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Feedback Form for In-patient Services
 

 

A. ADMISSION PROCESS  
1
 Information & assistance
Excellent
Good
Fair
Poor
2
 Admission process
Quick and simple(<15 min.)
Average wait
Long wait(25 to 35 min.)
Delayed(>35 minutes)
B. ROOM/WARD
1
 Cleanliness, hygiene and tidiness
Excellent
Good
Fair
Poor
2
 Linen (Dress, bed sheet, pilow cover, curtain towel etc.)
Excellent
Good
Fair
Poor
3
 Facilities, decor and comfort
Excellent
Good
Fair
Poor
4
 A/C (Room temperature)
Excellent
Good
Fair
Poor
5
 Washroom
Excellent
Good
Fair
Poor
 C. MEAL SERVICES  
1
 Dietician's advice and explanation
Excellent
Good
Fair
Poor
2
 Waiters communication and presentation
Excellent
Good
Fair
Poor
3
 Presentation of food
Excellent
Good
Fair
Poor
4
 Food temperature
Excellent
Good
Fair
Poor
5
 Quality of Food
Excellent
Good
Fair
Poor
6
 Serving time of food
Excellent
Good
Fair
Poor
 D. NURSING CARE  
1
 Response
Immediate
Prompt
Average
Delayed
2
 Courtesy, friendliness and communication
Excellent
Good
Fair
Poor
3
 Attiude & empathy of nurses : attention to your needs
Excellent
Good
Fair
Poor
4
 Quality of care
Excellent
Good
Fair
Poor
 E. PAIN MANAGEMENT  
1
 How well your pain was controlled
Excellent
Good
Fair
Poor
 F. PHYSICLANS CARE  
1
 Friendliness and politeness
Pleasant
Friendly
Warm
Indifferent
2
 Information and explanation : About proposed treatment plan, side effects and consent
Excellent
Good
Fair
Poor
3
 Addressing concerns
Excellent
Good
Fair
Poor
 G. WARD SECRETARY  
1
 Attitudes
Pleasant
Friendly
Warm
Indifferent
2
 Information and assistance
Excellent
Good
Fair
Poor
 H. BILLING AND CASH COUNTER  
1
 Attitude Courtesy and helpfulness
Pleasant
Friendly
Warm
Indifferent
2
 Payment process
Quick and simple (<10min)
Average wait (10 to 20 min)
Long wait (21 to 35 min)
Delayed (> 35 minutes)
3
 Addressing your queries
Immediate
Prompt
Average
Delayed
4
 Detail and accuracy to bill
Excellent
Good
Fair
Poor
 I. DISCHARGE PROCESS  
1
 Information & explanation : Home Care
Excellent
Good
Fair
Poor
2
 Discharge process
Quick and simple (< 1 hr.)
Average wait (1 to 2 hr.)
Long wait (2 to 3 hr.)
Delayed (> 3 hr.)
 J. OVERALL EXPERIENCE        
  Overall experience of services
Excellent
Good
Fair
Poor
           
 K. RECOMMEND THIS HOSPITAL TO OTHERS
Yes
No
   
 
 L. ANY COMMENTS/SUGGESTIONS THAT WILL HELP US TO IMPROVE THE CARE WE PROVIDE
 
PLEASE INCLUDE YOUR NAME AND CONTACT
Patient's/Attendant's Name
UHID:
Bed:
Patient's Age:
Patient's Sex:
Contact Number:
Email:

 
HOTLINE : 10678
Ambulance : 01714-090000
Duty Manager : 01713-064563
Appointment :  8845242
PABX :  8401661
FAX :  8401679
Master Health Check :  8401600
Chittagong info : 01713-064555
Sylhet info : 01713-047461
Bogra info : 01713-229988
Khulna info : 01713-489191
 
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