ሶሶሶሶሶሶሶ ሶሶሶ
Section: sociodemographic data
1.
Age: __________
2.
Area of residence
3.
4.
5.
ii. Rural
i. Male
ii.Female
Gender
Marital status
i. Married
ii. Single
iii.Separated
iv.Widowed
Education level
i.
6.
i. Urban
Illiterate
ii.
Primary school
iii.
High school
iv. Diploma
v.
Degree
vi. MSC and above
Religion
i. Muslim
ii. Orthodox
iii.Protestant
iv. Catholic v.
v. Others (specify) _______________________
7.
8.
Ethnicity
I . Oromo
ii.Hareri
iii. Amhara
iv. Tigray
v.Others (specify) ___________
Occupation
i.Student
ii. Unemployed
iii. Civil servant
iv.
Farmer
V.Housewife
vi.
Merchant
vii. Others (specify) ____________
9.
10.
Monthly income in ETH birr
i.
< 500
ii.
500-999
iii.
1000-1499
iv.
1500-2499
v.
>2500
Number of visit to Gondar hospital pharmacies.
I. 1x
II. 2-4x
III.>4x
Section 2:- patients satisfaction
Indicate 1 to 5 on the scale for the answer that most corresponds to your opinion
1. Very Poor
2.
Poor
3. No comment (neutral)
4.
Good
5. Very good
1.
The pharmacy location is convenient
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2.
The private counseling area is comfortable and convenient
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3.
The pharmacist explains how to take my medication
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4.
The pharmacist mention enough information about medication side effects
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5.
The pharmacist mention enough information about drug-drug interaction and drug-food
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interaction
6.
The pharmacist treated me with dignity and respect
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7.
The pharmacist is available at the time of visit
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8.
I get written information about medication use whenever I need
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9.
The pharmacist keep my privacy
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10.
The pharmacist serve me equally with other patients
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11.
The pharmacist gives me information on how to solve medication side effects if occur at
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any time
12.
The pharmacist answer my questions properly
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13.
The language used by the pharmacist is easy and understandable
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14.
The pharmacist label my medicine in readable and understandable instruction
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15.
The pharmacist gives me the medicine with appropriate packaging
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16.
The pharmacist told me information about proper storage of medication
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17.
I get all drugs I need
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18.
The waiting area is comfortable and convenient
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19.
The pharmacy is clean
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20.
Medications I need are available
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21.
The cost of the medication is fair
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22.
The staff numbers are enough to provide the service
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23.
Counseling time was enough
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24.
The politeness and interest of the pharmacist were good
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25.
Clarity of the voice and tone of the pharmacy personnel
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26.
The pharmacist ask any concerns about medication
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27.
Your pharmacy services overall
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