Sample Forms

Medical Practice Survey Form

September 16, 2014

The healthcare department of every country is comprised of a team of competent caregivers who provide extreme care in times of need. It helps patients stabilize themselves in the worrisome environment of hospitals. Every patient desires to be healthy and get discharged as quickly as possible. It is because of the efforts of doctors and nursing staff that, patients regain their health in less time than anticipated.

What is a medical practice survey form?

A medical practice survey form refers to the feedback that healthcare staff receives from patients and their representatives upon discharge. Patients shed light on all the good and bad things at the hospital and also acknowledge the efforts of the nursing staff, who not only boost their morale but also help them correct their mistakes. Using survey forms, patients point out mistakes that should be corrected immediately for a better response.

It is generally believed that a doctor’s behavior treats diseases. If a doctor listens carefully to their patients and prioritizes their values and beliefs, they can cure patients without starting treatment. It has a good effect on the overall health of the patient. Medical service survey forms are question-based documents that gather useful information for the better working of their healthcare facility.

[Template]

Medical Practice Survey Form

Form Template File: 47 KB

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Components of the form

Survey forms are devised by the administration of healthcare facilities to gain information about their medical services from their patients. These strategies have been in use for a long time because of their positive impact.

Questionnaires

Most survey forms are questionnaires with multiple choices to help people choose the most appropriate answer. The information they seek includes,

  • Patient information: The name, age, weight, date of birth, and hospital registration number are all filled out in the document to verify the authenticity of the patient.
  • Hospital information: date of admission, date of discharge, ailment, and services received; in-charge doctors and nursing staff are also included in the document.
  • Questionnaire: Mostly, the following information is collected through questions:
    • Admittance: Was the process of hospital admission smooth, or did you face difficulty? Was the staff at the reception helpful? Did you find assistance in filling out the forms?
    • Diagnosis: were you able to get in touch with the concerned doctor? Did the doctor make any diagnoses?
  • Communication: Did you communicate with the doctor about the diagnosis? Was the doctor able to help you understand the entire situation?
  • Diagnostic test: were you able to locate the laboratory for testing? Was the lab staff helpful? Was the entire procedure smooth?
  • Treatment: Was your treatment started immediately after the results came in? Did you notice any change in your health condition after the start of treatment? Was the nursing staff on time for medication and food?
  • Medications: Is the hospital pharmacy equipped with all the medications that are required? Is the staff helpful? Are they charging according to the actual price of the medicine?
  • Discharge: have you filled out your discharge papers? Did your doctor ask for a follow-up? Are you satisfied with the services provided here? Would you refer the medical services of this hospital to your relatives and friends?

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