Program Referral Type (required)--- High Utilizer Group/Frequent User Admission/Readmission Avoidance Observation Admission Avoidance Hospice Revocation Avoidance Home Health Partnership
Referring Agency Type (required)--- Hospital Physician Office Clinic Care Management Agency Hospice Agency Home Health Agency Community Partner Other
On a scale of 1-5, with 5 being the best, how would you rate the ease of making the referral?1 2 3 4 5
The efficiency of the referral process?1 2 3 4 5
The response time of the MedStar Medic?1 2 3 4 5 N/A
The Communication skills of the responding MedStar Medic?1 2 3 4 5 N/A
The feedback or follow-up provided to you about your patient.1 2 3 4 5
The professionalism of the responding Medic?1 2 3 4 5 N/A
How would you rate your overall satisfaction that the patient's needs were met by the MedStar MIH program?1 2 3 4 5
How was your overall satisfaction with the referral process?1 2 3 4 5
How was your overall satisfaction with our service?1 2 3 4 5
Would you recommend this service to others?Yes No Not Sure
Is there any way we can improve our service to you or the patient?
