Part A. Socio-Demographic Characteristic
Please write () in the appropriate column provided:
1. Gender
Male ☐ Female ☐
2. How old are you?
18-30 ☐ 31-40 ☐ 41-50 ☐ 51-60 ☐ > 60 ☐
3. What is your marital status?
Single ☐ Married ☐ Widowed/Separated ☐
4. What is your educational degree?
Illiterate ☐ Primary ☐ Secondary ☐ High school ☐ Post-graduate ☐
5. What do you do for living?
Student ☐ Unemployed ☐Self-employed ☐ Self-employed ☐
Government staff ☐ Farmer ☐Worker ☐Company staff ☐ NGOs’ staff ☐
6. How much do you earn per month?
<= 20,000 INR ☐ 20,001-40,000INR ☐40,001-60,000INR ☐ more than 60,000INR ☐
7. How many times have you visited Outpatient Department?
2-4 times ☐ more than 4 …show more content…
There were adequate amount of medicines. ☐ ☐
28. Pharmacists were punctual and reachable ☐ ☐
Registration Services Agreed Disagreed
29. Registration staffs warmly welcomed you. ☐ ☐
30. Registration staffs informed you where OPD is. ☐ ☐
31. Registration staffs were punctual and reachable. ☐ ☐ Part C. Accessibility to Services
Please write (✓) in the box that is appropriate for you. Note that the questions in this section are about patients’ opinions on services they have received. Waiting Time Agreed Disagreed
32. Waiting time in registration process is appropriate. ☐ ☐
33. Waiting time for receiving consultation is appropriate. ☐ ☐
34. Waiting time for receiving medicines is appropriate. ☐ ☐
Working Schedule Agreed Disagreed
35. OPD’s working shift was easy for you. ☐ ☐
36. Clinical staffs were available when required. ☐ ☐
Service Procedure: Agreed Disagreed
37. Registration process was done timely. ☐ ☐
38. Good coordination was established between OPD & wards. ☐ …show more content…
Patient Satisfaction:
Please write (✓) in the box that is appropriate for you. Note that the questions in this section are about patients’ opinions on services they have received Convenience: Satisfactory Unsatisfactory
39. Ease of registering process. ☐ ☐
40. Ease of finding OPD. ☐ ☐
41. Hospital facilities (bed, chair, restroom etc.) ☐ ☐
42. Appropriate waiting time. ☐
Please write () in the appropriate column provided:
1. Gender
Male ☐ Female ☐
2. How old are you?
18-30 ☐ 31-40 ☐ 41-50 ☐ 51-60 ☐ > 60 ☐
3. What is your marital status?
Single ☐ Married ☐ Widowed/Separated ☐
4. What is your educational degree?
Illiterate ☐ Primary ☐ Secondary ☐ High school ☐ Post-graduate ☐
5. What do you do for living?
Student ☐ Unemployed ☐Self-employed ☐ Self-employed ☐
Government staff ☐ Farmer ☐Worker ☐Company staff ☐ NGOs’ staff ☐
6. How much do you earn per month?
<= 20,000 INR ☐ 20,001-40,000INR ☐40,001-60,000INR ☐ more than 60,000INR ☐
7. How many times have you visited Outpatient Department?
2-4 times ☐ more than 4 …show more content…
There were adequate amount of medicines. ☐ ☐
28. Pharmacists were punctual and reachable ☐ ☐
Registration Services Agreed Disagreed
29. Registration staffs warmly welcomed you. ☐ ☐
30. Registration staffs informed you where OPD is. ☐ ☐
31. Registration staffs were punctual and reachable. ☐ ☐ Part C. Accessibility to Services
Please write (✓) in the box that is appropriate for you. Note that the questions in this section are about patients’ opinions on services they have received. Waiting Time Agreed Disagreed
32. Waiting time in registration process is appropriate. ☐ ☐
33. Waiting time for receiving consultation is appropriate. ☐ ☐
34. Waiting time for receiving medicines is appropriate. ☐ ☐
Working Schedule Agreed Disagreed
35. OPD’s working shift was easy for you. ☐ ☐
36. Clinical staffs were available when required. ☐ ☐
Service Procedure: Agreed Disagreed
37. Registration process was done timely. ☐ ☐
38. Good coordination was established between OPD & wards. ☐ …show more content…
Patient Satisfaction:
Please write (✓) in the box that is appropriate for you. Note that the questions in this section are about patients’ opinions on services they have received Convenience: Satisfactory Unsatisfactory
39. Ease of registering process. ☐ ☐
40. Ease of finding OPD. ☐ ☐
41. Hospital facilities (bed, chair, restroom etc.) ☐ ☐
42. Appropriate waiting time. ☐