Infusion Services, Provider Satisfaction Survey

This survey is specific to Jackson Health System Infusion Services department

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* 1. Name

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* 2. Title

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* 3. Primary Site

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* 4. How often do you refer patients to JHS Infusion Services?

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* 5. Please rate your satisfaction with the Jackson Health System Infusion Services department staff in each of the following areas:

	Very satisfied	Satisfied	Somewhat dissatisfied	Dissatisfied
Referral management turnaround time	Referral management turnaround time Very satisfied	Referral management turnaround time Satisfied	Referral management turnaround time Somewhat dissatisfied	Referral management turnaround time Dissatisfied
Referral support from staff to help with benefits investigation, prior authorization, and patient assistance?	Referral support from staff to help with benefits investigation, prior authorization, and patient assistance? Very satisfied	Referral support from staff to help with benefits investigation, prior authorization, and patient assistance? Satisfied	Referral support from staff to help with benefits investigation, prior authorization, and patient assistance? Somewhat dissatisfied	Referral support from staff to help with benefits investigation, prior authorization, and patient assistance? Dissatisfied
Ease of accessibility in speaking with a JHS Infusion Services staff?	Ease of accessibility in speaking with a JHS Infusion Services staff? Very satisfied	Ease of accessibility in speaking with a JHS Infusion Services staff? Satisfied	Ease of accessibility in speaking with a JHS Infusion Services staff? Somewhat dissatisfied	Ease of accessibility in speaking with a JHS Infusion Services staff? Dissatisfied
JHS Infusion Services staff experience	JHS Infusion Services staff experience Very satisfied	JHS Infusion Services staff experience Satisfied	JHS Infusion Services staff experience Somewhat dissatisfied	JHS Infusion Services staff experience Dissatisfied
Overall experience	Overall experience Very satisfied	Overall experience Satisfied	Overall experience Somewhat dissatisfied	Overall experience Dissatisfied
How would you rate the overall service compared to other home infusion pharmacies?	How would you rate the overall service compared to other home infusion pharmacies? Very satisfied	How would you rate the overall service compared to other home infusion pharmacies? Satisfied	How would you rate the overall service compared to other home infusion pharmacies? Somewhat dissatisfied	How would you rate the overall service compared to other home infusion pharmacies? Dissatisfied

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* 6. Please share any positive feedback on the services provided by JHS Infusion Services.

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* 7. Please share any suggestions/improvements on the services provided by JHS Infusion Services.