Ospital ng Maynila Medical Center
Quality Service Evaluation and Feedback

We, the management staff of Ospital ng Maynila Medical Center (OMMC), want to ensure that our patients always receive the best of service.  Please help us achieve this goal by answering this questionnaire and rating the services you experienced during your stay in OMMC.  You may use any criteria, such as promptness, courtesy, efficiency, and cleanliness to rate the services.  We request, however, that you specify the reasons in case you give a rating of poor and fair.  Thank you.

	Poor	Fair	Good	Very Good	Excellent	NA	
A. Professional Services							
1. Physicians (consultants, residents)							
2. Nurses and paramedics							
B. Services in Specialized Areas							
1. Outpatient Department							
2. Emergency Room							
3. Admitting Section							
4. Operating Room							
5. Nursery							
6. Laboratory Department 							
7. X-ray Department							
8. Pharmacy Department							
9. Medical Records							
10. Accounting Department							
11. Other department (pls. specify):
							
C. Food Services							
D. Linen Services							
E. General Services							
1. Rooms/Wards/Beds							
2. Comfort Rooms 							
3. General Equipments 							
4. Others (pls. specify):

Pls. give your suggestions/recommendations for improvement:

Name	Ward/Room/Bed No.		Date: