Republic of the Philippines
Depdrtment'of Health
OF'FICB OF THB SECRETARY
January 18,2016
DEPARTMENT MEMORANDUM
No.2016 - 003?.
TO: ALL REGIONAL DIRECTORS
ATTENTION: ALL MEDICAL CENTER
CHIEFS/DIRECTORS AND PHARMACISTS OF
MEDICINES ACCESS PROGRAMS ACCESS
SITES. PATIENT NAVIGATORS" DOH COMPACK
COORDINATORS AND DOH REGIONAL
PHARMACISTS
SUBJECT: Implementation of the Customer Satisfaction Survev
Forms for all Department of Health (DOH)
Pharmaceutical Division-Medicines Access Prosrams
(MAPs)
In order to monitor the proper implementation of the Department of Health-
Pharmaceutical Division Medicines Access Programs and ensure that the patients
receive proper health care from our access sites, all participating health facilities are
requested to require access program beneficiaries/patients to fill up the Customer
Satisfaction Survey Form during their visits to the health facilities. The
accomplished forms shall be submitted to the Pharmaceutical Division during
Program Implementation Reviews (PIR) scheduled every quarter for data analysis
and evaluation.
Moreover, the DOH Regional Pharmacists are hereby delegated to disseminate the
attached form to all Public Health Facilities implementing the MAPs. Reproduction
of the form shall be borne against the funds sub-allotted to the Regions.
Please make use of the attached survey form for uniformity. Should you have any
inquiries you may contact Mr. Michael D. Junsay or Ms. Tanya S. Samson at tel. no.
(02)-651-7800 local 2558 or through email ncpampimd@gmail.com.
Your cooperation is highly appreciated
Bv the Authoritv of the Secretarv of Health:
HARTIGAN-GO,
of Health t
,l
Office for Health Regulatio$s
Building I, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila o Trunk Line 651-7800 Direct Line: 711-9501
F ax: 7 43-1829; 7 43-1786 r URL: htto://rwvrv.doh.g.ov.ph; e-mail: osec@ldoh.gov.nh
Republic of the PhiliPPines
DEPARTMENT OF HEALTH
CUSTOMER SATISFACTION SURVEY
Thank you for availing the Pharmaceutical Division - Medicines Access Programs (PD-MAPsJ of
the Department of Health. In pursuit of service excellence, we would like to get your
comments/suggestions/inputs on the responsiveness of the Programs. We will appreciate if you can
spend a moment to ANSWER this survey form. Once again, thank you very much!
Date: Time:
Office/Hospital/Health Facility where MAP is availed:
Staff/health care provider who rendered service:
tell us a bit about you...
Please
Gender: QMale O Female MAP availed: \J DOH Maintenance Drugs
Age Group: o 18-21 (J ALLMAP o MHMAP
o 21-30 BCMAP o Other MAP
o 31-45 Insulin MAP
o 46-60 Stroke MAP
o >60
Please rate the Office/Hospital Facilityyou received assistance through MAF/s
Please check the box ( { lofvour choice and the rating scde
L. Assisted in a timely manner
2. The staff/health care provider was courteous and
3. The health care provider clearly explained the health
problem/ condition
4. Clearness of instructions: (the health care provider use
words that were easy to understandJ
5. The health care provider listened to your concerns and
Fulfilled all commitments made to
Comments/Suggestions/Recommendations DOH/ Hospital/ Health Facilities
Please rate the value of Medicines Access Program/s to your Health improvement
r'
Please check the box ( ) ofyour choice and response using the rating scale
Strongly Agree Disagree Strongly .
Agree t3) (2) Disagree
Parameters f4l f1)
L The DOH-MAP/s suited to your health needs
2. Adeouate Drocess of availine the Medicines
3. Would recommend the DOH-MAPs to other patients
4. Overall, I am satisfied with the services I received
from the DoH-MAP
Comments/Suggestions/Recommendations on the Medicines Access Program availed:
*** For immediate concern/feedbacks, kindly approach our Regional Pharmacists in your respective
area.
Thank you very much.
Republic of the PhiliPPines
DEPARTMENT OF HEALTH
SARBEY SA PAGLILINGKOD
Maraming Salamat sa inyong patuloy na pagtangkilik sa Pharmaceutical Division-Medicines
Access erogram 1PD-MAP) ng Department of Health. Hinahangad namin ang higit na
maayos na
paglilingkod. Hinihiling namin ang inyong mga puna at opinion para mapabuti at maisaayos aming mga
ir.ogrr*". Salamat sa panahon inilaan upang sagutin ang mga sumusunod.
Petsa: Oras:
Pangalan ngAhensya/ Ospital kung saan nagtungo para sa MAP:
fan[alan ttg T"gap"ttgalaga ng Kalusugan/ Kawani na nagbigay ng serbisyo:
Impormasyon tungkol sa Pasyente:
Kasarian:Olalaki OBabae UringMAP: O DOH Maintenance Drugs
Pangkatng Edad: O 18-2t O ALLMAP O iba pa MAP
o 21"-30 o BCMAP OMHMAP
o 3t-45 O Insulin MAP
O 46-60 O Stroke MAP
o >60
M""kaha" ng;aayon ang Opisina/Ospital/Ahensya kung saan nagtungo para sa DOH-MAP
Maarillamang laryan ng tsek 1 / ) ang naangkop na kahon na iyong napili
Lubos na Sumasang Sumasa Lubos na
sumasang- -ayon (3) ng-ayon hindi
Salaysay ayon (3)) sumasang-
(4) ayon
f1)
1. Mabilis at maagap na natugunan ang pangangailangan sa
Programa
2. Ang kawani ay magalang at madaling lap4qq
3. Ang kawani ay may sapat na kaalaman tungkol sa iyong
karamdaman/kundisyon at naipaliwanag ito ng mabuti:
4. Malinaw ang pagtuturo ng mga dapat gawin at gumamit
ns mga salitang madali at iyong nauunawaan
5. Nakinie at sinagot iyong mga katanungan at alqlehqqin'
6. Patas, tapat at sapat ang serbisyong nailaan
Komento/Suhestiyon/Rekomendasyon para sa DOH/Ospital/Ahensya:
Markahan ng naayon ang DOH- MAP para sa iyong Pangangailangan
Maari lama nns tsek (/ naanskoD na kahon na iYong naPili
1. Ang DOH- MAP ay sapat ayon sa ryong
;
L, Ang proseso ng pagpatala sa MAP ay maayos at
mabilis
3. Ang DOH-MAPs ay aking irerekuminda sa iba pang
nte na maaring makinabang dito
4. Sa kabuuan, ako ay nasisiyahan sa serbisyong
natanssaD ko mula sa DOH-MAP.
Komento/Suhestiyon/Rekomendasyon para sa DOH- MAP
Para sa agarang pansin sa inyong mga isyu o puna, pinapayuhang lapitan ang aming Regional
Pharmacist na malapit sainyo. Maraming Salamat po.
