VEO Disability Compensation Survey / VE Outpatient Survey Questions Non-Sub Change Request

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

VE OutpatientSurveyRatingScaleMeasure08032017

VEO Disability Compensation Survey / VE Outpatient Survey Questions Non-Sub Change Request

OMB: 2900-0770

Document [pdf]
Download: pdf | pdf
OMB: 2900-0770
Expiration: 09/30/2020
Respondent Burden: 1 minute
We are asking for this information so that you can provide compliments, comments, or concerns to VA. Title 38, United States
Code, allows us to ask for this information. We estimate that you will need an average of 1 minute to review the instructions and
complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed.
You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be
located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-844-MyVA311
(1-844-698-2311) to get information on where to send comments or suggestions about this form.

Outpatient Survey Rating Scale Question Updates
The following represents updated rating scale questions mapped to the below scale:

for the current outpatient survey series mapped to the following updated experience drivers:
1.

EASE

2.

EFFECTIVENESS

3.

EMOTION

4.

TRUST

New questions are indicated by (NEW) and bold font. All New questions with the exception
of 1.0.1 (Appointment Q 1) have been edited for clarity and specificity.
A revised assessment of (*Required) responses needs to be determined based on a review of
new questions.

1.0 Appointment
1.

It was easy to get my appointment. (NEW) EASE

2.

I got my appointment on a date and time that worked for me. (*Required)
EFFECTIVENESS

3.

When scheduling my appointment, I was treated with courtesy and respect. EMOTION

4.

I trust VA for my health care needs. (*Required) TRUST

1 VEOutpatientSurveyRatingScaleEdits08032017| 1
8/3/17

1.1 Healthcare
1. After I entered , I found it easy getting to my appointment. EASE
2. After I checked in for my appointment, I was told what to expect. EFFECTIVENESS
3. My provider explained things in a way that I could understand. EASE
4. After my visit, I knew what to do. EFFECTIVENESS
5. My provider listened carefully to me. EMOTION
6. I trust  for my healthcare needs. TRUST

1.2 Pharmacy (in-person)
1. It easy to get my prescriptions filled at  Pharmacy. (*Required) EASE
2. My wait time was reasonable. (NEW) (*Required) EFFECTIVENESS
3. When I picked up my prescription(s), I was treated with courtesy and respect.
EMOTION(*Required)
4. I trust  for my health care needs. (*Required) TRUST

1.2.1 Pharmacy (mail order)
1. It easy to request my mail-order prescription(s). (*Required) EASE
2. I felt comfortable requesting my mail-order prescription(s). (NEW)
EMOTION
3. I knew when to expect my prescription(s). (NEW) EASE
4. My prescription(s) arrived at my preferred address. (NEW) EFFECTIVENESS
5. I trust VA for my health care needs. (*Required) TRUST

1.3 Labs/Imaging
1. It was easy to find the location for my lab tests or imaging. (NEW) EASE
2. My lab tests or imaging were completed within a reasonable time frame.
1 VEOutpatientSurveyRatingScaleEdits08032017| 2
8/3/17

(NEW) EFFECTIVENESS
3. When I got my lab tests (blood draw, etc.) or imaging (X-ray, MRI, CT scan) done, I was
treated with courtesy and respect. (*Required) EMOTION
4. I trust  for my health care needs. (*Required) TRUST

1 VEOutpatientSurveyRatingScaleEdits08032017| 3
8/3/17


File Typeapplication/pdf
AuthorNewman, Jane E., VBAOAKL
File Modified2017-10-02
File Created2017-08-04

© 2024 OMB.report | Privacy Policy