Physician Feedback Form
Robert Wood Johnson University Hospital Hamilton employees can use this page to enter feedback on behalf of physicians. Feedback will be aggregated and automatically routed to the appropriate Robert Wood Johnson University Hospital Hamilton manager.
If you have questions or comments about this system, want to find out the status of an item you entered, or want to add additional comments to an item, please contact your manager.
Feedback Classification
Please select the type of feedback:
Input a CONCERN
Input a COMPLIMENT
Input a SUGGESTION
Input a QUESTION
Please select the feedback source:
In Person
Letter
Email
Telephone
Other
My comments are about the following area:
select
2 South
3 South
Administration
Billing, Registration
Cardiac Catherization Lab
Cardiopulmonary
Central Scheduling, Registration
Child Care Centers
CINJ
Clinic
Clinical Decisions Unit
Clinical Engineering
Community Education
Education
Emergency Department
Finance
Food and Nutrition
Gift Shop
Health Information Management
Housekeeping
Human Resources
ICU
Infection Control
Information Systems
Laboratory
Lakefront Tower 1
Lakefront Tower 2
Maintenance
Marketing and Public Relations
Materials Management
Maternity
Medical Staff Office
Nuclear Medicine
Neurology
OB/GYN Office
Occ Health
Oncology
Pastoral Care
Patient Management
Patient Relations
Pharmacy
Pre Admission Testing
Program Development
Radiology
Rehab and Physical Therapy
Security
Surgi Central
Surgical Services
Telemetry Central
Telenorth
Other
Employee Information
*
Employee name:
Employee e-mail address:
(Items marked with an (*) asterisk are required)
Feedback Information
From the physician's perspective, what is the CONCERN regarding?
Please make a selection
Administration / Management
Career Opportunities
Compensation / Benefits
Courtesy / Attitude / Responsiveness
Coworker Relations
Customer Service
Delay in Testing
Education / Training
Environment
Improvement Idea
Interdepartmental Communication
Medical staff
Parking
Policies & Procedures
Quality of Care
Safety
Staffing
Supplies / Equipment
Work Flow
Work Schedule
Other
Please describe the CONCERN.
(Information entered in this field MAY BE viewable by the physician.)
Spell Check
Does the physician have any suggestions for improvement?
(Information entered in this field MAY BE viewable by the physician.)
Spell Check
Estimate the date of occurrence.
Open the calendar popup.
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Partner Information
(Please provide as much information as you can. If feedback is from someone who is not a physician, please make note of it in the Feedback Information section.)
First name:
Last Name
Phone:
E-mail address:
Physician requires additional follow-up: (If yes, please provide the appropriate contact information in the fields above.)
Yes
No
Physician prefers future contact regarding this feedback via:
E-mail
Phone
In Person
Your Notes
Enter the details of anything you did to resolve the issue, start the resolution process, or respond to the partner.
Resolution/Notes:
(Information entered in this field WILL NOT be viewable by the physician.)
Spell Check
Attachment (optional):
(Maximum file size limit 8 MB)
Status
Open
In Progress
Closed
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