Q1. 您所在的年級（單選題）
Q2. 您的工作年限是多久？（單選題）
Q3. 請問您的性別是？（單選題）
Q4. 您此次住院的科室為？ Which department hosted your stay？（單選題）
外科病房 General surgery ward
骨科病房 Orthopedics ward
耳鼻喉科病房 ENT ward
內(nèi)科病房 Internal medicine ward
產(chǎn)科病房 Obstetrics ward
婦科病房 Gynecology ward
兒科病房 Pediatrics ward
其他 Other
Q5. 在您住院期間，您的房間及洗手間是否得到及時清潔。 During your stay, were your room and bathroom cleaned in a timely manner?（單選題）
是 Yes
否 No
Q6. 請您評價一下您的住院餐飲。Please describe the quality of the meals provided.（單選題）
非常好 Excellent
好 Good
一般 Satisfactory
不好 Poor
Q7. 在您住院期間，您的疼痛是否得到有效控制？ During your stay, was your pain controlled well?（單選題）
從始至終 Always
通常 Usually
偶爾 Sometimes
從來沒有 Never
不適用 Not applicable
Q8. 在您住院期間，醫(yī)院員工是否盡力幫助您控制疼痛？ During your stay, did hospital staff do everything they could to help you with your pain?（單選題）
從始至終 Always
通常 Usually
偶爾 Sometimes
從來沒有 Never
不適用 Not applicable
Q9. 在給您施用新的藥品前，醫(yī)院員工為您解釋其功效的頻率為？ Before giving you any medicine, did hospital staff explain what the medicine was for？（單選題）
從始至終 Always
通常 Usually
偶爾 Sometimes
從來沒有 Never
不適用 Not applicable
Q10. 在給您施用新的藥品之前，醫(yī)院員工是否為您解釋其副作用并使您容易理解？ Before giving you any medicine, did hospital staff describe possible side effects in a way that was easy to understand？（單選題）
從始至終 Always
通常 Usually
偶爾 Sometimes
從來沒有 Never
不適用 Not applicable
Q11. 如果您需要復(fù)查，是否有人幫您安排了具體的時間？If you need one, was a follow-up visit schedule for you?（單選題）
非常滿意 Definitely yes
比較滿意 Mostly yes
比較欠缺 Relatively not
非常欠缺 Definitely not
不需要復(fù)查 No need one
Q12. 關(guān)于您的保險，您是否獲得合理的關(guān)于保險理賠的解釋；或者如果您沒有保險，您是否一直得到關(guān)于賬單更新的信息？ How frequently did you receive adequate explanations regarding your insurance coverage for your stay? Or, if you do not have insurance, how regularly were you informed about the state of your bill?（單選題）
根據(jù)本人要求 As per my request
超過一周 More than a week
一周之內(nèi) In a week
每三天 Every 3 days
每天 Everyday
隨時 Whenever needed
Q13. 您是通過什么途徑了解到我們和睦家醫(yī)院/診所的？ How did you hear about us?（單選題）
使館 Embassy
親友 Friend
酒店 Hotel
保險公司 Insurance company
學(xué)校/公司 School/Company
搜索引擎 Search engine
社交媒體（微信/微博） Social media (Wechat/Weibo)
由其他醫(yī)療機(jī)構(gòu)推薦 Referred by another healthcare facality
Other 其他
Q14. 您是否愿意公開姓名讓我們介入調(diào)查您所提出的問題？ Would you like to waive anonymity to allow thorough investigation of any concerns raised?（單選題）
是 Yes
否 No
