Palmetto Infusion Services Satisfaction Survey

Patient Perception of Care Survey - Ambulatory Infusion Center

Palmetto Infusion is pleased to have the opportunity to provide you with infusion therapy services. We appreciate your taking a few minutes to give us valuable feedback on meeting your needs and expectations in providing your infusion therapy. Your confidential comments and suggestions will help us improve our care. Thank you.

* 1. At which Infusion Center did you receive services?

Anderson

Aiken

Beaufort

North Charleston

Charleston (West Ashley)

Columbia

Conway

Florence

Greenville

Hilton Head

Myrtle Beach

North Augusta

Pawleys Island

Spartanburg

* 2. How long have you been a patient of Palmetto Infusion Services?

* 3. What was the date of your most recent service? (Optional)

Date of Service

MM /

DD /

YYYY

* 4. What is the name of your physician who ordered your treatment? (Optional)

* 5. Which Therapy did you receive?

IVIG

Reclast

Remicade

Rituxan

Tysabri

Xolair

Other (please specify)

* 6. Please tell us the name of your insurance provider. (Optional)

* 7. Please rate the following regarding the Infusion Center's ENVIRONMENT OF CARE.

	Excellent	Very Good	Good	Poor	Very Poor
Cleanliness of infusion clinic and facility	Cleanliness of infusion clinic and facility Excellent	Cleanliness of infusion clinic and facility Very Good	Cleanliness of infusion clinic and facility Good	Cleanliness of infusion clinic and facility Poor	Cleanliness of infusion clinic and facility Very Poor
Privacy of infusion area	Privacy of infusion area Excellent	Privacy of infusion area Very Good	Privacy of infusion area Good	Privacy of infusion area Poor	Privacy of infusion area Very Poor
Noise control	Noise control Excellent	Noise control Very Good	Noise control Good	Noise control Poor	Noise control Very Poor
Temperature control	Temperature control Excellent	Temperature control Very Good	Temperature control Good	Temperature control Poor	Temperature control Very Poor
Cleanliness of restroom facilities	Cleanliness of restroom facilities Excellent	Cleanliness of restroom facilities Very Good	Cleanliness of restroom facilities Good	Cleanliness of restroom facilities Poor	Cleanliness of restroom facilities Very Poor
Friendliness of office staff	Friendliness of office staff Excellent	Friendliness of office staff Very Good	Friendliness of office staff Good	Friendliness of office staff Poor	Friendliness of office staff Very Poor

* 8. Please rate the following PHARMACY AND PHYSICIAN SERVICES.

	Excellent	Very Good	Good	Poor	Very Poor	N/A
Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site).	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). Excellent	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). Very Good	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). Good	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). Poor	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). Very Poor	Your Pharmacist was available for consultation (offered by phone if unavailable at infusion site). N/A
Communication with your pharmacist was professional and helpful.	Communication with your pharmacist was professional and helpful. Excellent	Communication with your pharmacist was professional and helpful. Very Good	Communication with your pharmacist was professional and helpful. Good	Communication with your pharmacist was professional and helpful. Poor	Communication with your pharmacist was professional and helpful. Very Poor	Communication with your pharmacist was professional and helpful. N/A
Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis.	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. Excellent	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. Very Good	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. Good	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. Poor	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. Very Poor	Your Palmetto Physician was knowledgeable regarding your therapy and diagnosis. N/A
Your Palmetto Physician was professional in appearance and communications.	Your Palmetto Physician was professional in appearance and communications. Excellent	Your Palmetto Physician was professional in appearance and communications. Very Good	Your Palmetto Physician was professional in appearance and communications. Good	Your Palmetto Physician was professional in appearance and communications. Poor	Your Palmetto Physician was professional in appearance and communications. Very Poor	Your Palmetto Physician was professional in appearance and communications. N/A
How well was your pain controlled (if applicable to your care).	How well was your pain controlled (if applicable to your care). Excellent	How well was your pain controlled (if applicable to your care). Very Good	How well was your pain controlled (if applicable to your care). Good	How well was your pain controlled (if applicable to your care). Poor	How well was your pain controlled (if applicable to your care). Very Poor	How well was your pain controlled (if applicable to your care). N/A

* 9. Please rate the EQUIPMENT used during your visit.

	Excellent	Very Good	Good	Poor	Very Poor
Equipment was clean and in good working order.	Equipment was clean and in good working order. Excellent	Equipment was clean and in good working order. Very Good	Equipment was clean and in good working order. Good	Equipment was clean and in good working order. Poor	Equipment was clean and in good working order. Very Poor

* 10. Please rate the service you received from our BUSINESS OFFICE.

	Excellent	Very Good	Good	Poor	Very Poor
Financial responsibilities were clearly explained.	Financial responsibilities were clearly explained. Excellent	Financial responsibilities were clearly explained. Very Good	Financial responsibilities were clearly explained. Good	Financial responsibilities were clearly explained. Poor	Financial responsibilities were clearly explained. Very Poor
Staff was knowledgeable about insurance coverage and benefits.	Staff was knowledgeable about insurance coverage and benefits. Excellent	Staff was knowledgeable about insurance coverage and benefits. Very Good	Staff was knowledgeable about insurance coverage and benefits. Good	Staff was knowledgeable about insurance coverage and benefits. Poor	Staff was knowledgeable about insurance coverage and benefits. Very Poor
Staff communication was professional and courteous.	Staff communication was professional and courteous. Excellent	Staff communication was professional and courteous. Very Good	Staff communication was professional and courteous. Good	Staff communication was professional and courteous. Poor	Staff communication was professional and courteous. Very Poor

* 11. Please rate the NURSING SERVICES you received.

	Excellent	Very Good	Good	Poor	Very Poor
Knowledge and technical ability of your nursing team.	Knowledge and technical ability of your nursing team. Excellent	Knowledge and technical ability of your nursing team. Very Good	Knowledge and technical ability of your nursing team. Good	Knowledge and technical ability of your nursing team. Poor	Knowledge and technical ability of your nursing team. Very Poor
Your nurse was responsive to your concerns and needs.	Your nurse was responsive to your concerns and needs. Excellent	Your nurse was responsive to your concerns and needs. Very Good	Your nurse was responsive to your concerns and needs. Good	Your nurse was responsive to your concerns and needs. Poor	Your nurse was responsive to your concerns and needs. Very Poor
On the initial visit your nurse thoroughly explained what to expect.	On the initial visit your nurse thoroughly explained what to expect. Excellent	On the initial visit your nurse thoroughly explained what to expect. Very Good	On the initial visit your nurse thoroughly explained what to expect. Good	On the initial visit your nurse thoroughly explained what to expect. Poor	On the initial visit your nurse thoroughly explained what to expect. Very Poor
Instructions and educational materials were clear.	Instructions and educational materials were clear. Excellent	Instructions and educational materials were clear. Very Good	Instructions and educational materials were clear. Good	Instructions and educational materials were clear. Poor	Instructions and educational materials were clear. Very Poor
Instructions on how to contact your Palmetto Clinical Team after hours were clear.	Instructions on how to contact your Palmetto Clinical Team after hours were clear. Excellent	Instructions on how to contact your Palmetto Clinical Team after hours were clear. Very Good	Instructions on how to contact your Palmetto Clinical Team after hours were clear. Good	Instructions on how to contact your Palmetto Clinical Team after hours were clear. Poor	Instructions on how to contact your Palmetto Clinical Team after hours were clear. Very Poor

* 12. Please rate our BILLING/REIMBURSEMENT DEPARTMENT.

	Excellent	Very good	Good	Poor	Very poor
Knowledge and professional communication with your billing department.	Knowledge and professional communication with your billing department. Excellent	Knowledge and professional communication with your billing department. Very good	Knowledge and professional communication with your billing department. Good	Knowledge and professional communication with your billing department. Poor	Knowledge and professional communication with your billing department. Very poor
Billing statements were explained clearly.	Billing statements were explained clearly. Excellent	Billing statements were explained clearly. Very good	Billing statements were explained clearly. Good	Billing statements were explained clearly. Poor	Billing statements were explained clearly. Very poor
Calls from reimbursement department were returned promptly and courteously.	Calls from reimbursement department were returned promptly and courteously. Excellent	Calls from reimbursement department were returned promptly and courteously. Very good	Calls from reimbursement department were returned promptly and courteously. Good	Calls from reimbursement department were returned promptly and courteously. Poor	Calls from reimbursement department were returned promptly and courteously. Very poor

* 13. Please rate your overall satisfaction with your experience with Palmetto Infusion Services.

Excellent

Very good

Good

Poor

Very poor

Excellent

Very good

Good

Poor

Very poor

* 14. Did you experience any problems during your ambulatory infusion therapy? If yes, please explain.

Yes

If yes, please explain below.

* 15. How can we improve our services?

* 16. Do you have any suggestions to improve patient safety? If yes, please explain.

Yes

If yes, please explain below.

* 17. Additional comments:

* 18. Would you recommend Palmetto Infusion Services to friends or family?

Yes

* 19. Would you use Palmetto Infusion Services in the future?

Yes

* 20. Would you like someone to contact you to discuss this survey?

Yes

Please enter your name and the phone number in which you wish to be contacted.

Thank you for completing this survey. Your comments are important to us!