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CRRH Patient Satisfaction checklist
Patient's answer(choose the appropriate answers)
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Section A: 1. Patient Details
*
Inpatient
Outpatient
2. Age (in years)
*
Your answer
Sex
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Male
Female
Others
3. Ethnic
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Sharchop
Ngalop
Lhotshampa
Others
4. Number of times services availed (within last six months)
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Once
More than once
5. Service availed (current)
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IPD
OPD
6. Marital Status
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Married
Unmarried
Divorced
Widowed
7. Occupation
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Civil Servant
Bussiness/Private
Coorporate
Student
Farmer
Religious personnel
Others
8. Education Level
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PhD/Equivalent
Master
Bachelor
Diploma
Certificate
Class 12 or less
Other qualifications
Illiterate
Non-formal Education
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