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[en] Other -#- 003 - Hospital Patient Survey
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Please find a couple of minutes to evaluate your experience in [HOSPITAL]. Your feedback is higly important for us.
Was this your first time as a patient at [HOSPITAL]?
Yes
No
This block is required.
How did you select [HOSPITAL]?
My doctor recommended
My doctor insisted it be this hospital
My insurance determined it
It was my own choice
I came through emergency dept
This block is required.
What is the specialty of the doctor who admitted you to this hospital?
General/Family/Internal
Pediatrician
OB/GYN
Ear, Nose, Throat
General Surgery
Neurosurgery
Urology
Orthopedic
Cancer/Tumor
Other, please specify:
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How many days were you in the hospital?
1 to 3 days
4 to 6 days
7 or more
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What type of unit were you in for most of your stay?
Maternity
General
Surgical
Intensive/critical
Rehabilitation
Pediatric
Children's
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Please rate the following statements concerning [HOSPITAL]:
Strongly agree
Somewhat agree
Neutral
Somewhat disagree
Strongly disagree
Highest quality doctor staff in the area
Highest quality nursing staff in the area
Most up-to-date medical equipment
Most up-to-date facilities in the area
My doctors were skilled and experienced
My doctor was kind and caring
My doctor kept me fully informed
Tests and procedures were completely explained to me
The nurses were skilled in the treatment provided me
The nurses were responsive when I called
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What is your overall satisfaction with [HOSPITAL] and the medical care you received?
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
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If you are dissatisfied, why?
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If you wish, please comment on your experience as a patient of [HOSPITAL]:
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