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Exit Survey
 
 
Is patient 70 or older?
 
0
 
1
 
 
 
Does the patient have 5 or more CHRONIC conditions?
 
0
 
1
 
 
 
Does the patient have a "high risk" diagnosis?
 
0
 
1
 
 
 
Has the patient reported a pain score of 6 or greater 2 or more times in the past 30 days?
 
0
 
1
 
 
 
Is the patient receiving chemo with emetogenic potential?
 
0 (low)
 
1 (moderate)
 
2 (high)
 
 
 
Is the patient receiving Granix or Neulasta?
 
0
 
1
 
 
 
Is radiation therapy part of the treatment plan?
 
0
 
1