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* Patient Name:
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* E-mail:
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* Patient ID:
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PLEASE RATE HOSPITAL PROCEDURES AND CONDITIONS
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Please tick and rate the following services you received at Suva Private Hospital:
1: Poor; 2: Fair; 3: Good; 4: Very Good; 5: Excellent
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1. Ease of getting admitted to hospital, including the amount of time it took. |
1
2
3
4
5
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2. At the time of discharge,
how clearly and completely were you told what to do and what to expect when
you left the hospital.
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1
2
3
4
5
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3. Explanation about costs
and how to handle your hospital bills: the completeness and accuracy of
information and the willingness of hospital staff to answer your questions about
finances.
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1
2
3
4
5
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4. Cleanliness, comfort,
lighting and temperature of hospital room.
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1
2
3
4
5
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5. Food quality, quantity
and service.
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1
2
3
4
5
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6. Willingness of nurse(s) to answer your
questions. |
1
2
3
4
5
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7. How well and efficient
would you rate nurses in giving you medicines, medical or surgical
treatment and handling of intravenous treatments?
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1
2
3
4
5
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8. The frequency with which
nurse(s) checked on you to keep track on how you are doing.
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2
3
4
5
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9. Courtesy and respect you
were given: friendliness and kindness.
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1
2
3
4
5
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10. How well nurses and
other staff explained tests, treatments and what to expect.
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1
2
3
4
5
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YOUR DOCTOR(S) Optional:
I saw Doctor(s):
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11. Were you satisfied with
the service provided by your doctor?
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1
2
3
4
5
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12. Courtesy and respect you
were given: friendliness and kindness.
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1
2
3
4
5
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13. Ability to diagnose
problems, thoroughness of examinations, and skill in treating your
condition.
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1
2
3
4
5
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14. Amount of information
you were given about your illness and treatment; what to do after leaving
hospital.
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1
2
3
4
5
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LOOKING BACK ON YOUR CARE |
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15. The teamwork of all the
hospital staff that took care of you.
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1
2
3
4
5
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16. Sensitivity of hospital
staff to your special problems and concerns.
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1
2
3
4
5
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17. Overall quality of care
and services you received from the hospital.
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1
2
3
4
5
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18. Would you recommend Suva Private Hospital to your friends and
relatives?
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1
2
3
4
5
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19. Would you use Suva Private Hospital
again in future?
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1
2
3
4
5
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* Comments:
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Please identify the reason for your visit:
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Hospital
Stay
Emergency
Visit
Radiology
Medical
Laboratory
Physician/
Specialist visit
Other
Outpatient Clinic
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* required field
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