03_Best Practices in Pediatric Emergency Medicine 2018 | Comment Form

Best Practices in Pediatric Emergency Medicine 2018 | Comment Form

Please complete and submit by 10:00 a.m. on Friday, March 2

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* 1. Provide name to be entered into Echo Dot drawing

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* 2. Have we cared for any of your patients at the Children's Hospital of Wisconsin in the last 24 months?

Yes

No

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* 3. Please rate Children's Hospital of Wisconsin as it relates to the following:

	Excellent	Very Good	Good	Fair	Poor	N/A
The Availability of Providers to See Your Patients in a Timely Manner	The Availability of Providers to See Your Patients in a Timely Manner Excellent	The Availability of Providers to See Your Patients in a Timely Manner Very Good	The Availability of Providers to See Your Patients in a Timely Manner Good	The Availability of Providers to See Your Patients in a Timely Manner Fair	The Availability of Providers to See Your Patients in a Timely Manner Poor	The Availability of Providers to See Your Patients in a Timely Manner N/A
The Ease of the Referral Process	The Ease of the Referral Process Excellent	The Ease of the Referral Process Very Good	The Ease of the Referral Process Good	The Ease of the Referral Process Fair	The Ease of the Referral Process Poor	The Ease of the Referral Process N/A
Your Relationship with the Providers	Your Relationship with the Providers Excellent	Your Relationship with the Providers Very Good	Your Relationship with the Providers Good	Your Relationship with the Providers Fair	Your Relationship with the Providers Poor	Your Relationship with the Providers N/A
Communication When INPATIENT Care is Provided	Communication When INPATIENT Care is Provided Excellent	Communication When INPATIENT Care is Provided Very Good	Communication When INPATIENT Care is Provided Good	Communication When INPATIENT Care is Provided Fair	Communication When INPATIENT Care is Provided Poor	Communication When INPATIENT Care is Provided N/A
Communication When OUTPATIENT Care is Provided	Communication When OUTPATIENT Care is Provided Excellent	Communication When OUTPATIENT Care is Provided Very Good	Communication When OUTPATIENT Care is Provided Good	Communication When OUTPATIENT Care is Provided Fair	Communication When OUTPATIENT Care is Provided Poor	Communication When OUTPATIENT Care is Provided N/A
Communication When ED Care is Provided	Communication When ED Care is Provided Excellent	Communication When ED Care is Provided Very Good	Communication When ED Care is Provided Good	Communication When ED Care is Provided Fair	Communication When ED Care is Provided Poor	Communication When ED Care is Provided N/A
Convenience of Location for Your Patients	Convenience of Location for Your Patients Excellent	Convenience of Location for Your Patients Very Good	Convenience of Location for Your Patients Good	Convenience of Location for Your Patients Fair	Convenience of Location for Your Patients Poor	Convenience of Location for Your Patients N/A
Your Patients' Satisfaction with Specialty Providers	Your Patients' Satisfaction with Specialty Providers Excellent	Your Patients' Satisfaction with Specialty Providers Very Good	Your Patients' Satisfaction with Specialty Providers Good	Your Patients' Satisfaction with Specialty Providers Fair	Your Patients' Satisfaction with Specialty Providers Poor	Your Patients' Satisfaction with Specialty Providers N/A
The Accessibility of Children's Hospital of Wisconsin Providers by Phone	The Accessibility of Children's Hospital of Wisconsin Providers by Phone Excellent	The Accessibility of Children's Hospital of Wisconsin Providers by Phone Very Good	The Accessibility of Children's Hospital of Wisconsin Providers by Phone Good	The Accessibility of Children's Hospital of Wisconsin Providers by Phone Fair	The Accessibility of Children's Hospital of Wisconsin Providers by Phone Poor	The Accessibility of Children's Hospital of Wisconsin Providers by Phone N/A
Returning Your Patients Back to You for Follow-Up Care	Returning Your Patients Back to You for Follow-Up Care Excellent	Returning Your Patients Back to You for Follow-Up Care Very Good	Returning Your Patients Back to You for Follow-Up Care Good	Returning Your Patients Back to You for Follow-Up Care Fair	Returning Your Patients Back to You for Follow-Up Care Poor	Returning Your Patients Back to You for Follow-Up Care N/A
Treating You as a Valued Member of the Care Team	Treating You as a Valued Member of the Care Team Excellent	Treating You as a Valued Member of the Care Team Very Good	Treating You as a Valued Member of the Care Team Good	Treating You as a Valued Member of the Care Team Fair	Treating You as a Valued Member of the Care Team Poor	Treating You as a Valued Member of the Care Team N/A
Involving You in Medical Decision Making	Involving You in Medical Decision Making Excellent	Involving You in Medical Decision Making Very Good	Involving You in Medical Decision Making Good	Involving You in Medical Decision Making Fair	Involving You in Medical Decision Making Poor	Involving You in Medical Decision Making N/A
The Courtesy and Respect Shown to You	The Courtesy and Respect Shown to You Excellent	The Courtesy and Respect Shown to You Very Good	The Courtesy and Respect Shown to You Good	The Courtesy and Respect Shown to You Fair	The Courtesy and Respect Shown to You Poor	The Courtesy and Respect Shown to You N/A

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* 4. Overall, would you say your impression of Children's Hospital of Wisconsin is:

Excellent

Very Good

Good

Fair

Poor

N/A

Excellent

Very Good

Good

Fair

Poor

N/A

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* 5. What would you say is the MAIN reason you feel it is NOT "Excellent" or "Very Good"