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* 1. The home infusion equipment:

  Yes No I did not use equipment.
Was clean when it was delivered.
Worked properly.

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* 2. The home infusion medications and supplies arrived before I needed them.

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* 3. I knew who to call if I needed help with my home infusion therapy.

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* 4. The response I received to phone calls for help on weekends or during evening hours met my needs.

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* 5. The home infusion nurse or pharmacist informed me of the possible side effects of the medication.

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* 6. I understood the explanation of my financial responsibilities for home infusion therapy.

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* 7. How often was each staff courteous?

  Always Very often Sometimes Rarely Never N/A
Nursing staff:
Pharmacy Staff:
Billing staff:
Delivery staff:

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* 8. How often was each staff helpful?

  Always Very often Sometimes Rarely Never N/A
Nursing staff:
Pharmacy staff:
Billing staff:
Delivery staff:

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* 9. I understood instructions provided for:

  Yes No N/A
How to wash my hands
How to give home infusion medications
How to care for IV catheter
How to store home infusion medications
How to use home infusion equipment

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* 10. Satisfaction:

  Strongly Agree Agree Uncertain Disagree Strongly Disagree
I was satisfied with the overall quality of services provided.
I would recommend Infusion Solutions to my family and friends.

T