Language
  • English (US)
  • Español
  • JRP Class Forms- HIP- Jan2023

  • 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 answered. You will be
    asked in 90 days and 1-year post surgery to re-submit these surveys to track your
    overall improvement.


    Attestation: In completing the following surveys you are attesting that you have
    attended an in-person or on-line PVHMC Total Joint Replacement class with in a
    year of your scheduled surgery.


    Thank you and we wish you a speedy recovery


    Aimee Castillejo, MSN, RN, CEN
    Quality Clinical Coordinator
    (909) 630-7403


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

  • Link to hospital website
  • Patient Information

  •  / /
    Pick a Date
  •  / /
    Pick a Date
  •  / /
    Pick a Date
  • Link to hospital website
  • 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.
  • Link to hospital website
  • 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.
  • Link to hospital website
  • Global Health

  •  
  • Heading

    In the past 7 days...
  • Link to hospital website
  • 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) 630-7403

  • Image-67
  • Thinking about the class you just attended and the appointments at your surgeons office...

  •  
  •  
  • Should be Empty: