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  • JRP Class Forms- HIP- May2020

  • Dear Joint Replacement Surgery Candidate,

    Pomona Valley Hospital Medical Center (PVHMC) is committed to providing excellent care with quality outcomes to our patients.

    PVHMC participates in the American Joint Replacement Registry (AJRR) by submitting data. Their mission is to improve the care for patients having joint replacement surgery of the hip and knee. “By collecting and reporting data, AJRR provides actionable information to guide physicians and patient decision making to improve care.”

    For those with Medicare, we are mandated to collect and report data with outcomes as part of the Comprehensive Care for Joint Replacement (CJR) Model. Their model aims to support better and more efficient care for those undergoing hip and knee replacements.

    Please complete the following surveys. Please fill them out completely before turning them in. It is very important that each question is answer.

    Thank you.

    Aimee Castillejo, MSN, RN, CENQuality Clinical Coordinator

    Ana Marrero, MSN, APRN, FNP-C Quality Clinical Coordinator, Nurse Practioner (909) 630-7815

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  • Patient Information

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    Pick a Date
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  • Instructions

    Answer each question by marking the appropriate box, only one box for each question. If you are unsure about how to answer a question, please give the best answer you can.
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  • HOOS, JR. HIP SURVEY

    INSTRUCTIONS: This survey asks for your view about your hip. This information will help us keep track of how you feel about your hip and how well you are able to do your usual activities. Answer every question by ticking the appropriate box, only one box for each question. If you are unsure about how to answer a question, please give the best answer you can.

  • Pain

    What amount of hip pain have you experienced the last week during the following activities?

  • Function, daily living

    The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your hip.
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  • Global Health

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    In the past 7 days...
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  • Most patients are in the hospital just overnight after joint replacement surgery and are then discharged home with help from their “coach”. Their coach is a family member or friend helping them out after surgery. For most patients this means going home with minimal to moderate assistance. Patients should plan for a coach to help them, for approximately 5 -7 days after surgery, with housekeeping, grocery shopping, appointments, and meal preparation.

    Please answer below questions according to where you will be going after discharge: home, friends, or relatives.

  • Walker must have front wheel

  • Your surgeon will order the needed equipment and services when you are in the hospital for your discharge home.

    Thank you, The Joint Replacement Program at PVHMC (909) 630-7815

  • Thinking about the class you just attended and the appointments at your surgeons office...

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