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Family Satisfaction with Care in the Intensive Care Unit? Coding Key Manual for the FS-ICU (24) How are we doing? Your opinions about your family member’s recent admission to the Intensive Care Unit (ICU) Your family member was a patient in this ICU. You have been recorded as being the “next-of-kin”. The questions that follow ask YOU about your family member’s most recent ICU admission. We understand that there were probably many doctors and nurses and other staff involved in caring for your family member. We know that there may be exceptions but we are interested in your overall assessment of the quality of care we delivered. We understand that this was probably a very difficult time for you and your family members. We would appreciate you taking the time to provide us with your opinion. Please take a moment to tell us what we did well and what we can do to make our ICU better. Please be assured that all responses are confidential. The Doctors and Nurses who looked after your family member will not be able to identify your responses. DEMOGRAPHICS: Please complete the following to help us know a little about you and your relationship to the patient. I am: ( Male ( Female I am years old I am the patient’s: ( Wife ( Husband ( Partner ( Mother ( Father ( Sister ( Brother ( Daughter ( Son ( Other (Please specify): Before this most recent event, have you been involved as a family member of a patient in an ICU (Intensive Care Unit)? ( Yes ( No 5. Do you live with the patient? ( Yes ( No If no, then on average how often do you see the patient? ( More than weekly ( Weekly ( Monthly ( Yearly ( Less than once a year 6. Where do you live? ( In the city where the hospital is located ( Out of townPART 1: SATISFACTION WITH CARE Please check one box that best reflects your views. If the question does not apply to your family member’s stay then check the not applicable box (N/A).