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334-749-3411
About East Alabama Health
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Specialty Pharmacy and Home Infusion Provider Satisfaction Survey
Specialty Pharmacy and Home Infusion Provider Satisfaction Survey
General Information
Practice/Clinic Name
*
Provider Name
Provider Specialty:
Communication and Responsiveness
Timeliness of communication regarding patient status:
*
Excellent
Good
Fair
Poor
N/A
Responsiveness to inquires or orders:
*
Excellent
Good
Fair
Poor
N/A
Ease of reaching clinical or pharmacy staff:
*
Excellent
Good
Fair
Poor
N/A
Professionalism and courtesy of staff:
*
Excellent
Good
Fair
Poor
N/A
Clinical Care and Service Quality
Accuracy and completeness of clinical documentation
*
Excellent
Good
Fair
Poor
N/A
Confidence in clinical expertise of pharmacy/nursing staff:
*
Excellent
Good
Fair
Poor
N/A
Coordination of care with your office:
*
Excellent
Good
Fair
Poor
N/A
Timeliness of therapy initiation:
*
Excellent
Good
Fair
Poor
N/A
Prescription and Order Management
Ease of submitting new orders/refills:
*
Excellent
Good
Fair
Poor
N/A
Accuracy of order processing:
*
Excellent
Good
Fair
Poor
N/A
Notification of missing or incomplete information:
*
Excellent
Good
Fair
Poor
N/A
Overall Experience
Overall satisfaction with our pharmacy/infusion services:
*
Excellent
Good
Fair
Poor
N/A
Likelihood of continuing to refer patients:
*
Excellent
Good
Fair
Poor
N/A
Likelihood of recommending our services to other providers:
*
Excellent
Good
Fair
Poor
N/A
Open Feedback
What do we do well?
What could we improve?
Additional comments or suggestions:
Thank you for your time and feedback!
(Optional) Please provide contact information if you would like a follow-up:
Name:
Phone Number:
Email Address
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