1 Start 2 Complete OUTCOME MEASURES SURVEYHome Care Partners and Parkinson’s Foundation Community Partners in Parkinson’s CareAs a scholarship recipient with the Parkinson’s Foundation Community Partners in Parkinson’s Care, Home Care Partners is piloting a client report to track metrics that are not currently part of the Community Partners in Parkinson’s Care Outcome Measures.The goal of this survey is to measure, over time, your client’s lived experience with PD. Because Parkinson’s progresses differently for each person, we ask that the following report be completed every six months until April 2027 or as long as your client is being cared for by your agency. Please provide your Client #: * Please select if this is this persons 1st, 2nd, 3rd, etc. time being surveyed. * - Select -1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 What was the admission date of this client to your facility or agency? * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Were they already diagnosed with PD when admitted? * Yes No In the past 6 months, has this client experienced a fall? * Yes No How many? * How many resulted in an emergency room or urgent care visit? * In the past 6 months, has this client been hospitalized unrelated to a fall? * Yes No Was it Parkinson's Related? * Yes No What was the reason? * What was the reason? * Was this a planned or unplanned hospitalization? * Planned Unplanned How long was their stay? * Did they return to your care after their hospitalization? * Yes No Leave this field blank
