Outpatient Services Survey

Source: http://www.hcahpsonline.org/,
Centers for Medicare and Medicaid Services,
Baltimore, MD, June 26, 2011
 
 
SURVEY INSTRUCTIONS
  • Complete this survey only if you received services in the lab and/or radiology departments.
  • Answer all of the questions by checking the box to the left of your answer.



REGISTRATION

1. Was the registration easy to complete?    Never
   Sometimes
   Usually
   Always

2. Was the manner of the person who registered you courteous, respectful, and sensitive?    Never
   Sometimes
   Usually
   Always

3. Was the waiting time before you were called to your outpatient service appropriate?    Never
   Sometimes
   Usually
   Always

ENVIRONMENT

1. Was the area clean and free of clutter?    Never
   Sometimes
   Usually
   Always

2. Was the equipment in working order?    Never
   Sometimes
   Usually
   Always

3. Was the noise level in the area kept to a minimum?    Never
   Sometimes
   Usually
   Always

4. Was the room temperature comfortable?    Never
   Sometimes
   Usually
   Always

SERVICES

1 . Was the manner of the staff courteous, respectful, and sensitive?    Never
   Sometimes
   Usually
   Always

2. Was the staff thorough, careful, and knowledgeable in their performance of the procedure?    Never
   Sometimes
   Usually
   Always

OVERALL RATING OF HOSPITAL

Please answer the following questions about this visit to Pointe Coupee General Hospital.
Do not include any other hospital visits in your answers.

1. Using any number 0 to 10, where 0 is the worst hospital possible and 10 the best hospital possible, what number would you use to rate this hospital during your visit?    0 Worst
   1
   2
   3
   4
   5
   6
   7
   8
   9
   10 Best

2. Would you recommend this hospital to your friends and family?    Never
   Sometimes
   Usually
   Always

ABOUT YOU

1. In general, how would you rate your overall health?    Excellent
   Very Good
   Good
   Fair
   Poor

2. What is the highest grade or level of school that you have completed?    8th grade or less
   Some high school, but did not graduate
   High school graduate or GED
   Some college or 2-year degree
   4-year college graduate
   More than 4-year college degree

3. Are you of Spanish, Hispanic, or Latino origin or descent?    No, not Spanish/Hispanic/Latino
   Yes, Puerto Rican
   Yes, Mexican, MexicanAmerican, Chicano
   Yes, Cuban
   Yes, other SpanishAlispaniclLatino

4. What is your race? Please choose one or more.
Caucasian
African-American
Asian
Native American or other Pacific Islander
American Indian or Alaska Native

5. What language do you mainly speak at home?    English
   Spanish
   Chinese
   Russian
   Vietnamese
   Other (see below)

6. If answer to 5 is Other, what language do you mainly speak at home?
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