Lanai Community Health Center - Patient Satisfaction Survey - Ilocano

Pangngaasi ta sungbatan AMIN a saludsod

Kayatmi nga ammoen no ania ti kaririknayo maipanggep kadagiti serbisyo nga ipapaymi tapno masigurado a maited dagiti kasapulanyo. Dagiti sungbatyo ket isu ti diretso a pangibasaranmi para ti panangpasayaat kadagiti ipaaymi a serbisyo. Amin a sungbatyo ket agtalinaed a konpidensyal ken saan a maibutaktak ti naggappuanna. Agyaman kami ti orasyo.

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* 1. Taw-en mo:

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* 2. Katataom:

Lalaki

Babai

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* 3. Rasa/Etnisidad mo:

Asian

Pacific Islander

American Indian/Alaska Native

Black/African American

Hispanic or Latino (All Races)

White (Not Hispanic or Latino)

Unknown

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* 4. Adda appointmentmo?

Nagan ti Provider

Wenno Walk-in Ka?

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* 5. Nagan ti Provider

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* 6. Ibilangmo kadi daytoy a klinika nga isu ti regular a pangalaam ti taripato?

Yes

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* 7. Pangngaasi ta patimbukelan no kasano ti panangitarabahomi kadagiti sumaganad a kategorya:

Great 5

Good 4

Ok 3

Fair 2

Poor 1

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* 8. Kapaspas ti panangala ti taripato:
Ablidad a pannakaala ti lugar no kayat ti agpakita

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 9. Oras ti panag lukat ti klinika

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 10. Kaano ti kaykayatmo a panangiskedyul ti appointmentmo?

Lawasna, Agsapa iti Bigat (7:30 bigat – 9:30 bigat)

Lawasna, Oras ti Aldaw (10:00 bigat - 4:00 malem)

Lawasna, Oras ti Rabiii (4:30 malem – 6:00 malem)

Oras ti Sabado (9:00 bigat – 12:00 malem)

Oras ti Sabado (11:00 bigat – 2:00 malem)

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* 11. Pakalag-anan ti lokasyon ti Center

Poor 1

Fair 2

OK 3

Good 4

Great 5

N/A

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* 12. Insegida a pannakaasikaso kadagiti “return calls”

Poor 1

Fair 2

Ok 3

Good 4

Great 5

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* 13. Panaguray: Oras ti panaguray iti “waiting room””

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 14. Panaguray: Oras ti kaadda iti “exam room”

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 15. Panaguray: Panaguray kadagiti “tests” a maaramid

Poor 1

Fair 2

OK 3

Good 4

Great 5

N/A

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* 16. Panaguray: Panaguray kadagiti resulta ti “tests”

Poor 1

Fair 2

OK 3

Good 4

Great 5

N/A

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* 17. Empleado:
Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Agdengngegda kenka

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 18. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Naan-anay ti orasda kenka

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 19. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Ipalawagda ti kayatmo nga ammoen

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 20. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) -Itedda kenka ti kasasayaatan a balakad ken taripato

Poor 1

Fair 2

Ok 3

Good 4

Great 5

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* 21. Provider: Nurses, Medical Assistants and Dental Assistants - Mannakigayyem ken managtulongda kenka

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 22. Provider: Nurses, Medical Assistants and Dental Assistants - Sungbatanda dagiti saludsodmo

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 23. Staff: (Health Educator, Case Manager, Outreach-Eligibility, ken dadduma pay) - Mannakigayyem ken managtulongda kenka

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 24. Staff: (Health Educator, Case Manager, Outreach-Eligibility, ken dadduma pay) - Sungbatanda dagiti saludsodmo

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 25. Staff: (Health Educator, Case Manager, Outreach-Eligibility, Ken dadduma pay) - Serbisyo ti panagiterprete/translasyon iti bukod a langguahe

Poor 1

Fair 2

OK 3

Good 4

Great 5

N/A

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* 26. Singir/bayad: Ania ti paanagkunam iti bayad

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 27. Singir/bayad: Nalawag dagiti listaan ti babayadan

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 28. Singir/bayad: Panangkolekta iti bayad/kuarta

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 29. Ammom kadi nga adda Financial Assistance ditoy LCHC (i.e., sliding fee scale, budget plans, ken dadduma pay.)?

Yes

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* 30. Facilidad: Naurnos ken nadalus a pasdek

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 31. Facilidad: Nalaka a biroken ti papanan

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 32. Facilidad: Komportable ken natalged bayat ti panaguray

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 33. Facilidad: Praybasi

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 34. Facilidad: Oras ken aldaw ti panagpakita appoinment

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 35. Panangiggem kadagiti banag a Kompdensyal: Pannakaidulin kadagiti pribado nga impromasyon panggep kaniak

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 36. Posibilidad a panangiyawis kadagiti gagayyem ken kakabagian nga umay kadakami?

Poor 1

Fair 2

OK 3

Good 4

Great 5

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* 1. Taw-en mo:

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* 2. Katataom:

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* 3. Rasa/Etnisidad mo:

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* 4. Adda appointmentmo?

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* 5. Nagan ti Provider

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* 6. Ibilangmo kadi daytoy a klinika nga isu ti regular a pangalaam ti taripato?

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* 7. Pangngaasi ta patimbukelan no kasano ti panangitarabahomi kadagiti sumaganad a kategorya:

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* 8. Kapaspas ti panangala ti taripato:Ablidad a pannakaala ti lugar no kayat ti agpakita

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* 9. Oras ti panag lukat ti klinika

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* 10. Kaano ti kaykayatmo a panangiskedyul ti appointmentmo?

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* 11. Pakalag-anan ti lokasyon ti Center

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* 12. Insegida a pannakaasikaso kadagiti “return calls”

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* 13. Panaguray: Oras ti panaguray iti “waiting room””

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* 14. Panaguray: Oras ti kaadda iti “exam room”

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* 15. Panaguray: Panaguray kadagiti “tests” a maaramid

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* 16. Panaguray: Panaguray kadagiti resulta ti “tests”

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* 17. Empleado:Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Agdengngegda kenka

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* 18. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Naan-anay ti orasda kenka

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* 19. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Ipalawagda ti kayatmo nga ammoen

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* 20. Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) -Itedda kenka ti kasasayaatan a balakad ken taripato

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* 21. Provider: Nurses, Medical Assistants and Dental Assistants - Mannakigayyem ken managtulongda kenka

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* 22. Provider: Nurses, Medical Assistants and Dental Assistants - Sungbatanda dagiti saludsodmo

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* 23. Staff: (Health Educator, Case Manager, Outreach-Eligibility, ken dadduma pay) - Mannakigayyem ken managtulongda kenka

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* 24. Staff: (Health Educator, Case Manager, Outreach-Eligibility, ken dadduma pay) - Sungbatanda dagiti saludsodmo

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* 25. Staff: (Health Educator, Case Manager, Outreach-Eligibility, Ken dadduma pay) - Serbisyo ti panagiterprete/translasyon iti bukod a langguahe

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* 26. Singir/bayad: Ania ti paanagkunam iti bayad

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* 27. Singir/bayad: Nalawag dagiti listaan ti babayadan

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* 28. Singir/bayad: Panangkolekta iti bayad/kuarta

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* 29. Ammom kadi nga adda Financial Assistance ditoy LCHC (i.e., sliding fee scale, budget plans, ken dadduma pay.)?

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* 30. Facilidad: Naurnos ken nadalus a pasdek

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* 31. Facilidad: Nalaka a biroken ti papanan

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* 32. Facilidad: Komportable ken natalged bayat ti panaguray

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* 33. Facilidad: Praybasi

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* 34. Facilidad: Oras ken aldaw ti panagpakita appoinment

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* 35. Panangiggem kadagiti banag a Kompdensyal: Pannakaidulin kadagiti pribado nga impromasyon panggep kaniak

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* 36. Posibilidad a panangiyawis kadagiti gagayyem ken kakabagian nga umay kadakami?

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* 37. PAKDAAR: No ti sungbatmo iti abaluwasyon ket 3 wenno nababbaba, pangngaasi ta isurat ti PARTIKULAR A DETALYE:

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* 38. Ania ti kangrunaan a pangayatam iti health center?

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* 39. Ania ti saanmo unay a kayat iti health center?

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* 40. Balakad/Rekomendasyon para ti panangpasayaat iti serbisyo?

* 8. Kapaspas ti panangala ti taripato:
Ablidad a pannakaala ti lugar no kayat ti agpakita

* 17. Empleado:
Provider: (Doktor, Behavioral Health, Dentista, Nurse Practitioner) - Agdengngegda kenka

* 41. Ited ti impormasyon iti baba no LAENG kayatmo a tawagandaka:

Nagan: ____________

Email:

Telepono: _