Surveylist Wizard 1. About 1. About 1. Enter a name for this list and if needed a description. Name * Description Organisation / Department *Is a cluster or location not listed? Check in the admin if the organization already has clusters and locations. ‘t Heem Cliënten 2. Topics 2. Topics 2. Enter the topics of the questions. Topic * Subject Name * 1 2 3 4 5 6 7 8 9 10 11 12 1 + Add Topic 3. General Questions 3. General Questions 3. Change the field names for the general part of the questionnaire. If a question is not needed, then leave the field value empty. May the questionnaire be filled in anonymously? Yes First Name Label Last Name Label Date of Birth Label Location/Department Label Fill-in Date Label Explanation Label Explanation <strong>Introductie</strong> Deze vragenlijst is bedoeld voor cliënten die persoonlijke verzorging of verpleging ontvangen van 't Heem of in de afgelopen 12 maanden hebben ontvangen. Het invullen van de vragenlijst duurt ongeveer 10 minuten. We stellen het zeer op prijs als u uw ervaring met en beleving van de zorg met ons deelt. Het geeft de wijkteams leer- en verbeterinformatie. De ervaringen komen ook beschikbaar als keuze-informatie op Zorgkaart Nederland voor toekomstige cliënten. Uiteraard bent u vrij om hier al dan niet gehoor aan te geven. Heeft u vragen dan kunt u die stellen aan de verzorgende die bij u aan huis komt of bellen met de wijkverpleging (zie uw zorgdossier voor het nummer). <strong>Invulinstructie</strong> <ul> <li>De vragenlijst mag anoniem ingevuld worden.</li> <li>Bij de meeste vragen kunt u één hokje aankruisen. Kies het antwoord dat het meest op uw ervaring van toepassing is.</li> </ul> 4. Questions 4. Questions 4. Enter the questions of the questionnaire. Questions * 1 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 2 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 3 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 4 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 5 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 6 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 7 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 8 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 9 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 10 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 11 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 12 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 13 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 14 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 15 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 16 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 17 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 18 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 19 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 20 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 21 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 22 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 23 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation 1 Question * Subject * reading themes... Required Yes Type * Open - Single Line TextOpen - Paragraph TextMultiple ChoiceNet Promotor ScoreMultiple Choice - not used for analysesExplanation for user Add 'not-applicable' as a possible answer Yes Not-applicable Label Answer layout verticalhorizontal Answers * Description Value 1 1 + Antwoord toevoegen Answers (not used for analyses) * Description 1 1 Voeg antwoord toe Text for explanation + Add answer Validate Email
