Infusion Solutions Patient Satisfaction Survey Question Title * 1. The home infusion equipment: Yes No I did not use equipment. Was clean when it was delivered. Was clean when it was delivered. Yes Was clean when it was delivered. No Was clean when it was delivered. I did not use equipment. Worked properly. Worked properly. Yes Worked properly. No Worked properly. I did not use equipment. Comments: Question Title * 2. The home infusion medications and supplies arrived before I needed them. Always Very Often Sometimes Rarely Never Not Applicable Comments: Question Title * 3. I knew who to call if I needed help with my home infusion therapy. Yes No Comments: Question Title * 4. The response I received to phone calls for help on weekends or during evening hours met my needs. Always Very Often Sometimes Rarely Never Not Applicable Comments: Question Title * 5. The home infusion nurse or pharmacist informed me of the possible side effects of the medication. Yes No Comments: Question Title * 6. I understood the explanation of my financial responsibilities for home infusion therapy. Yes No Comments: Question Title * 7. How often was each staff courteous? Always Very often Sometimes Rarely Never N/A Nursing staff: Nursing staff: Always Nursing staff: Very often Nursing staff: Sometimes Nursing staff: Rarely Nursing staff: Never Nursing staff: N/A Pharmacy Staff: Pharmacy Staff: Always Pharmacy Staff: Very often Pharmacy Staff: Sometimes Pharmacy Staff: Rarely Pharmacy Staff: Never Pharmacy Staff: N/A Billing staff: Billing staff: Always Billing staff: Very often Billing staff: Sometimes Billing staff: Rarely Billing staff: Never Billing staff: N/A Delivery staff: Delivery staff: Always Delivery staff: Very often Delivery staff: Sometimes Delivery staff: Rarely Delivery staff: Never Delivery staff: N/A Comments: Question Title * 8. How often was each staff helpful? Always Very often Sometimes Rarely Never N/A Nursing staff: Nursing staff: Always Nursing staff: Very often Nursing staff: Sometimes Nursing staff: Rarely Nursing staff: Never Nursing staff: N/A Pharmacy staff: Pharmacy staff: Always Pharmacy staff: Very often Pharmacy staff: Sometimes Pharmacy staff: Rarely Pharmacy staff: Never Pharmacy staff: N/A Billing staff: Billing staff: Always Billing staff: Very often Billing staff: Sometimes Billing staff: Rarely Billing staff: Never Billing staff: N/A Delivery staff: Delivery staff: Always Delivery staff: Very often Delivery staff: Sometimes Delivery staff: Rarely Delivery staff: Never Delivery staff: N/A Comments: Question Title * 9. I understood instructions provided for: Yes No N/A How to wash my hands How to wash my hands Yes How to wash my hands No How to wash my hands N/A How to give home infusion medications How to give home infusion medications Yes How to give home infusion medications No How to give home infusion medications N/A How to care for IV catheter How to care for IV catheter Yes How to care for IV catheter No How to care for IV catheter N/A How to store home infusion medications How to store home infusion medications Yes How to store home infusion medications No How to store home infusion medications N/A How to use home infusion equipment How to use home infusion equipment Yes How to use home infusion equipment No How to use home infusion equipment N/A Comments: Question Title * 10. Satisfaction: Strongly Agree Agree Uncertain Disagree Strongly Disagree I was satisfied with the overall quality of services provided. I was satisfied with the overall quality of services provided. Strongly Agree I was satisfied with the overall quality of services provided. Agree I was satisfied with the overall quality of services provided. Uncertain I was satisfied with the overall quality of services provided. Disagree I was satisfied with the overall quality of services provided. Strongly Disagree I would recommend Infusion Solutions to my family and friends. I would recommend Infusion Solutions to my family and friends. Strongly Agree I would recommend Infusion Solutions to my family and friends. Agree I would recommend Infusion Solutions to my family and friends. Uncertain I would recommend Infusion Solutions to my family and friends. Disagree I would recommend Infusion Solutions to my family and friends. Strongly Disagree Comments: Done