Thank you for taking this survey! We are interested in your honest opinions so that we can continue to improve our Emergency Department.

If you are going to reference a previous transport, please refrain from mentioning any patient identifiers or Protected Health Information (PHI).

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* 1. Please name the EMS agency you are with:

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* 2. What was the estimated time and data of your pediatric transport to El Paso Children's Hospital? (omit question if it does not apply)

Date / Time

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* 3. If you provided a pre-arrival radio report to El Paso Children's Emergency Department, the staff listened and acknowledged the information.

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* 4. On arrival to El Paso Children's Hospital Emergency Department, I was greeted promptly and assigned a bed.

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* 5. When giving my bedside report, staff acknowledged the information and made eye contact with me.

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* 6. I would feel comfortable approaching the Physician on Duty.

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* 7. Overall, I would recommend this Emergency Department to my family or friends.

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* 8. What works well at El Paso Children's Emergency Department?

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* 9. Is there anything El Paso Children's Hospital can do to improve the care and service to you or your patients?

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* 10. If there is a specific staff member that you would like to recognize for exceptional service or patient care, please list their name here:

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