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Your opinion is valuable to us, Please give us your feedback about your experience while at the hospital. |
Please take a few minutes to fill out this survey on the timeliness and quality of the service you received today. Rangely District Hospital welcomes your feedback and your answers will be kept confidential. Thank you for your participation. |
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GENERAL PATIENT INFORMATION |
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In general, what is the quality of your health? |
Outstanding Good Some Chronic Issues Poor |
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How would you rate our concern for your privacy? |
Outstanding Good Adequate Needs Improvement Poor N/A |
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How often have you visited RDH within the past year? |
First Visit 2-5 Visits More Than 6 |
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If you were seeking a referral to a specialist, was your request handled in a timely manner? |
Yes No N/A |
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Which department did you visit? |
Lab Radiology Cardio/Pulmonary ER P/T Clinic N/A |
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THE NURSING STAFF |
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How would you rate the competence of the nurse who helped you? |
Outstanding Good Adequate Needs Improvement Poor N/A |
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How would you characterize the concern shown to you by the nurse? |
Outstanding Good Adequate Needs Improvement Poor |
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Did the nurse respond to you within a reasonable period of time? |
Yes No |
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THE DOCTORS |
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Were you able to see the doctor of your choice? |
Yes No N/A |
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Did you feel that your doctor spent an adequate amount of time with you? |
Yes No N/A |
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Mark the boxes that characterize the demeanor of your doctor |
Attentive Concerned Friendly Distracted Rushed Inconsiderate |
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How would you rate the competence of your doctor? |
Outstanding Good Adequate Needs Improvement Poor N/A |
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Did you feel that your doctor's exam was thorough? |
Yes No N/A |
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Please rate the clarity of your doctor's explanation of your condition and treatment options? |
Outstanding Good Adequate Needs Improvement Poor N/A |
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How well did your doctor include you in your healthcare decisions? |
Outstanding Good Adequate Needs Improvement Poor N/A |
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Were your questions answered to your satisfaction? |
Yes No N/A |
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CLINIC |
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If you needed an appointment, did you have to wait longer than expected? |
Yes No |
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How easy was it to make an appointment by telephone? |
Very Easy Moderately Easy Very Difficult |
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How long did you wait to speak to a scheduling staff member? |
0 to 2minutes 3 to 5minutes 5 to 7minutes Longer |
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Was the person who scheduled your appointment courteous and helpful? |
Very Courteous Moderately Courteous Rude |
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How would you rate the courtesy of the staff at the reseption desk? |
Very Courteous Moderately Courteous Rude |
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How long did you wait in the reception area beyond your appointment time? |
0 to 5minutes 5 to 20minutes 20 to 40minutes Longer |
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How long did you wait in the exam room before you saw your physician? |
0 to 5minutes 5 to 20minutes 20 to 40mintues Longer |
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THE LAB STAFF |
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How would you rate the professionalism and competence of the lab tech who took your blood? |
Outstanding Good Adequate Needs Improvement Poor |
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How long did you have to wait to speak to a lab tech? |
0-2minutes 3-5minutes 5-7minutes Longer |
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BUSINESS OFFICE |
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How would you rate your level of satisfaction with our business office staff? |
Very Satisfied Satisfied Dissatisfied Very Dissatisfied |
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How would you rate the helpfulness of the business office staff? |
Very Helpful Helpful Not Helpful Indifferent |
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If you had an issue with your bill, did you feel that you received the necessary help to resolve your issue? |
Yes No |
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How would you rate your overall experience in dealing with the hospital staff and services? |
Very satisfied Satisfied Adequate Needs Improvement Poor |
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ADDITIONAL FEEDBACK |
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Please list any areas in which our services could be improved. |
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Please share any additional comments you may have. |
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PERSONAL INFORMATION Providing the following information is optional. |
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First Name |
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Last Name |
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Address |
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City |
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Telephone |
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Would you like some one to contact you? |
Yes No |
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