🏥 St. Raphael Medical Center, Inc.
Mabalacat City, Pampanga | CONFIDENTIAL
📋 In-Patient Survey
← Back to Survey Selection
Instructions / Panuto:
Kindly place a check (✓) on your choice based on your experience.
Pakilagyan po ng tsek (✓) ang inyong piniling kasagutan ayon sa inyong karanasan sa SRMCI.
Rating Scale:
5
– Excellent (Napakahusay)
4
– Very Good (Mas Mainam)
3
– Good (Mainam)
2
– Fair (Pangkaraniwan)
1
– Poor (Kailangan Pagbutihin)
I. Introduction to SRMCI
Is this your first confinement at SRMCI?
*
Ito po ba ang una ninyong pagka-confine dito sa SRMCI?
✅ Yes (Oo)
❌ No (Hindi)
You selected SRMCI because it was:
*
Pinili nyo po ang SRMCI dahil sa:
Recommended by my attending physician
Recommended by relatives/friends
SRMCI is your personal choice
Your HMO's accredited hospital
II. Attending Physician
Name of attending physician (DR./DRA.):
*
Pangalan ng inyong manggagamot:
III-A. During the Admission Process
The medical personnel who attended me at the ER were competent and compassionate.
*
Ang mga tauhan sa Emergency Room ay mahuhusay at may malasakit sa kapwa.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The person who handled my admission was polite, friendly and explained things clearly.
*
Ang tao sa Admission ay magalang, mabait at mahusay magpaliwanag.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The admission process was facilitated within a reasonable period of time.
*
Nagawa ang mga proseso ng Admission sa loob ng sapat na oras.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The medical attendant and nurse who transported me to my room were polite and caring.
*
Ang mga tauhang naghatid patungo sa aking silid/ward ay magagalang at mapagkalinga.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
III-B. SRMCI Staff During Confinement
My attending physician(s) was/were competent, skilled and experienced.
*
Ang mga doktor na tumingin sa akin ay may kakayahan, sanay at bihasa.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The attending physician(s) was really kind, caring, and compassionate.
*
Ang doktor na tumingin sa akin ay tunay na mabait, mapagkalinga at mahabagin.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The nurses assigned were all skilled, experienced and competent.
*
Ang mga nars ay may kakayahan, sanay at bihasa.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The attending nurses were really respectful, kind, caring and compassionate.
*
Ang mga nars ay magagalang, mababait, mapagkalinga, at mahabagin.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The nurses were responsive to our calls and immediately attended to our needs.
*
Naging maagap sa pagtugon sa tawag at sa oras ng pangangailangan ang mga nars.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The laboratory personnel were really respectful, kind, caring and compassionate.
*
Ang mga tauhan sa laboratory ay magagalang, mababait, mapagkalinga at mahabagin.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The ultrasound and radiology personnel were very respectful, kind, and caring.
*
Ang mga tauhan sa ultrasound at radiology ay magagalang, mabait at mapagkalinga.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
Laboratory test results and radiological interpretations were made available in time for the attending physician to evaluate.
*
Ang lahat ng mga resulta ng pagsusuri ng laboratory at radiology ay nagamit ng doktor na wasto sa panahon.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
III-C. Other Facilities and Services
The food served was satisfactory (palatable, tasty and clean).
*
Ang mga pagkaing inihain ay masarap, malasa at malinis.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The room is clean and regularly cleaned. Waste disposal is timely.
*
Ang silid ay malinis at palaging nililinis. Ang mga basura ay agad nakukuha at nililimas.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The room amenities (aircon, TV, telephone and restroom facilities) were functional.
*
Ang aircon, telebisyon, telepono, at palikuran ay maayos at nagagamit ng maayos.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The environment within and outside the hospital premises was safe and secured.
*
Ang loob at labas na kapaligiran ng Ospital ay ligtas at maayos.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The billing statement was prepared within a reasonable period of time upon notice of patient's discharge.
*
Ang bill o bayarin ay nagawa sa loob ng wastong panahon kasunod ng utos sa paglabas sa ospital.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
The overall in-patient experience in this hospital was very satisfactory.
*
Sa kabuuan, ang pangkahalatang karanasan sa pagka-confine sa SRMCI ay lubos na kasiya-siya.
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
III-D. Comments and Suggestions
Comments and Suggestions (Mga Puna at mga mungkaho):
*
III-E. Staff Commendation
Name(s) of hospital staff you wish to commend for high quality services:
*
Mga tauhan ng SRMCI na nais ninyong purihin:
📋 Patient / Informant Information
(Mga Pagkakakilanlan)
Patient's Name
(Pangalan ng Pasyente)
Informant's Name
(Pangalan ng Nagpahayag)
Age
(Edad)
Room No.
(Silid)
Contact No.
Date Admitted
(Petsa ng Pag-admit)
Date Discharged
(Petsa ng Paglabas)
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