Patient Experience Survey

SURVEY OF EXPERIENCE WITH YOUR PROVIDER, DOCTOR, MEDICAL GROUP 2018

Dear Client:
At Hispanic Physician IPA, we know how important your health care is. That is why we would like to hear from you about your experience with the services you are receiving when: you had at least ONE service/ visit in the past 6 months and you are still enrolled with this IPA. Your participation will let us know how we are doing and how we can improve. Please take a few minutes to read and answer the following questions. Please check the answer that best reflects your experience.



YOUR PROVIDER/DOCTOR OFFICE

1. Our records show that you got care from this clinic in the last 6 months.
Is that Right? YesNoN/A


2. In the last 6 months, when you called this doctor to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?
NeverSometimesUsually


3. When you called the doctor and the office is closed, did this office give you information about what to do if you if you feel that it's an "Emergency"
YesNoN/A


4. When you call your doctor’s office during regular office hours, how often do you get a call back to your medical question on that same day?
NeverSometimesUsually


5. Wait time includes the time spent in the waiting room and exam room. How often did you see your doctor within 15 minutes on your appointment time?
NeverSometimesUsually

MANAGING YOUR CARE/COMMUNICATION

6. In the last 6 months, how often did your doctor explained things in a way that was easy to understand?
NeverSometimesUsually


7. In the last 6 months, how often did your doctor listen carefully to you and spend enough time with you?
NeverSometimesUsually


8. In the last 6 months, how often did the doctor seem to know the important information about your medical history with the specialists (heart doctor, skin doctor, surgeon, eye doctor), and other doctors who specialize in one area of your health care.
NeverSometimesUsually


9. In the last 6 months when your doctor ordered blood test, x-ray, or other test for you, how often did someone from the office call you to give you those results?
NeverSometimesUsuallyDidn't have any test


10. In the last 6 months, did you have any problem getting approval though your Plan (IPA) for any tests, care or treatment, medication, that your doctor said you needed?
NeverSometimesUsuallyMy doctor didn't ask for authorization for referral, medication or treatment


11. Using any number from 0 to 5, where 0 is the worst and 5 is the best doctor offices possible, what number would you use to rate this doctor?
0 - Worst possible12345 - Best doctor possible


12. Would you recommend you Primary Doctor?
Yes, definitelyMaybeUndecidedNo

CUSTOMER SERVICES, COORDINATORS AT THE IPA/ MEDICAL GROUP

13. In the last 6 months, how often were
the UM coordinator, Nurse case manager, customer services at the IPA as helpful as you thought they should be?
NeverSomehowAlways

LANGUAGE ASSISTANCE SERVICES (LAP)

14. Do you know about the Language Assistance Program (LAP), for face-to-face interpreter services and translation of written materials?
YESNO

PREVENTIVE SERVICES

15. In the last 6 months, did you receive any written materials or your doctor talked to you about early check up CHOLESTEROL, Cancer, (based on your gender and age)
Breast cancer screeningColon cancer screening/COLONOSCOPYAnnual Wellness Exam (Annual Physical)Cervical Cancer screening( PAP smear)

ADDITIONAL EXPERIENCE

16. In the last 6 months, did you and your doctor talk about a risk to fall, or your problem with balance?
Yes, definitelyYes, somewhatNo


17. In the last 6 months, did your doctor talk about THE EXCERCISE AND PHYSICAL ACTIVITY THAT YOU GET?
Yes, definitelyYes, somewhatNo


18. In the last 6 months, did your doctor or other office assistance talk to you about importance of physical
activity, exercises that you get?
NeverSometimesUsually


19. Did your doctor or other health care suggest any treatment, such as using cane or walker, having your blood pressure checked or having your eye/vision or hearing checked?
Yes, definitelyYes, somewhatNo


20. Have you ever talked with a doctor, nurse, or other health care provider about leaking urine?
Yes, definitelyYes, somewhatNo


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