Questions to Ask for Identifying Communication and Accommodation Needs

PREFERRED COMMUNICATION: IDENTIFIES METHODS BY WHICH PATIENTS WANT TO RECEIVE COMMUNICATIONS AND INFORMATION:

8. PREFERS TO RECEIVE INFORMATION REGARDING APPOINTMENTS, TEST RESULTS, ETC

• USPS mail

• Email

• Voice mail

9. WHEN TRYING TO REACH ME IT IS BEST TO USE: [CHECK ALL THAT APPLY]

• Email (address: _______________)

• Text message (phone #: ___________)

• TTY

• Video relay

• Speech to Speech relay

• Phone

• USPS mail [if not time sensitive]

10. I UNDERSTAND / LEARN / GET DIRECTIONS/ BEST WHEN I GET INFORMATION: [check all that apply]

• In pictures

• In writing

• Explained to me

• Shown to me

11. WHEN VIEWING FILMS AND VIDEOS I NEED:

• Descriptive narration

• Captioning

• Signed