Patient Survey - Urgent Care

Would you please take a few moments to answer questions about the medical care you received recently in the Urgent Care Department at the RCMS Gualala Medical Center?  Your responses will be kept confidential.  Thank you! 

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* 1. Date of your visit:

Date

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* 2. Your telephone prefix:

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* 3. Was your visit to Daytime Urgent Care due to:

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* 4. For Illness, please describe briefly whether you needed treatment for a chronic disease such as asthma, diabetes, hypertension, etc., or treatment for a severe cold, flu, allergy, tick bite, etc.

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* 5. For Accident/Injury, please describe briefly what type of accident/injury you suffered, e.g., sprain, strain, cut/laceration, concussion, etc.

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* 6. Are you aware that Urgent Care medical services are now available on an on-call basis at RCMS Gualala Medical Center on weekends and holidays from 8:00am-6:00pm?

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* 7. Have you ever utilized the RN-staffed Advice Line, available when the RCMS Clinics are closed?

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* 8. If, yes, was the information you received helpful? 

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* 9. Did your condition require hospitalization?

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* 10. Were you advised to see an RCMS Primary Care Provider for a follow-up visit?

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* 11. If yes, did you get an appointment in the time needed?

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* 12. Overall, how would you rate the service you received from the staff at our office? (Please check one - with 1 being Very Disatisfied and 10 being Very Satisfied)

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* 13. Do you receive primary care at RCMS?

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* 14. If you answered No, would you consider becoming a registered patient at RCMS?

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* 15. Additional Comments:

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* 16. If you would like to include your name and phone number, you may be contacted to discuss the results of the survey.

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