1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment

Outpatient Survey Questions
The following represents updated rating scale questions mapped to the below scale:

1.

EASE

2.

EFFECTIVENESS

3.

EMOTION

4.

TRUST

1.0 Appointment
1.

It was easy to get my appointment. 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 for my health care needs. (*Required) TRUST

Open Text question (NEW)*Pending OMB Approval*
(*Required) Would you like to provide additional feedback about your healthcare
appointment at [FacilityName]? Please select from one of the following options. Please do
not include any personally identifiable information, Social Security Number, Veteran ID,
or medical information, but do provide details about your experience.
[Dropdown of feedback types]




Compliment
Concern
Recommendation

 Will not provide feedback

1.1 Healthcare Visit
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 listened carefully to me. (*Required) EMOTION

4.

My provider explained things in a way that I could understand. EFFECTIVENESS

5.

After my visit, I knew what I needed to do next. EASE

6.

I trust for my healthcare needs. (*Required) TRUST

Open Text question (NEW)*Pending OMB Approval*
(*Required) Would you like to provide additional feedback about your healthcare visit at
[FacilityName]? Please select from one of the following options. Please do not include any
personally identifiable information, Social Security Number, Veteran ID, or medical
information, but do provide details about your experience.
[Dropdown of feedback types]
 Compliment
 Concern
 Recommendation
 Will not provide feedback

1.2 Pharmacy (in-person)
1. It was easy to get my prescriptions filled at Pharmacy. (*Required)
EASE
2. My wait time was reasonable. (*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
Open Text question (NEW)*Pending OMB Approval*
(*Required) Would you like to provide additional feedback about your experience(s) with
[FacilityName]? Please select from one of the following options. Please do not include any
personally identifiable information, Social Security Number, Veteran ID, or medical
information, but do provide details about your experience.
[Dropdown of feedback types]
 Compliment
 Concern
 Recommendation
 Will not provide feedback

1.2.1 Pharmacy (mail order)
1. It was easy to request my mail-order prescription(s). (*Required) EASE
2. I felt comfortable requesting my mail-order prescription(s). EMOTION
3. I knew when to expect my prescription(s). EASE
4. My prescription(s) arrived at my preferred address. EFFECTIVENESS
5. I trust for my health care needs. (*Required) TRUST
Open Text question (NEW)*Pending OMB Approval*
(*Required) Would you like to provide additional feedback about your experience(s) with
[FacilityName]? Please select from one of the following options. Please do not include any
personally identifiable information, Social Security Number, Veteran ID, or medical
information, but do provide details about your experience.
[Dropdown of feedback types]
 Compliment
 Concern
 Recommendation
 Will not provide feedback

1.3 Labs/Imaging
1. It was easy to find the location for my lab tests or imaging. EASE
2. My lab tests or imaging were completed within a reasonable time frame.
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
Open Text question (NEW)*Pending OMB Approval*
(*Required) Would you like to provide additional feedback about your lab tests/imaging at
[FacilityName]? Please select from one of the following options. Please do not include any
personally identifiable information, Social Security Number, Veteran ID, or medical
information, but do provide details about your experience.
[Dropdown of feedback types]
 Compliment
 Concern
 Recommendation
 Will not provide feedback