PATIENT QUESTIONNAIRE
The main aim of this questionnaire is to know your opinion about some aspects of the Patient
Summary service received.
The results of this study will only be used for evaluating purposes.
Please, return this questionnaire at the Health Medical Center of the University (“Service de médecine
préventive et de promotion de la santé”).
ID
Question
Answer
LEGAL ASPECTS
1
I think that my data privacy was
appropriately maintained.
2
I gave or confirmed consent.
□ 1. Strongly disagree.
□ 2. Disagree.
□ 3. Uncertain.
□ 4. Agree.
□ 5. Strongly agree.
□ 6. I don't know
□ 1. Yes
□ 2. No
□ 3. I don't know
ASPECT SERVICE
3
Did the Patient Summary service facilitate
the communication with the Health Care
Professional?
4
Do you think that you received care faster
than before with the Patient Summary
service?
EN
□ 1. Yes
□ 2. No
□ 3. I don't know
□ 1. Yes
□ 2. No
□ 3. I don't know
1
PATIENT QUESTIONNAIRE
5
The Patient Summary service was useful
for exchanging medical information.
6
Would you use the Patient Summary
service again?
7
Please explain why / why not.
8
Would you recommend the Patient
Summary service to a friend or family
member?
9
Please explain why / why not.
10
Do you think that the Patient Summary
service is an improvement?
11
What is the most important benefit of the
Patient Summary service?
EN
□ 1. Strongly disagree.
□ 2. Disagree.
□ 3. Uncertain.
□ 4. Agree.
□ 5. Strongly agree.
□ 6. I don't know
□ 1. Yes
□ 2. No
□ 3. I don't know
□ 1. Yes
□ 2. No
□ 3. I don't know
□ 1. Yes
□ 2. No
2