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Summer Internship Programme 2005 CASE STUDY QUESTIONAIRRE

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Summer Internship Programme 2005
CASE STUDY QUESTIONAIRRE
Name of Patient:
Name of Interviewer:
Class and School of Interviewer:
I. Biographical Information of Patient:
Date: ____________________
Patient Record Number: ____________________
Category: ____________________
Doctor: ____________________
Hospital’s Expenses on Patient: ____________________
a) Age:
b) Address:
c) Physical Description:
d) Marital Status:
e) Age at the time of Marriage:
f) Children (if any):
II. Experience at Fatima Memorial Hospital (FMH):
1) Is this your first visit to FMH?

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2) How did you hear about FMH?
3) What is the nature of your problem?
4) How long has the problem been there?
5) Did you come straight to FMH or go elsewhere first? If
elsewhere first, what happened there?
6) How has FMH helped you?

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 Summer Internship Programme 2005 CASE STUDY QUESTIONAIRRE Name of Patient: Name of Interviewer: Class and School of Interviewer: I. Biographical Information of Patient: Date: ____________________ Patient Record Number: ____________________ Category: ____________________ Doctor: ____________________ Hospital’s Expenses on Patient: ____________________ a) Age: b) Address: c) Physical Description: d) Marital Status: e) Age at the time of Marriage: f) Children (if any): II. Experience at Fatima Memorial Hospital (FMH): 1) Is this your first visit to FMH? 2) How did you hear about FMH? 3) What is the nature of your problem? 4) How long has the problem been there? 5) Did you come straight to FMH or go elsewhere first? If elsewhere first, what happened there? 6) How has FMH helped you? 7) Are you pleased with the services the hospital has to offer? 8) What do you like most about FMH? 9) If necessary in the future, will you come back to FMH, or go elsewhere? 10­) Have you been explained the importance of good hygiene? What changes will you make in your lifestyle when you go back home? III. LIVING CONDITIONS OF PATIENT: 11) Can you read and write? 12) Do you work? Where? 13) Does your spouse work? Where? 14) How many breadwinners are there at home? 15) Total Family Income: 16) Is your spouse educated? 17) Are your children being educated? If not, why not? 18) Have you ever tried to get you ...
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Anonymous
Very useful material for studying!

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