D.4 Patient Satisfaction Survey.docx
DOCX document 15 KB Posted
- Attached to
- Q201--FY26 Miami Home Oxygen Service
- Solicitation number
- 36C24825Q0568
About this file
The document is a Patient Satisfaction Survey for Oxygen Services, designed to collect feedback from patients receiving medical equipment and services. The survey consists of 11 questions that evaluate various aspects of service quality, including staff identification, equipment condition, delivery timeliness, staff courtesy, equipment instructions, patient rights information, complaint procedures, emergency contact availability, reliability, and overall medical needs satisfaction. Patients are asked to rate each aspect using a scale from A (Excellent) to D (Poor).
The related federal contract opportunity (Solicitation Number 36C24825Q0568) is for Home Oxygen Services for VA Beneficiaries in the Miami VA Healthcare System, covering Broward, Dade, and Monroe Counties. This is an Indefinite Delivery Contract set aside for Service Disabled Veterans Owned Small Business, with a base twelve-month period and four optional twelve-month extensions. The contract requires providing delivery, setup, installation, and management of home oxygen services for patients at the Miami VA Medical Center and associated Community Based Outpatient Centers. The primary NAICS Code is 621610 (Home Health Care Services), with a $19 million size standard. Interested offerors must be registered in SAM, with questions due by 06/30/2025 and quote offers due by 07/07/2025.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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 .