QUSTIONARY

The Information Provided by you will be Strictly Confidential and used only
for Research Purpose.

FOR THE PATIENTS

Name:___________________________
Age:_____________________________
Sex: ______________________________
Education:_________________________
Religion:___________________________
Caste: _____________________________
Marital Status: Married/Unmarried/
Q.1 What do you mean by health?
Ans.
A. One who is energetic?
B. Has good posture.
C. Weighs normal for age and height.
D. Has all body organs functioning normally.
E. Has a good appetite.
F. Gets sound sleep.
G. Able to work properly.
H. Free from disease/illness.

Q. 2. Is the individual responsible for his/her good health?

Ans.
Yes/No.
Q. 3. How the individual is responsible for his/her good health?
Ans.
1. Regular health check-up.
2. Newer ignore illness.
3. Follow healthy lifestyles.
4. Any other.......
Q. 4. Are you taking treatment regularly?
Ans.
Yes/No.

Q. 5. Why do you not ask doctor for quicker relief?

Ans.
A. Doctor is more expert in his profession.
B. We should not interfere with treatment process.
C. Some diseases take time to get cured.
D. Any other.......
Q. 6. Do you worry about the cost of your medical care?
Ans.
Yes/No.

Q. 7. Do you read the manufacture and expiry date of medicine?

Ans.
Yes/No.

Q. 8. Why do you read manufacture and expiry date of medicine?

Ans.
A. Its our duty to check out properly about manufacture and expiry date of medicine.
B. It may be harmful to us instead to relief if it is out dated.
C. Loss of money for expired medicine.
D. Any other......

Q. 9. Do you read or understand the prescribed medicine by doctor?

Ans.
Yes/No.
Q. 10. Do you match the medicines purchased from the medical store which are
prescribed by the doctor?
Ans.
Yes/No/Just try.

Q.11. Till now, how much money did you spent for treatment?

Ans. Approximate money- ......Lakh.........Thousand...........Hundred.

Q.12. On whom advise did you take up treatment?

Ans.
A. Self.
B. Family members.
C. Friends.
D. Relatives.
E. Doctor
F. Any other.........
Q. 13. Before coming to this hospital, where did you go for the treatment?
Ans.
A. Govt. Hospital.
B. Private Hospital.
2011
C. Traditional.
D. Ignore illness.
E. Jhola chap.
F. Any other.........
Q. 14. Are you taking treatment according to doctors instructions?
Ans.
Yes/No.

Q. 15. Why have you selected this hospital to take treatment?

Ans.
A. Better treatment.
B. Qualified staff.
C. Better facilities.
D. Less distance from home.
E. Less costly as compare to other hospitals.
F. Advised by friends.
G. Advised by Doctors.
H. Referred from other hospital.
I. Any other............

Q. 16. What is proper way to communicate with patient?

Ans.
A. Free and frank talk.
B. Reveal everything related to disease.
C. Any other......

Q. 17. Do you get the prescribed medicine from medical store outside the hospital?

Ans. Yes/No.

Q. 18. Does the doctor visit timely.

Ans.
A. Visit morning time daily.
B. Visit evening time daily.
C. Not visit morning time daily.
D. Not visit evening time daily.

QUSTIONARY
The Information Provided by you will be Strictly Confidential and used only
for Research Purpose.

FOR THE DOCTORS

Name:___________________________
Age:_____________________________
Sex: ______________________________
Education:_________________________
Religion:___________________________
Caste: _____________________________
Marital Status: Married/Unmarried/

Q. 1. What do you mean by health?

Ans.
A. Is energetic.
B. Has good posture.
C. Weighs normal for age and height.
D. Has all body organs functioning normally.
E. Has a good appetite.
F. Gets sound sleep.

G. Able to work properly.

H. Free from morbidity.
I. Any other..
Q. 2. What is more important to you?
Ans.
A. Service to human being.
B. Earn more and more money.
C. Casteism/Relationship.
D. Respect in society.
E. Any other.......
Q. 3. Is the doctor only responsible for any medical negligence?
Ans.
Yes/No.

Q. 4. How the doctor is not only responsible for any medical negligence?
Ans.
A. If patient explain wrong case history.
B. Due to irregularity paid by patient.
C. Any other........

Q.5. How can you provide better options for health care?

Ans.
A. Emergent treatment of health problem.
B. Improving health care quality and efficiency.
C. Providing free preventive care.
D. Preventing disease and illness.
E. Cracking down on health care fraud.
F. Instructions for healthy life style.
G. Regular medical check-up.
H. Minimal charges for treatment.
I. Treat equal to all.
J. Any other........

Q. 6. Is regular medical check-up necessary?

Ans.
Yes/No.

Q. 7. Why regular medical check-up is necessary?

Ans.
A. For healthy life style.
B. To prevent disease.
C. For better cure.

D. To get well soon.

E. To Encourage other.
F. Prevention is better than cure.
G. Spending little on medical check-up keeps good health.
H. Any other.......

Q. 8. In which type of treatment consent is necessary?

Ans.
A. Serious treatment (major operation).
215
B. Emergency treatment.
C. Normal treatment.
D. Any other.......

Q. 9. Can the emergency treatment be given without consent?

Ans.
Yes/No.

Q. 10. What are the Elements of Consent?

Ans.
A. Consent must be related to treatment.
B. Consent must be informed.
C. Consent must be voluntary.

D. Consent must not be obtained through fraud or misrepresentation.

E. Any other......

Q. 11. Do you know about the patients rights?

Ans.
Yes/No.

Q. 12. What wrong can be done by doctor with patient?

Ans.
A. Wrong treatment.
B. Not timely treatment.
C. Not paying proper attention for treatment.
D. Busy with their own relatives or colleagues while treating patients.
E. Discrimination in care.
F. Expensive medical care.
G. Any other......

Q.13. Is the relationship between doctor and patient play a good role in the
improvement of patient health?
Ans.
Yes/No.

Q. 14. Can a doctor refuse to treat a patient?

Ans.
Yes/No.

Q. 15. Why should doctor tell the nature of illness to the patient?
Ans.
A. To clear doubts regarding illness.
B. To avoid cases of illness.
C. Patient should be involved in the decision making.
D. Any other.....
.
Q. 16. What will you do if anyone is sick or injured outside the hospital?
Ans.
A. To provide him/her first Aid.
B. To admit him/her in nearby health centre.
C. To inform his/her relative.
D. Any other......

Q. 17. Is the doctors behaviour related to the patient?

Ans.
Yes/No.

Q. 18. What type of behaviour should be by doctor with patient?

Ans.
A. Cooperative.
B. Normal.
C. Emotional.
D. Friendly.
E. Any other.......