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Community driving screen for stroke survey
Name
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Last
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Q1. Does your driving screen cover physical, cognitive and visual assessments? (Tick all that apply)
(Required)
Physical assessments
Cognitive assessments
Visual assessments
None
Don't know
Please state what physical, cognitive and/or visual assessments your team completes as part of your driving screen
(Required)
Q2. Do you complete a driving screen with all patients wanting to return to driving?
(Required)
Yes
No
Don't know
If no, what is the criteria a patient must meet for a driving screen not to be needed?
(Required)
Q3. What are the clinical indications that result in a referral to the Regional Driving Assessment Centre (RDAC)?
(Required)
Q4. If a referral to RDAC is not needed, who do you share the results from your assessments with for a final decision to be made regarding the patient returning to driving?
(Required)
Q5. If a patient has no physical, cognitive or visual impairments, what processes do you follow when it is time for the patient to return to driving?
(Required)
Q6. Do you advise all patients to inform their insurance company of the stroke before they return to driving?
(Required)
Yes
No
Don't know
If no, what are the circumstances when you would not provide this advise?
(Required)
Phone
This field is for validation purposes and should be left unchanged.