Form 0917-0036 Patient Assessment –Clinton Service Unit - IMPRESS

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

OMB Form 0917-0036-11 IMPRESS Patient Assessment.pub

Patient Assessment –Clinton Service Unit - IMPRESS

OMB: 0917-0036

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Phone: 580-323-2884

Fax: 580-323-2579

10321 N 2274 Rd.

Rt1, Box 3060

Clinton, OK 73601

Indian Health Service

Clinton Service Unit

Clinton/El Reno/Watonga

Service Excellence Priorities

To renew and strengthen our partnership with tribes

To reform the IHS

To improve the quality of and access to care

To make all our work accountable, transparent, fair, and inclusive

Continually Improving Patient Care

Background

The staff at Clinton Service Unit is taking on the challenge of obtaining……..

Customer Service Excellence.

Improving Customer Service starts with you as a patient to provide feedback of how we currently provide service.

This survey will help us as a Service Unit to improve patient care utilizing these five elements:

Performing– Looking at ways to learn about and improve on the services we provide.

Rounding– Improving communication with patients by building relationships and learning what our patients want and need.

Expecting– Establishing goals and meeting expectations of our patients.

Scripting– Making sure that we are sending the same message to our patients and delivering consistent information.

Storytelling.– Whether positive or negative, stories are very valuable and can be used to communicate information, build up a community or initiate action. We hope that you will share your story of your experience here with us.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0917-0036.

The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.

Form Approved

OMB Form No. 0917-0036

Expiration Date:

PERFORMING

I am informed on all the services that Clinton, El Reno, or Watonga provides.