| Visit Date | Patient MRN | Patient Name | 1. How would you rate the waiting time before you were seen? | Comment | 2. How would you rate the courtesy and behavior of doctors and nurses? | Comment | 3. How would you rate the overall quality of service you received? | Comment | 4. Did the staff clearly explain your condition and treatment? | 5. Would you recommend our Emergency Department to family or friends? |
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| Visit Date | Patient MRN | Patient Name | 1. How would you rate the waiting time before you were seen? | Comment | 2. How would you rate the courtesy and behavior of doctors and nurses? | Comment | 3. How would you rate the overall quality of service you received? | Comment | 4. Did the staff clearly explain your condition and treatment? | 5. Would you recommend our Emergency Department to family or friends? |
