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    IPD Patient Feedback Form

    Uploaded by

    Natasha Bhasin
    The patient feedback form aims to help the hospital improve patient services by soliciting feedback on various aspects of inpatient care. Patients are asked to rate on a scale of 1 to 5 or select yes/no for questions related to admission process, doctor's care, nursing, diet/kitchen, physiotherapy, diagnostics, blood bank, pharmacy, housekeeping, billing, discharge process, security, facilities, confidentiality, and overall experience. Space is also provided for comments, suggestions, and mentioning staff who provided good care.

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    IPD Patient Feedback Form

    Uploaded by

    Natasha Bhasin
    4K views1 page
    The patient feedback form aims to help the hospital improve patient services by soliciting feedback on various aspects of inpatient care. Patients are asked to rate on a scale of 1 to 5 or select yes/no for questions related to admission process, doctor's care, nursing, diet/kitchen, physiotherapy, diagnostics, blood bank, pharmacy, housekeeping, billing, discharge process, security, facilities, confidentiality, and overall experience. Space is also provided for comments, suggestions, and mentioning staff who provided good care.

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    The patient feedback form aims to help the hospital improve patient services by soliciting feedback on various aspects of inpatient care. Patients are asked to rate on a scale of 1 to 5 or select yes/no for questions related to admission process, doctor's care, nursing, diet/kitchen, physiotherapy, diagnostics, blood bank, pharmacy, housekeeping, billing, discharge process, security, facilities, confidentiality, and overall experience. Space is also provided for comments, suggestions, and mentioning staff who provided good care.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4K views1 page

    IPD Patient Feedback Form

    Uploaded by

    Natasha Bhasin
    The patient feedback form aims to help the hospital improve patient services by soliciting feedback on various aspects of inpatient care. Patients are asked to rate on a scale of 1 to 5 or select yes/no for questions related to admission process, doctor's care, nursing, diet/kitchen, physiotherapy, diagnostics, blood bank, pharmacy, housekeeping, billing, discharge process, security, facilities, confidentiality, and overall experience. Space is also provided for comments, suggestions, and mentioning staff who provided good care.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PATIENT FEEDBACK FORM - IPD

    At AIMS, we aim to render the best standards of care. To help us in our endeavour to serve you better we sincerely request you to kindly give us your opinion &
    suggestions on the Inpatient services of the hospital by checking the appropriate box. We are extremly grateful if you complete this questionnaire.

    N/A
    Please circle how well we are doing in the following areas: Great 5 Good 4 OK 3 Fair 2 Poor 1 Dont
    Know
    Staff is efficient and courteous
    1 Admission Process Information provided at the admission
    Time taken for admission
    Regular visits of the doctor
    Periodic briefings on patient health status
    2 Doctor's experience
    Responsiveness to your queries/ your invlovement in decision
    making during treatment
    Prompt and courteous response to your call
    3 Nursing
    Timely and efficient implementation of doctor's order
    Taste and Hygiene
    4 Dietitics/Kitchen Services Patient's food service experience: Delivery & Clearance
    Attendant's service experience: Delivery & Clearance
    Explanation about the treatment
    5 Physiotherapy
    Satisfaction with Physiotherapy treatment
    Efficient Sample collection
    6 Diagnostic Services Waiting Time for diagnostics (Xray, CT, MRI, Ultrasound, Echo, etc) procedures
    Timely delivery and accuracy of reports
    7 Blood Center Services Services are professionally delivered
    8 Pharmacy Services Timely availability of prescribed medications
    Cleanliness of the room and toilets
    9 Houskeeping Services
    Prompt and courteous responseby housekeeping staff
    Estimate provided and explained well
    10 Billing Services Timely information regarding outstanding bill
    Satisfactory reply regarding billing queries
    Time taken for discharge
    11 Discharge Process
    Discharge instructions explained well
    Courtesy/ assistance of security personnel
    12 Security Services
    Car parking services
    Well furnished rooms and all fitments working well
    13 Facilities
    Complaints were handled properly
    14 Confidentiality Keeping your personal information private
    How was your overall experience in the hospital
    15 Overall
    Would you recommend this hospital to others □ Yes □ No
    Comments/Suggestions

    As an appreciation to our staff members, please feel free to mention any staff who has taken good care of you during your stay at the hospital

    Patient/Attendent's Name: UHID No: IPD No:


    Phone/Mob No: Email:
    Signature: Date:

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