, you can
keep the flywheel turning in your organization. (For more about the Healthcare Flywheel, see page 10).
We are always interested in learningplease let us know how these prescriptive actions work for your
organization, and how we can help you further.
Thank you for helping make health care a better place for employees to work, physicians to practice
medicine, and patients to receive care.
*Consumer Assessment of Healthcare Providers and Systems (CAHPS) was previously referred to as Consumer
Assessment of Health Plans Survey. The name was changed to reflect the expansion of the programs focus from
health plans to the broader health care system.
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TABLE OF CONTENTS:
SECTION ONE:
H-CAHPS OVERVIEW...............................3
SECTION TWO:
STUDER GROUP RECOMMENDED ACTIONS AND H-CAHPS........................................4
SECTION THREE:
STUDER GROUP RESOURCES..................10
SECTION FOUR:
H-CAHPS SURVEY QUESTIONS (DECEMBER 2005)..........................................16
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SECTION ONE:
H-CAHPS OVERVIEW
T
he Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research
and Quality (AHRQ) developed the H-CAHPS initiative to provide a standardized survey
instrument and data collection methodology for measuring patients perspectives on hospital care.*
Specific survey instrument and measurement methodologies have been developed, with the intention
of national implementation in 2006. In January 2006, the U.S. Office of Management and Budget
(OMB) approved the use of the CAHPS Hospital Survey, and national implementation is scheduled
to move ahead.
The sponsoring organizations also say, H-CAHPS can be viewed as a core set of questions that can be
combined with a customized set of hospital-specific items. H-CAHPS is meant to complement the data
hospitals currently collect to support improvements in internal customer services and quality related activities.*
CMS and AHRQ will have required training sessions for those organizations who want to administer
the survey, including vendors or hospitals, prior to the national implementation. These training
sessions start in early 2006.
To learn more about Hospital CAHPS, please visit the following Web sites:
For general information: www.cms.hhs.gov/quality/hospital or www.ahrq.gov
For information about training: www.hcahpsonline.org
Email addresses to comment or to ask questions:
To communicate with CMS staff about implementation issues: [email protected]
To communicate with AHRQ staff on survey development issues: Hospital-CAHPS@ ahrq.gov
For technical assistance, contact the Arizona QIO: [email protected]
H-CAHPS Survey Questions:
Listed on pages 1620 are the questions contained in the H-CAHPS survey as of December 2005.
*Centers for Medicare and Medicaid Services website, December 2005
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SECTION TWO:
STUDER GROUP RECOMMENDED ACTIONS AND H-CAHPS
S
tuder Group has worked with many organizations for the purpose of improving operational excellence.
All of these organizations experience gains when they follow appropriate prescriptive actions, regardless
of their measurement tool.
We encourage you to stay committed to the basics. Activities such as rounding on employees and patients,
conducting discharge phone calls, and using key words that explain to patients what you are doing in
order to reduce their anxiety are actions you should take to improve the patient care experience. For example,
one of the issues addressed in most survey tools is how staff communicated with the patient and family
members. Consider how a patient would perceive communication if the nurse manager explained:
At our organization, we want to make sure we are always communicating with the patient. One of the
ways we do this is through a patient communication board in your room. We ask all our staff who are
caring for you to use this board to write their name and important information that you should know
about, such as todays test procedures. We also have written the name of the doctor who is caring for you
while you are in the hospital and your referring physician. To help us in our commitment to providing
very good care, please let us know if we can improve our efforts at any time.
It is important to always use language your staff can relate to and understand. Studer Group coaches
have learned that by calling the survey tool the patients perception of our core clinical and operational
competencies the staff will better relate to it. By doing so, we align behavior to achieve what we all want:
a patient and family who are condent in their caregivers, are less anxious, are compliant with treatment,
and tell everyone that the care they received was provided by a competent and compassionate group of
individuals.
Improving our patients perception of care represents all the best things about health care. It leads us to
what brought us to a career in health care in the rst place: purpose, worthwhile work, and making a
difference.
Studer Group Recommended Actions:
The following table on pages 59 provides Studer Groups recommended actions so an organization
may improve the patients perception of care related to each question or topic presented on the
H-CAHPS survey.
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Your Care from NursesDuring this
hospital stay:
How often did nurses treat you with
courtesy and respect?
How often did nurses listen carefully to
you?
How often did nurses explain things in a
way you could understand?
After you pressed the call button, how
often did you get help as soon as you
wanted it?
Conduct nurse leader rounding on patients for
courtesy, communication, explanation, and
responsiveness to call.
Implement AIDET: Five Fundamentals of Patient
Communication as an overall communication plat-
form to address most of the core questions on the
survey (See AIDET overview on page 11).
Introduce/implement Key Words at Key Times
using the language of the survey during rounds.
Is there anything else I can do for you?
I have time.
We are committed to providing you with very
good/excellent care. As part of our commitment,
we will treat you with courtesy and respect,
listen carefully to you, and explain things so you
can understand.
I would like to make notes while you are talking
because what you are saying is important. Is that
OK with you? I am listening.
I want to make sure that I explain the
procedure in a way that you can understand.
Do you have any questions?
Address call lights effectively:
Round frequently on the patient to anticipate
needs such as pain medication, toileting, and
positioning.
Ask, Is there anything else I can do before
I go? I have time.
Check the environment of the room for call
light, telephone, lights, TV, garbage can in
reach, bedside table next to the bed, full water
pitchers, etc.
Tell the patient when you will return.
Mr. Johnson, it looks like you are comfortable. I
will be back to check on you in about an hour.
When someone answers a call light they should
say, How may I help you? The request may
not require a nurse and we want to promote
a philosophy that any staff can help by
responding to requests.
H-CAHPS SURVEY QUESTION: STUDER GROUP RECOMMENDED ACTION AND STEPS:
Studer Group Recommended Actions
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Your Care from DoctorsDuring this hos-
pital stay how often did doctors treat you
with:
Courtesy and respect?
Listen carefully to you?
Explain things in a way you could
understand?
The Hospital EnvironmentDuring this
hospital stay, how often:
Were your room and bathroom kept clean?
Was the area around your room quiet
at night?
During the rst hour of the shift, nurses should
spend ve minutes with each patient going over
the plan of care and asking the patient if there
are one or two things that would make the care
excellent.
The nurse then documents that need or request
on the white board so all staff are aware of the
most important need for that patient and can be
responsive. The key words would be Mr. John-
son, I want you to know we are listening carefully
to your needs so I am going to write this on our
board. This way, we can be sure everyone knows
whats important to you.
Physicians:
Ensure that staff manages up physicians to
patient and families. Dr. Smith is a very good
listener. You are fortunate to have him
Implement AIDET: Five Fundamentals of
Patient Communication (See overview on
page 11).
Sit at the patients bedside.
Introduce/implement Key Words at Key Times
using the language of the survey during rounds:
I will listen carefully to what you say to me.
I want to make sure that I explained the
(procedure) in a way that you could understand.
Do you have any questions?
Ensure that the environmental service director
conducts rounds.
Ensure that the environmental service staff
use AIDET: Five Fundamentals of Patient
Communication:
Acknowledge: Good morning, Mrs. Smith
Introduce: My name is Barbara. I will be
taking care of your room today. I have worked in
housekeeping for more than 17 years. I have
cleaned thousands of rooms and receive more than
20 hours of training yearly on environmental
services. We strive to deliver very good care and it
will be my pleasure to serve you during your stay.
H-CAHPS SURVEY QUESTION: STUDER GROUP RECOMMENDED ACTION AND STEPS:
(Your Care from Nurses, continued)
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Your Experiences in this Hospital:
During this hospital stay, did you need help
from nurses or other hospital staff in getting
to the bathroom or in using a bedpan?
How often did you get help in getting to
the bathroom or in using a bedpan as soon
as you wanted?
During this hospital stay, did you need med-
icine for pain?
During this hospital stay, how often was
your pain well controlled?
During this hospital stay, how often did the
hospital staff do everything they could to
help you with your pain?
Duration: I will be in your room for about
10 minutes. Is now a good time?
Explanation: I will begin by emptying your
trash and then I will mop the floors and clean
your bathroom. When I nish I will check with
you to be sure I have not missed anything.
Thank you: I have nished cleaning. Is there
anything I have missed? Is there anything I can
do for you before I leave? I have time.
Place a tent card at the bedside with the
environmental service number stating, Call
us for cleaning needs.
Install a noise meter at nursing station.
Conduct a quiet campaign.
Introduce/implement Key Words at Key Times,
using the language of the survey during rounds:
May I close your door for your privacy
and quiet?
I am here to clean your room . . .
Did I miss anything?
Explain hourly comfort rounds at every shift.
Use Key Words at Key Times to focus on managing
expectations of pain:
Say to the patient: We want you to be completely
satised with your care. We work very hard to help
meet your physical comfort needs which include
help with things like hygiene, bathing, and getting
to the bathroom. We will help you manage any
pain you might have.
Manage up the doctor: Your doctor wants you
to be as comfortable as possible and has ordered
pain medicine to help you manage your pain.
Conduct nonverbal communication: Post the
pain scale in each patient room with a message
that states Pain controlour medical center
respects and supports the patients right to the best
possible management of pain.
H-CAHPS SURVEY QUESTION: STUDER GROUP RECOMMENDED ACTION AND STEPS:
(The Hospital Environment, continued)
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During this hospital stay, were you given
any medicine that you have not taken
before?
Before giving you any new medicine, how
often did hospital staff tell you what the
medicine was for?
Before giving you any new medicine, how
often did hospital staff describe possible
side effects in a way you could understand?
When You Left the Hospital:
After you left the hospital, did you go
directly to your own home, to someone
elses home, or to another health facility?
During this hospital stay, did doctors, nurs-
es or other hospital staff talk with you
about whether you would have the help
you needed when you left the hospital?
Manage up the staff: We want you to be very
satised with our management of your pain.
Our staff is specically trained to help manage
your pain.
Ask about pain medicine: Set select times to use
key words to ask about pain medicine such as
before breakfast, before therapy, or while per-
forming care for personal needs. Document the
patients response and be proactive at the next
opportunity.
Incorporate Key Words into discharge phone calls:
We are focusing on pain management at our
hospital; was there anything we could have done
differently to help you manage your pain?
Is there anything I can do for you? I have the time
I will do everything I can to help you with
your pain.
Your physician has ordered a new medication
for you, let me tell you what it is for . . .
Let me also describe possible side effects.
If you experience any of these symptoms, let me
know right away.
Do you have any questions? I want to make sure
that you understand.
Use the 110 pain scale and then round back to
check on the degree to which medication worked.
Tell the patient when the nurse will be back to check
on him or her.
In-service other departments on key words for
pain and processes to follow through for the
patient.
Introduce/implement Key Words at Key Times
using the language of the survey during rounds:
I want to make sure that you will have everything
you need when you go home.
Ensure that case management rounds on patients to
nd out if they have all the help they will need when
they leave. Ask if the physicians and nurses talked
with the patient about their post-stay care.
Conduct multidisciplinary rounds.
H-CAHPS SURVEY QUESTION: STUDER GROUP RECOMMENDED ACTION AND STEPS:
(Your Experiences in this Hospital Stay, continued)
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During this hospital stay, did you get infor-
mation in writing about what symtoms or
health problems to look out for after you
left the hospital?
Overall rating of the hospital:
Using any number from 010, where 0 is
the worst hospital possible and 10 is the
best hospital possible, what number would
you use to rate this hospital during your
stay?
Would you recommend this hospital to
your friends and family?
Understand that discharge planning is part of the
care plan and is discussed daily with the patient
and family.
Conduct discharge phone calls:
Review discharge instructions during
discharge phone call. Make sure the patient
has these in writing.
Manage up the discharge phone call during
the hospitalization. Let the patient know that a
staff person will call the patient after they have
gone home.
Introduce/implement Key Words at Key Times
using the language of the survey during rounds.
For example, Our goal is to provide you with
(very good/excellent) care. We want you to think
of us as the best possible hospital.
If the patient does not feel like the hospital is
the best possible, then nd out what you
should do to become the best.
Ask if there is anything you could have done
so that the patient would recommend your
hospital to others.
H-CAHPS SURVEY QUESTION: STUDER GROUP RECOMMENDED ACTION AND STEPS:
(When You Left the Hospital, continued)
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SECTION THREE:
STUDER GROUP RESOURCES
THE HEALTHCARE FLYWHEEL

In the book Good to Great, Jim Collins writes

about great organizations beneting from the
flywheel effect where the power of continued
improvement and the delivery of results create
momentum. Applying this concept to health
care, the Studer Group developed the Health-
care Flywheel to help organizations understand
the journey in creating great places for
employees to work, physicians to practice,
and patients to receive care.
The beginning of this journey is not a launch or a kick off. It is simply recognition that all we do should
start at the core of the organization: our values. In this way, we center or balance the flywheel. In health
care, we have great purpose, do worthwhile work, and have the opportunity to make a difference. This is
our hub.
From here, the rst step to creating movement is to connect the dots to our hub so that people truly
believe that they can make a difference. This inspiration is what allows organizations to implement
initial changes.
The second part of our flywheel is when we give organizations very prescriptive to dos, called Nine
Principles

to achieve results. From measuring the important things, to rounding for outcomes, to
implementing an objective performance measurement system, to discharge phone calls, these prescriptive
To Doswhen implementedwill continue to turn the flywheel.
The third part of the flywheel process is when the organization starts to see bottom-line results under the
Pillars, which provide a framework for prioritizing the desired results in step two. Instead of focusing on
what is not getting done, the organization focuses on what is getting done.
In studying great health care organizations, we nd what motivates people is the accomplishment of
desired results. By tying results back to purpose, worthwhile work, and making a difference, the organiza-
tion is inspired to follow more prescriptive behaviors to achieve even greater results, thereby creating a self
perpetuating culture of excellence, fueled by the momentum of the flywheel.
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AIDET: FIVE FUNDAMENTALS OF PATIENT COMMUNICATION
AIDET is a framework for communicating with patients and their families as well as with each other.
This framework can be used as we communicate with other staff and colleagues especially when we are
providing an internal service.
What Is AIDET? AIDET Stands For:
It is a simple acronym that represents a very powerful way to communicate with people who are often
nervous, anxious, and feeling vulnerable. It allows us, as trained health care professionals, to share our
experience, knowledge, and training; demonstrate empathy; and establish trust.
What Are the Results and Advantages of Using AIDET?
Decreased anxiety
Increased compliance
Increased clinical outcomes
Increased patient and physician satisfaction
11 2005 Studer Group
Decreased
Anxiety
Increased
Compliance
+
Increased Clinical
Outcome and
Increased Patient and
Physician Satisfaction
=
A I D E T
Acknowledge Introduce Duration Explanation Thank You
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The ve individual components of AIDET allow staff to communicate effectively with patients as they
focus on those questions and concerns that the majority of patients have. By proactively addressing these
through AIDET, we are telling patients that we are highly trained, compassionate professionals who put
the patients interests and comfort rst.
Here are the details of each the AIDET components:
ACKNOWLEDGE:
Goal: Establish trust by demonstrating empathy.
Tell the patient that you have been expecting them
Acknowledge their pain or concerns
INTRODUCE:
Goal: Reduce anxiety by sharing with the patients the skill set and experience
of those that will be touching them.
Introduce self:
Name, role, and department
Certication, training, skills, and experience
Establish successful handoff to others by introducing others:
Co-workers, other departments, and physicians
DURATION
Goal: Reduce anxiety by establishing time expectations.
Time to wait before test, procedure, exam, to see the doctor
Time of test, exam, etc.
Time until the patient can leave
Time to get results
EXPLANATION
Goal: Enlist patient in care plan.
Explain the test, procedure, visit, etc.
Explain what will be taking place in terms the patient can understand
THANK YOU
Goal: Thank the patient for trusting us and letting us care for them. Provides nal
opportunity for patient to share any concerns or questions.
Thank them for choosing your organization.
Ask if he or she has any nal questions or concerns.
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A
I
D
E
T
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WEB SITE RESOURCES
www.studergroup.com
H-CAHPS Toolkit Resource
Hardwired Results, Physician Engagement, Issue 4
Tool, Patient Perception of Care: What to Do if Your Scores are Low
Article, Key Words at Key Times
Insights, AIDET
SM
: Five Fundamentals of Patient Communication
Insights, Making Key Words at Key Times Work
Insights, Maximizing Your Patient Satisfaction Survey
Insights, One Step that Creates a Large Leap in Patient Satisfaction with Physicians
Insights, Pain Management
Insights, Seven Steps of Driving Patient Satisfaction - One Question at a Time
Insights, Its Patient Perception of Care, Not a Number
To reorder additional H-CAHPS Toolkits, go to www.studergroup.com
FIRE STARTER PUBLISHING RESOURCES
Books:
Hardwiring Excellence, by Quint Studer
101 Answers to Questions Leaders Askinformative answers to real questions from the eld.
Training Videos:
Must Haves
SM
Video Seriesa video/DVD training series focusing on hardwiring the ve Must Haves
SM
.
highmiddlelow
SM
Performer Conversationsa video/DVD training series focusing on retaining
high performers, developing skills of middle performers, and confronting low performers.
AIDET
SM
Five Fundamentals of Patient Communicationa video/DVD training focusing on reducing
anxiety and increasing patient compliance.
Software:
Leader Evaluation Manager
SM
performance management software system that automates the Annual
Evaluation, 90-Day Plan, and Monthly Report Card.
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Healthcare Flywheel

:
A teaching tool/diagram that illustrates the power that Purpose, Passion, Principles, and Pillar Results
have in creating momentum in an organization. Studer Group developed the Healthcare Flywheel to
help organizations understand the journey in creating great places for employees to work, physicians
to practice, and patients to receive care.
Key Words at Key Times:
Key words at key times are things said and done to connect the dots and help patients, families, and
visitors better understand what you are doing. They align your words with your actions to give a
consistent experience and message.
Manage Up:
Positioning others in a positive light. It is a form of communication at all levels that aligns your own
skills, your co-workers, other departments, and physicians to the goals of your organization. Example:
Letting your supervisor know to attend a celebration regarding achievement of results or to pass on
positive information regarding an area so that they can be recognized. This makes you and your
organization better, and aligns everyone to working on the right goals.
Must Haves
SM
:
Specic actions and to dos common to organizations achieving exceptional results. These Must
Haves
SM
are based on the Nine Principles

and evolved from the Studer Group partnering with more

than 250 organizations to identify these actions. The Must Haves
SM
are (1) Rounding for Outcomes,
(2) Employee Thank You Notes, (3) Selection and the First 90 Days, (4) Discharge Phone Calls,
(5) Key Words at Key Times, and (6) Aligning Leader Evaluations with Desired Behaviors.
Nine Principles

:
A sequenced step-by-step process and roadmap to attain desired results, and help leaders develop and
achieve an excellence-based culture. The Nine Principles

are (1) Commit to Excellence, (2) Measure the

Important Things, (3) Build a Culture Around Service, (4) Create and Develop Leaders, (5) Focus on
Employee Satisfaction, (6) Build Individual Accountability, (7) Align Behavior with Goals and Values,
(8) Communicate at all Levels, and (9) Reward and Recognize Success.
Pillar:
A foundation and framework used to set organizational goals and the evaluation process. Once the goals
for each Pillar are set for the organization as a whole, they are cascaded throughoutfrom the division
level to department or unit level, to individual leader. Most organizations use the five PillarsService,
People, Quality, Financial, and Growth. These can be customized to t specic language or organizational
terms, or other Pillars can be added, such as Community. These Pillars then lay the framework for
consistent evaluations, communications, and work planning.
Rounding for Outcomes:
Communicating with employees, physicians, and patients in such a way that there is a specic purpose to
walk away with specic outcomes.
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SECTION FOUR:
H-CAHPS SURVEY QUESTIONS
Listed below are the questions contained in the survey as of December 2005:
YOUR CARE FROM NURSES:
1. During this hospital stay, how often did nurses treat you with courtesy and respect?
1 Never
2 Sometimes
3 Usually
4 Always
2. During this hospital stay, how often did nurses listen carefully to you?
1 Never
2 Sometimes
3 Usually
4 Always
3. During this hospital stay, how often did nurses explain things in a way you could understand?
1 Never
2 Sometimes
3 Usually
4 Always
4. During this hospital stay, after you pressed the call button, how often did you get help as soon
as you wanted it?
1 Never
2 Sometimes
3 Usually
4 Always
5 I never pressed the call button
YOUR CARE FROM DOCTORS:
5. During this hospital stay, how often did doctors treat you with courtesy and respect?
1 Never
2 Sometimes
3 Usually
4 Always
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6. During this hospital stay, how often did doctors listen carefully to you?
1 Never
2 Sometimes
3 Usually
4 Always
7. During this hospital stay, how often did doctors explain things in a way you could understand?
1 Never
2 Sometimes
3 Usually
4 Always
THE HOSPITAL ENVIRONMENT:
8. During this hospital stay, how often were your room and bathroom kept clean?
1 Never
2 Sometimes
3 Usually
4 Always
9. During this hospital stay, how often was the area around your room quiet at night?
1 Never
2 Sometimes
3 Usually
4 Always
YOUR EXPERIENCES IN THIS HOSPITAL:
10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the
bathroom or in using a bedpan?
1 Yes
2 No (If No, go to Question 12.)
11. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
1 Never
2 Sometimes
3 Usually
4 Always
12. During this hospital stay, did you need medicine for pain?
1 Yes
2 No (If No, go to Question 15.)
13. During this hospital stay, how often was your pain well-controlled?
1 Never
2 Sometimes
3 Usually
4 Always
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14. During this hospital stay, how often did the hospital staff do everything they could to help you
with your pain?
1 Never
2 Sometimes
3 Usually
4 Always
15. During this hospital stay, were you given any medicine that you had not taken before?
1 Yes
2 No (If No, go to Question 18.)
16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
1 Never
2 Sometimes
3 Usually
4 Always
17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a
way you could understand?
1 Never
2 Sometimes
3 Usually
4 Always
WHEN YOU LEFT THE HOSPITAL:
18. After you left the hospital, did you go directly to your own home, to someone elses home, or to
another health facility?
1 Own home
2 Someone elses home
3 Another health facility (If Another, Go to Question 21.)
19. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether
you would have the help you needed when you left the hospital?
1 Yes
2 No
20. During this hospital stay, did you get information in writing about what symptoms or health
problems to look out for after you left the hospital?
1 Yes
2 No
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OVERALL RATING OF HOSPITAL:
Please answer the following questions about your stay at the hospital named on the cover. Do not
include any other hospital stays in your answer.
21. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best
hospital possible, what number would you use to rate this hospital during your stay?
0 Worst hospital possible
1
2
3
4
5
6
7
8
9
10 Best hospital possible
22. Would you recommend this hospital to your friends and family?
1 Definitely no
2 Probably no
3 Probably yes
4 Definitely yes
ABOUT YOU: There are only a few remaining items left.
23. In general, how would you rate your overall health?
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
24. What is the highest grade or level of school that you have completed?
1 8th grade or less
2 Some high school, but did not graduate
3 High school graduate or GED
4 Some college or two-year degree
5 Four-year college graduate
6 More than four-year college degree
25. Are you of Spanish, Hispanic or Latino origin or descent?
1 No, not Spanish/Hispanic/Latino
2 Yes, Puerto Rican
3 Yes, Mexican, Mexican-American, Chicano
4 Yes, Cuban
5 Yes, other Spanish/Hispanic/Latino
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26. What is your race? Please choose one or more.
1 White
2 Black or African-American
3 Asian
4 Native Hawaiian or other Pacific Islander
5 American Indian or Alaska Native
27. What language do you mainly speak at home?
1 English
2 Spanish
3 Some other language (please print): _____________________
20 2005 Studer Group
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2005 Studer Group
ROC#020500000605
913 Gulf Breeze Parkway, Suite 6
Gulf Breeze, FL 32561
Phone: 850-934-1099
www.studergroup.com
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