GNP Doctor Ghassan N. Pharaon Healthcare
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Inpatient Satisfaction Questionnaire
 
Our Dear Customers
» The goal of GNP Hospital is to provide you with the best possible medical care and make your stay as comfortable as possible.
» It is very important for us to know your honest opinion about our services, whether positive or negative.
» We assure you that all your responses will be kept confidential.
 
I. DEMOGRAPHICS
 
1. Date of interview:  
2. Respondent is:
Patient   Guest (Specify):    
3. Unit:  
4. Room:  
5. Patient Age:  
6. Gender
Male   Female
7. Medical Record #:  
8. I was hospitalized here previously:
Yes   No
9. I was admitted to the hospital through:
OPD   ER
10. Check the main reasons for coming to this hospital:
Close to home            Friend’s recommendation
Self / relative works in the hospital Insurance / credit company
Transferred from another hospital GNP is my regular hospital
Good medical referral / Best doctors Outside hospital referral
Other  
 
II. DID YOU WAIT TOO LONG?
 
1. For the elevators:
Yes, for how long?     No
 
2. To be admitted to your room:
Yes, for how long?     No
 
3. For the nursing staff to respond to your call:
Yes, for how long?     No
 
4. For the nursing staff to assist you with your meals or bathing:
Yes, for how long?     No
 
5. For Operator’s assistance?
Yes, for how long?     No
 
6. Before entering the Operating Room?
Yes, for how long?     No   Not applicable
 
7. Before X-ray / Physiotherapy / Lab tests?
Yes, for how long?     No   Not applicable
 
Comments:
 
III. HOW COURTEOUS WERE:(CONT’D)
 
1. Admitting Office?
Very courteous   Courteous   Not courteous   Not applicable
 
2. Emergency Unit Staff?
Very courteous   Courteous   Not courteous   Not applicable
 
3. Nursing Staff?
Very courteous   Courteous   Not courteous
 
4. Medical Staff?
Very courteous   Courteous   Not courteous
 
5. Radiology / Physical Therapy / Lab Staff?
Very courteous   Courteous   Not courteous
 
6. Housekeeping (Cleaning) Staff?
Very courteous   Courteous   Not courteous
 
7. Pantry Staff?
Very courteous   Courteous   Not courteous
 
8. Maintenance Staff?
Very courteous   Courteous   Not courteous   Not applicable
 
IV. INFORMATION RECEIVED FROM WAS:
 
Admitting Office (regarding financial arrangements, coverage forms)?
Enough   Not enough   Not at all
 
2. The Nursing Staff regarding:
a) Nurse call button, bed, bath/shower, phone, TV,…?  
b) The various nursing procedures?  
c) Instructions before your surgery?  
 
3. The Medical Staff regarding:
a) Your case?  
b) The various medical procedures?  
c) The purpose of each medication?  
d) Surgical procedures / complications/ options & risks   
     of anesthesia?    
 
4. Nursing & Medical staff regarding self-care, medications, use of equipment, follow-up, radiology or physiotherapy procedures)?
Enough   Not enough   Not at all
 
V. PAIN MANAGEMENT:
 
1. How was your pain managed?
Satisfactorily   Not Satisfactorily   Not at all   Not applicable
 
VII. TELL US ABOUT YOUR FOOD…
 
1. Specify the type of your diet:
Regular   Low fat   Low salt   Diabetic   Other
 
2. The portion size was enough:
Yes   No   Not applicable
 
3. The meals were appetizing:
Yes   No   Not applicable
 
4. Food was served at the right time:
Yes   No   Not applicable
 
5. The meals’ temperature was appropriate:
Yes   No   Not applicable
 
VIII. GENERAL SERVICES
 
1. The room was clean & presentable:
a) Upon arrival:  
b) During your stay in the hospital:  
 
2. The equipment/furniture was in good shape:
Yes   No, specify what was wrong  
 
3. The linen was changed daily:
Yes   No
 
IX. GLOBAL SATISFACTION
 
1. Please specify the number of days you stayed in the hospital:
 
2. According to you, the length of stay is:
Short   Long   O.K.
 
3. Did you improve with the management you received?
Yes   No
 
4. Would you recommend this hospital to others?
Yes   No
 
5. Would you return to this hospital again?
Yes   No
 
6. Do you wish to compliment any staff member?
Name:     Position:  
 
X. GENERAL COMMENTS
 
 
 
 
 
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