Attachment 3 - PATIENT SATISFACTION SURVEY.docx

DOCX document 15 KB Posted

Attached to
6515--VACHCS Home Oxygen Delivery Federal contract opportunity
Solicitation number
36C24822R0033
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

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Other files for this federal contract opportunity

Other files attached to 6515--VACHCS Home Oxygen Delivery, newest first.
File Type Posted
36C24822R0033 0003.docx DOCX document
36C24822R0033 0002.docx DOCX document
Attachment 1 - PAST PERFORMANCE QUESTIONNAIRE (Orlando).docx DOCX document
36C24822R0033 0001.docx DOCX document
36C24822R0033_Revised.pdf PDF
Attachment 2 - PATIENT RIGHTS AND RESPONSIBILITIES.docx DOCX document
Attachment 5 -Quality Assurance Surveillance Plan.docx DOCX document
36C24822R0033.pdf PDF
Attachment 4 - Ventilator_Caregiver Checklist.docx DOCX document
Attachment 1 - PAST PERFORMANCE QUESTIONNAIRE.docx DOCX document

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PATIENT SATISFACTION SURVEY

PATIENT SATISFACTION SURVEY OXYGEN SERVICES

STATION NAME:

Vendor being surveyed: _______________________

Patient Name (Data Validation Purposes) It is very important to Prosthetics that our patients receive quality service from our contractors. If you would take a few minutes out and complete this survey regarding the recent services you received, it would be most appreciative. Please use the Rating Scale below and return to the Prosthetic Department.

Thanks in advance for the opportunity to better serve you.

1. Were you asked to identify yourself by the contractor? Yes No

A=EXCELLENT B=GOOD C=FAIR D=POOR

2. Was your equipment in clean and working order? A B C D

3. Was the equipment delivered at the time agreed upon or expected? A B C D

4. Was the delivery and set/up provided by courteous and knowledgeable staff? A B C D

5. Were instructions provided on the use, care and cleaning of the equipment? A B C D

6. Were you provided with clear information about your rights and responsibilities? A B C D

7. Were you provided information about contractor’s complaint procedures? A B C D

8. Were you provided telephone numbers for emergency services/questions? A B C D

9. RELIABILITY, please rate. A B C D

10. Were employees courteous and efficient when you called their office? A B C D

11. Did the equipment and/or services meet your medical needs? A B C D Comments:

File details come from the government source that posted it. Updated .