Page 252 - QAP Manual 2020
P. 252
15. PROXY ALLOWED Since the start of COVID time, did you do any of the following services
using video conference technology like Skype, Zoom or FaceTime? [CHECK ALL THAT
APPLY]
[Note to surveyor: This question refers to services provided by the state DD system or a DD
system provider agency)
Other respondent: During COVID time, did this person use a remote (video) platform like Zoom,
Skype or FaceTime to participate in any of the following services?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other
1. Job coaching, job skills, other employment related activity
2. Social groups organized by day program
3. Exercise or physical activity
4. Life skills (cooking, other self-care)
5. Other __________________________
99. Don’t know, no response, unclear response
16. PROXY ALLOWED If you did any services over video conference or telehealth, did you like
doing services over video conference or telehealth?
Other respondent: Did this person like getting services using video conference or telehealth?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other
2. Yes
3. In-Between
1. No
98. Not applicable, did not use video conference
99. Don’t know, no response, unclear response
Now I am going to ask some questions about staying safe and healthy right now
17. PROXY ALLOWED Do you need more help or reminders to wash your hands regularly
during the day?
Other respondent: Does this person need more help or reminders to wash hands regularly during
the day?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other
2. I need more help and/or reminders to do this
1. I don’t need more help and/or reminders to do this
99. Don’t know
