MSDS/Reference Manual for GPs/ Family Physicians/Specialist Clinics ANNEX. A: Tuy ee ier orl m i) Sr.# | Questions Response 1 | Are you satisfied with the health services, behavior of Staff and the environment at | Yes No Clinic ABC 2 2 | IFYES, how? (Youcan circle | 1. Complete information provided more than one response and | 2. Services available when needed. write below) 3. Services are not costly. 4, Convenient to reach the facility. 5. Staff is courteous. 6. Relevant staff is available. 7. Privacy is observed. 8. Female staffis available. 9. I recovered after treatment. 10. Other(specify), 3 | IFNO, why? (Youcancircle | 4. Issues of confidentiality. more than one) response and | 2. Issues of privacy. write below) 3. Lack of attention. 4, Inadequate information provided. 5. | was asked to come another time. 6. Medicines/services are costly. 7. Waiting time is too long. 8. Staff is discourteous / Unsatisfactory behavior. 9. Staff is not competent. 10. Relevant staff NOT available. 11. Female staff NOT available (Gender issue). 12. | suffered from side effects of the treatment. 13, Other (specify) Signatures of patient/relative: ‘Action by the person in charge with date: | Punjab Healthcare Commission Ea