Idaho Hospital-Magic Valley Regional Medical Center

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Patient & Visitor Information

Patient Survey

At Magic Valley Regional Medical Center, we want to make sure we are always communicating with our patients, their families, guests and our visitors. To help us in our commitment to providing excellent care, please let us know if we can improve our efforts at any time. 

The following patient survey is one of the ways you can share your observations with us. We use this information to recognize and reward staff and to make performance improvements to our care and service. 

Please comment on the following questions and then rate each 
question using the scale below: 
5 4 3 2 1 n/a
very good good fair poor very poor  
Patient Name: (Optional)   
Age: (optional)

Are you the patient? Yes      No
Your name: (Optional) {if not actual patient}

Your Relation to Patient:

Unit:  

Other (please specify)

Date of Service:

Physician (s):  

 

Survey Question

Rating

Responsiveness to your concerns/needs: 
5 4 3   2 1   n/a
very good good  fair poor very poor  

Comments:

Doctor’s Concern & Sensitivity: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Teamwork: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Information regarding your care and treatment: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Information to your family and friends: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Pain Management: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

How well did the medicine for pain take away the pain? 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Attention to your emotional needs: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Overall Rating of Care: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Would you recommend MVRMC to others without hesitation? 
5 4  3 2 1 n/a
very good good  fair poor very poor  

   (Why or why not) Comments:
  

   Is there anything more we need to know to improve care at MVRMC?:
 

   Please comment and rate your experience in with the following areas: (Mark all that apply) 

  

Dietary Service: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Quality of Food: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Were you on a special diet?

Yes      No

Was your diet explained? 

Yes      No

Respiratory Therapy:
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Transport Dept: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Diagnostic Imaging (x-ray, CT, MRI, ultrasound,  mammography, etc): 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Laboratory Services: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Please comment and rate your 
perceptions of the following issues:

  

Have you noticed any problems with equipment or the facility? 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Cleanliness of facility: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Did the staff check your Identification Band before giving you medications? 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Did the staff wash their hands or use hand sanitizer before & after your care? 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Concern for your privacy: 
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Are staff Identification Badges visible consistently?
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

Did you know who your Primary RN was for each shift?
5 4  3 2 1 n/a
very good good  fair poor very poor  

Comments:

   General Anesthesia Patients Only:

  

What is the last thing you remember before going to sleep?

What is the first thing you remember after waking up?

Do you remember anything between going to sleep and waking up?

Yes      No

   
Is there anyone you would like to recognize for giving outstanding care?

Date:

Check here for Signature Authorization. 

Please read the following statement:
I understand that by submitting this information on a non secure site, patient confidentiality cannot be fully protected. MVRMC's site uses forms which require users to give us contact information (like their email address). We collect this information for internal use only and do not release this information to any other party. Although our site utilizes SSL security we can not fully protect information confidentiality.

 

 

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