2021 Out-Patient Survey QUESTIONS REGARDING HOSPITAL STAFF **If a question does not apply to your visit, please choose N/A as your answer** OK Question Title * 1. Department(s) accessed during this visit Mental Health Crisis Intervention Oncology Emergency Ambulatory Clinic Operating Room X-Ray ECG Mammography Ultra Sound Respiratory Therapy Laboratory Physio Occupational Therapy Telehealth Dietician Diabetes Management Other (please specify) OK Question Title * 2. In terms of friendliness and respect, how would you rate the staff that you saw? Excellent Good Poor Very Poor N/A OK Question Title * 3. Please rate how you felt about the communication between yourself, nurses, and other hospital staff. Excellent Good Poor Very Poor N/A OK Question Title * 4. Please share how you felt about the amount of information you received from the hospital staff regarding what to do if you were worried about your condition or treatment after you left the hospital Excellent Good Poor Very Poor N/A OK Question Title * 5. How do you feel the health team member explained your care plan to you and answered any questions you may have had? Excellent Good Poor Very Poor N/A OK Question Title * 6. Were you informed (verbally or in writing) of any follow-up or discharge instructions? Yes No N/A OK Question Title * 7. Did you see the staff wash their hands upon entering and leaving the room, and before and after administering treatment? Yes No OK Question Title * 8. Was your sensitive health information treated in a respectful and confidential manner? Yes No N/A OK Question Title * 9. Did staff confirm your name and date of birth prior to initiating assessment/treatment? Yes No N/A OK Question Title * 10. Did you see a Physician/ Physiatrist today? Yes No OK NEXT
