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Inpatient Service Feedback

The document is a patient feedback form from an inpatient at a hospital. It requests the patient to provide confidential feedback on their experience by rating various attributes of the hospital services on a scale from poor to excellent. It asks the patient to rate attributes like cleanliness, behavior of staff, doctors' attention and communication, availability of nurses and drugs. It also requests the patient to provide suggestions for improvement and the reasons for choosing this hospital along with their willingness to return.

Uploaded by

Hiral Panchal
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348 views1 page

Inpatient Service Feedback

The document is a patient feedback form from an inpatient at a hospital. It requests the patient to provide confidential feedback on their experience by rating various attributes of the hospital services on a scale from poor to excellent. It asks the patient to rate attributes like cleanliness, behavior of staff, doctors' attention and communication, availability of nurses and drugs. It also requests the patient to provide suggestions for improvement and the reasons for choosing this hospital along with their willingness to return.

Uploaded by

Hiral Panchal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Inpatient Feedback

Dear Client

You have spent your valuable time in the hospital in connection with your / relative’s/ friend’s
treatment. You are requested to share your opinion about the quality of services, which you
experienced, while staying in the hospital. The information provided by you would be kept confidential,
and would only be used for improving the services.

Please tick the appropriate box and drop the questionnaire in the Suggestion box

Sl No Attributes Poor Fair Good Very Excell No


1 2 3 Good ent comments
4 5
1. Availability of sufficient information at
Registration/Admission counter (Directional & location
signages, Registration counter, Laboratory, Radiology
Department, Dispensary, etc)
2. Waiting time at the Registration/Admission counter more than 30 10-30 mins 5-10 mins Within 5 mins Immedia
mins te
3. Behaviour and attitude of hospital staff at the registration/
admission counter
4. Your feedback on discharge process
5. Cleanliness of the ward
6. Cleanliness of Bathrooms & toilets
7. Cleanliness of Bed sheets, pillow-covers, etc
8. Cleanliness of surroundings and campus drains
9. Regularity of Doctor’s attention
10. Attitude & communication of Doctors
11. Time spent for examination of patient and counselling
12. Promptness in response by Nurses in the ward
13. Round the clock availability of Nurses in the ward
14. Attitude and communication of Nurses
15. Availability, attitude & promptness of Ward boys/girls
16. All prescribed drugs were made available from Hospital
Supply
17. Your Perception of Doctor’s knowledge
18. Diagnostics Services were provided within the hospital
19. Timeliness of supply of the diet and its quality
20. Your overall satisfaction during the treatment as an in-
patient

1. What improvement would you like to see in the hospital

2. What made you come to this hospital for treatment?

3. Would you like to return to this hospital next time for treatment

4. Your valuable suggestions

Date __________ Ward_________ Age _____________Sex_______ Date of Admission

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