{"id":24072,"date":"2026-08-12T11:25:37","date_gmt":"2026-08-12T04:25:37","guid":{"rendered":"https:\/\/abdiwaluyo.com\/inpatient-satisfaction-survey-2\/"},"modified":"2026-08-12T11:52:53","modified_gmt":"2026-08-12T04:52:53","slug":"inpatient-satisfaction-survey","status":"publish","type":"page","link":"https:\/\/abdiwaluyo.com\/en\/inpatient-satisfaction-survey\/","title":{"rendered":"INPATIENT SATISFACTION SURVEY"},"content":{"rendered":"<div class=\"container mt-4\">Choose Language : \n<div role=\"navigation\" aria-label=\"Language Switcher\" class=\"wpml-ls-statics-shortcode_actions wpml-ls wpml-ls-legacy-dropdown-click js-wpml-ls-legacy-dropdown-click\">\n\t<ul>\n\n\t\t<li class=\"wpml-ls-slot-shortcode_actions wpml-ls-item wpml-ls-item-en wpml-ls-current-language wpml-ls-first-item wpml-ls-item-legacy-dropdown-click\">\n\n\t\t\t\t\t\t\t\t\t<a href=\"#\" hreflang=\"en\" lang=\"en\" class=\"js-wpml-ls-item-toggle wpml-ls-item-toggle\" aria-current=\"page\" aria-expanded=\"false\" aria-controls=\"wpml-ls-submenu-click-default\" aria-haspopup=\"true\" aria-label=\"English \u2013 Language switcher, click to open then tab to navigate\" tabindex=\"0\" role=\"button\" title=\"Switch to English\">\n\t\t\t\t                                    <img decoding=\"async\"\n            class=\"wpml-ls-flag\"\n            src=\"https:\/\/abdiwaluyo.com\/wp-content\/plugins\/sitepress-multilingual-cms\/res\/flags\/en.png\"\n            alt=\"\"\n            loading=\"lazy\"\n            width=18\n            height=12\n    \/><span class=\"wpml-ls-native\">English<\/span><\/a>\n\n\t\t\t<ul id=\"wpml-ls-submenu-click-default\" class=\"js-wpml-ls-sub-menu wpml-ls-sub-menu\">\n\t\t\t\t\n\t\t\t\t\t<li class=\"wpml-ls-slot-shortcode_actions wpml-ls-item wpml-ls-item-id wpml-ls-last-item\">\n\t\t\t\t\t\t<a href=\"https:\/\/abdiwaluyo.com\/\" hreflang=\"id\" lang=\"id\" class=\"wpml-ls-link\" aria-label=\"Switch to Indonesian\" title=\"Switch to Indonesian\">\n\t\t\t\t\t\t\t                                    <img decoding=\"async\"\n            class=\"wpml-ls-flag\"\n            src=\"https:\/\/abdiwaluyo.com\/wp-content\/plugins\/sitepress-multilingual-cms\/res\/flags\/id.png\"\n            alt=\"\"\n            loading=\"lazy\"\n            width=18\n            height=12\n    \/><span class=\"wpml-ls-display\">Indonesian<\/span><\/a>\n\t\t\t\t\t<\/li>\n\n\t\t\t\t\t\t\t<\/ul>\n\n\t\t<\/li>\n\n\t<\/ul>\n<\/div>\n<\/div>\n<div class=\"container mt-4\">\n<div class=\"card shadow-sm\">\n<div class=\"card-header text-white\" style=\"background-color: #00549f;\">\n<h5 class=\"mb-0\">Inpatient Questionnaire<\/h5>\n<\/div>\n<div class=\"card-body\">\n<div id=\"quform-15b798\" class=\"quform quform-26 quform-theme-bootstrap quform-support-page-caching\"><form id=\"quform-form-15b798\" class=\"quform-form quform-form-26\" action=\"\/en\/wp-json\/wp\/v2\/pages\/24072#quform-15b798\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:26,&quot;uniqueId&quot;:&quot;15b798&quot;,&quot;theme&quot;:&quot;bootstrap&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-26\"><input type=\"hidden\" name=\"quform_form_id\" value=\"26\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"15b798\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/abdiwaluyo.com\/en\/wp-json\/wp\/v2\/pages\/24072\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_loaded\" value=\"1787668744|6814991cfba6645e3b7d051156bf8cb1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"knlFdygg7pmOwaP34CJfVE5Ij8jvswxq2xgAKT3G\" \/><div class=\"quform-elements quform-elements-26 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-26_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-group quform-element-26_6 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-26_5 quform-cf\"><div class=\"quform-spacer\"><h3 style=\"color: green;\">INSTRUCTIONS FOR COMPLETION<\/h3>\nPlace a checkmark in the box (\u25cb) that best corresponds to your experience.<\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-26_595491 quform-sr-only quform-cf\" style=\"clip: rect(1px, 1px, 1px, 1px); clip-path: inset(50%); position: absolute !important; height: 1px; width: 1px; overflow: hidden;\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_595491\"><label class=\"quform-label-text\" for=\"quform_26_595491_15b798\">Company Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-26_595491\"><textarea id=\"quform_26_595491_15b798\" name=\"quform_26_595491\" class=\"quform-field quform-field-textarea quform-field-26_595491\" tabindex=\"-1\" autocomplete=\"new-password\"><\/textarea><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-26_21 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-26_22 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_23\"><div class=\"quform-element quform-element-radio quform-element-26_26 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_26\"><label class=\"quform-label-text\" id=\"quform_26_26_15b798_label\">Our hospital's physical facilities ,including cleanliness, comfort, and the completeness of services.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_26\"><div class=\"quform-input quform-input-radio quform-input-26_26 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_26_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_26\" id=\"quform_26_26_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_26 quform-field-26_26_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_26_15b798_6\" class=\"quform-option-label quform-option-label-26_26_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_26\" id=\"quform_26_26_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_26 quform-field-26_26_7\" value=\"Satisfied\" \/><label for=\"quform_26_26_15b798_7\" class=\"quform-option-label quform-option-label-26_26_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_26\" id=\"quform_26_26_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_26 quform-field-26_26_8\" value=\"Neutral\" \/><label for=\"quform_26_26_15b798_8\" class=\"quform-option-label quform-option-label-26_26_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_26\" id=\"quform_26_26_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_26 quform-field-26_26_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_26_15b798_9\" class=\"quform-option-label quform-option-label-26_26_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_26\" id=\"quform_26_26_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_26 quform-field-26_26_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_26_15b798_10\" class=\"quform-option-label quform-option-label-26_26_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_69 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_69\"><label class=\"quform-label-text\" id=\"quform_26_69_15b798_label\">The atmosphere, cleanliness, and comfort of your room \/ ward<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_69\"><div class=\"quform-input quform-input-radio quform-input-26_69 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_69_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_69\" id=\"quform_26_69_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_69 quform-field-26_69_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_69_15b798_6\" class=\"quform-option-label quform-option-label-26_69_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_69\" id=\"quform_26_69_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_69 quform-field-26_69_7\" value=\"Satisfied\" \/><label for=\"quform_26_69_15b798_7\" class=\"quform-option-label quform-option-label-26_69_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_69\" id=\"quform_26_69_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_69 quform-field-26_69_8\" value=\"Neutral\" \/><label for=\"quform_26_69_15b798_8\" class=\"quform-option-label quform-option-label-26_69_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_69\" id=\"quform_26_69_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_69 quform-field-26_69_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_69_15b798_9\" class=\"quform-option-label quform-option-label-26_69_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_69\" id=\"quform_26_69_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_69 quform-field-26_69_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_69_15b798_10\" class=\"quform-option-label quform-option-label-26_69_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_70 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_70\"><label class=\"quform-label-text\" id=\"quform_26_70_15b798_label\">The taste and quality of the food you receive during your stay.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_70\"><div class=\"quform-input quform-input-radio quform-input-26_70 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_70_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_70\" id=\"quform_26_70_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_70 quform-field-26_70_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_70_15b798_6\" class=\"quform-option-label quform-option-label-26_70_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_70\" id=\"quform_26_70_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_70 quform-field-26_70_7\" value=\"Satisfied\" \/><label for=\"quform_26_70_15b798_7\" class=\"quform-option-label quform-option-label-26_70_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_70\" id=\"quform_26_70_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_70 quform-field-26_70_8\" value=\"Neutral\" \/><label for=\"quform_26_70_15b798_8\" class=\"quform-option-label quform-option-label-26_70_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_70\" id=\"quform_26_70_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_70 quform-field-26_70_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_70_15b798_9\" class=\"quform-option-label quform-option-label-26_70_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_70\" id=\"quform_26_70_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_70 quform-field-26_70_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_70_15b798_10\" class=\"quform-option-label quform-option-label-26_70_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_31 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_32\"><div class=\"quform-element quform-element-radio quform-element-26_33 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_33\"><label class=\"quform-label-text\" id=\"quform_26_33_15b798_label\">The reliability of our officers and staff in serving you.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_33\"><div class=\"quform-input quform-input-radio quform-input-26_33 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_33_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_33\" id=\"quform_26_33_15b798_11\" class=\"quform-field quform-field-radio quform-field-26_33 quform-field-26_33_11\" value=\"Very Satisfied\" \/><label for=\"quform_26_33_15b798_11\" class=\"quform-option-label quform-option-label-26_33_11\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_33\" id=\"quform_26_33_15b798_12\" class=\"quform-field quform-field-radio quform-field-26_33 quform-field-26_33_12\" value=\"Satisfied\" \/><label for=\"quform_26_33_15b798_12\" class=\"quform-option-label quform-option-label-26_33_12\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_33\" id=\"quform_26_33_15b798_13\" class=\"quform-field quform-field-radio quform-field-26_33 quform-field-26_33_13\" value=\"Neutral\" \/><label for=\"quform_26_33_15b798_13\" class=\"quform-option-label quform-option-label-26_33_13\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_33\" id=\"quform_26_33_15b798_14\" class=\"quform-field quform-field-radio quform-field-26_33 quform-field-26_33_14\" value=\"Dissatisfied\" \/><label for=\"quform_26_33_15b798_14\" class=\"quform-option-label quform-option-label-26_33_14\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_33\" id=\"quform_26_33_15b798_15\" class=\"quform-field quform-field-radio quform-field-26_33 quform-field-26_33_15\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_33_15b798_15\" class=\"quform-option-label quform-option-label-26_33_15\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_34 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_35\"><div class=\"quform-element quform-element-html quform-element-26_73 quform-cf\"><div class=\"quform-spacer\"><strong style=\"font-weight:700\">The speed of the service process you experienced.<\/strong>\n<\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_36 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_36\"><label class=\"quform-label-text\" id=\"quform_26_36_15b798_label\"><strong style=\"color: green\">Admission Department<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_36\"><div class=\"quform-input quform-input-radio quform-input-26_36 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_36_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_36\" id=\"quform_26_36_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_36 quform-field-26_36_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_36_15b798_6\" class=\"quform-option-label quform-option-label-26_36_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_36\" id=\"quform_26_36_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_36 quform-field-26_36_7\" value=\"Satisfied\" \/><label for=\"quform_26_36_15b798_7\" class=\"quform-option-label quform-option-label-26_36_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_36\" id=\"quform_26_36_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_36 quform-field-26_36_8\" value=\"Neutral\" \/><label for=\"quform_26_36_15b798_8\" class=\"quform-option-label quform-option-label-26_36_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_36\" id=\"quform_26_36_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_36 quform-field-26_36_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_36_15b798_9\" class=\"quform-option-label quform-option-label-26_36_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_36\" id=\"quform_26_36_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_36 quform-field-26_36_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_36_15b798_10\" class=\"quform-option-label quform-option-label-26_36_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_74 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_74\"><label class=\"quform-label-text\" id=\"quform_26_74_15b798_label\"><strong style=\"color: green\">Nurse (in responding to bells or calls)<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_74\"><div class=\"quform-input quform-input-radio quform-input-26_74 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_74_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_74\" id=\"quform_26_74_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_74 quform-field-26_74_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_74_15b798_6\" class=\"quform-option-label quform-option-label-26_74_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_74\" id=\"quform_26_74_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_74 quform-field-26_74_7\" value=\"Satisfied\" \/><label for=\"quform_26_74_15b798_7\" class=\"quform-option-label quform-option-label-26_74_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_74\" id=\"quform_26_74_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_74 quform-field-26_74_8\" value=\"Neutral\" \/><label for=\"quform_26_74_15b798_8\" class=\"quform-option-label quform-option-label-26_74_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_74\" id=\"quform_26_74_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_74 quform-field-26_74_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_74_15b798_9\" class=\"quform-option-label quform-option-label-26_74_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_74\" id=\"quform_26_74_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_74 quform-field-26_74_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_74_15b798_10\" class=\"quform-option-label quform-option-label-26_74_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_75 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_75\"><label class=\"quform-label-text\" id=\"quform_26_75_15b798_label\"><strong style=\"color: green\">Cashier Department (during the discharge process)<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_75\"><div class=\"quform-input quform-input-radio quform-input-26_75 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_75_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_75\" id=\"quform_26_75_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_75 quform-field-26_75_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_75_15b798_6\" class=\"quform-option-label quform-option-label-26_75_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_75\" id=\"quform_26_75_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_75 quform-field-26_75_7\" value=\"Satisfied\" \/><label for=\"quform_26_75_15b798_7\" class=\"quform-option-label quform-option-label-26_75_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_75\" id=\"quform_26_75_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_75 quform-field-26_75_8\" value=\"Neutral\" \/><label for=\"quform_26_75_15b798_8\" class=\"quform-option-label quform-option-label-26_75_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_75\" id=\"quform_26_75_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_75 quform-field-26_75_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_75_15b798_9\" class=\"quform-option-label quform-option-label-26_75_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_75\" id=\"quform_26_75_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_75 quform-field-26_75_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_75_15b798_10\" class=\"quform-option-label quform-option-label-26_75_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_94 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_94\"><label class=\"quform-label-text\" id=\"quform_26_94_15b798_label\"><strong style=\"color: green;font-weight:700\">Pharmacy Department<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_94\"><div class=\"quform-input quform-input-radio quform-input-26_94 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_94_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_94\" id=\"quform_26_94_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_94 quform-field-26_94_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_94_15b798_6\" class=\"quform-option-label quform-option-label-26_94_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_94\" id=\"quform_26_94_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_94 quform-field-26_94_7\" value=\"Satisfied\" \/><label for=\"quform_26_94_15b798_7\" class=\"quform-option-label quform-option-label-26_94_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_94\" id=\"quform_26_94_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_94 quform-field-26_94_8\" value=\"Neutral\" \/><label for=\"quform_26_94_15b798_8\" class=\"quform-option-label quform-option-label-26_94_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_94\" id=\"quform_26_94_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_94 quform-field-26_94_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_94_15b798_9\" class=\"quform-option-label quform-option-label-26_94_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_94\" id=\"quform_26_94_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_94 quform-field-26_94_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_94_15b798_10\" class=\"quform-option-label quform-option-label-26_94_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-26_78 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_78\"><label class=\"quform-label-text\" for=\"quform_26_78_15b798\"><strong style=\"color: green;font-weight:700\">Other Department (please specify, if any) :<\/strong><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_78\"><div class=\"quform-input quform-input-text quform-input-26_78 quform-cf\"><input type=\"text\" id=\"quform_26_78_15b798\" name=\"quform_26_78\" class=\"quform-field quform-field-text quform-field-26_78\" placeholder=\"Enter another department\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_77 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-26_77\"><div class=\"quform-input quform-input-radio quform-input-26_77 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_77\" id=\"quform_26_77_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_77 quform-field-26_77_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_77_15b798_6\" class=\"quform-option-label quform-option-label-26_77_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_77\" id=\"quform_26_77_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_77 quform-field-26_77_7\" value=\"Satisfied\" \/><label for=\"quform_26_77_15b798_7\" class=\"quform-option-label quform-option-label-26_77_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_77\" id=\"quform_26_77_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_77 quform-field-26_77_8\" value=\"Neutral\" \/><label for=\"quform_26_77_15b798_8\" class=\"quform-option-label quform-option-label-26_77_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_77\" id=\"quform_26_77_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_77 quform-field-26_77_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_77_15b798_9\" class=\"quform-option-label quform-option-label-26_77_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_77\" id=\"quform_26_77_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_77 quform-field-26_77_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_77_15b798_10\" class=\"quform-option-label quform-option-label-26_77_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_37 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_38\"><div class=\"quform-element quform-element-radio quform-element-26_39 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_39\"><label class=\"quform-label-text\" id=\"quform_26_39_15b798_label\"><strong style=\"color:green\">Doctor<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_39\"><div class=\"quform-input quform-input-radio quform-input-26_39 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_39_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_39\" id=\"quform_26_39_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_39 quform-field-26_39_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_39_15b798_6\" class=\"quform-option-label quform-option-label-26_39_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_39\" id=\"quform_26_39_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_39 quform-field-26_39_7\" value=\"Satisfied\" \/><label for=\"quform_26_39_15b798_7\" class=\"quform-option-label quform-option-label-26_39_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_39\" id=\"quform_26_39_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_39 quform-field-26_39_8\" value=\"Neutral\" \/><label for=\"quform_26_39_15b798_8\" class=\"quform-option-label quform-option-label-26_39_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_39\" id=\"quform_26_39_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_39 quform-field-26_39_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_39_15b798_9\" class=\"quform-option-label quform-option-label-26_39_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_39\" id=\"quform_26_39_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_39 quform-field-26_39_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_39_15b798_10\" class=\"quform-option-label quform-option-label-26_39_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_50 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_50\"><label class=\"quform-label-text\" id=\"quform_26_50_15b798_label\"><strong style=\"color:green\">Nurse<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_50\"><div class=\"quform-input quform-input-radio quform-input-26_50 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_50_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_50\" id=\"quform_26_50_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_50 quform-field-26_50_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_50_15b798_6\" class=\"quform-option-label quform-option-label-26_50_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_50\" id=\"quform_26_50_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_50 quform-field-26_50_7\" value=\"Satisfied\" \/><label for=\"quform_26_50_15b798_7\" class=\"quform-option-label quform-option-label-26_50_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_50\" id=\"quform_26_50_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_50 quform-field-26_50_8\" value=\"Neutral\" \/><label for=\"quform_26_50_15b798_8\" class=\"quform-option-label quform-option-label-26_50_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_50\" id=\"quform_26_50_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_50 quform-field-26_50_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_50_15b798_9\" class=\"quform-option-label quform-option-label-26_50_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_50\" id=\"quform_26_50_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_50 quform-field-26_50_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_50_15b798_10\" class=\"quform-option-label quform-option-label-26_50_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-26_82 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_82\"><label class=\"quform-label-text\" for=\"quform_26_82_15b798\"><strong style=\"color: green;font-weight:700\">Other Medical Personnel (please specify, if any)<\/strong><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_82\"><div class=\"quform-input quform-input-text quform-input-26_82 quform-cf\"><input type=\"text\" id=\"quform_26_82_15b798\" name=\"quform_26_82\" class=\"quform-field quform-field-text quform-field-26_82\" placeholder=\"Enter other medical personel\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_83 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-26_83\"><div class=\"quform-input quform-input-radio quform-input-26_83 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_83\" id=\"quform_26_83_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_83 quform-field-26_83_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_83_15b798_6\" class=\"quform-option-label quform-option-label-26_83_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_83\" id=\"quform_26_83_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_83 quform-field-26_83_7\" value=\"Satisfied\" \/><label for=\"quform_26_83_15b798_7\" class=\"quform-option-label quform-option-label-26_83_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_83\" id=\"quform_26_83_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_83 quform-field-26_83_8\" value=\"Neutral\" \/><label for=\"quform_26_83_15b798_8\" class=\"quform-option-label quform-option-label-26_83_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_83\" id=\"quform_26_83_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_83 quform-field-26_83_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_83_15b798_9\" class=\"quform-option-label quform-option-label-26_83_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_83\" id=\"quform_26_83_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_83 quform-field-26_83_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_83_15b798_10\" class=\"quform-option-label quform-option-label-26_83_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_56 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_57\"><div class=\"quform-element quform-element-radio quform-element-26_85 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_85\"><label class=\"quform-label-text\" id=\"quform_26_85_15b798_label\"><strong style=\"color:green\">Admission \/ Registration<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_85\"><div class=\"quform-input quform-input-radio quform-input-26_85 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_85_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_85\" id=\"quform_26_85_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_85 quform-field-26_85_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_85_15b798_6\" class=\"quform-option-label quform-option-label-26_85_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_85\" id=\"quform_26_85_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_85 quform-field-26_85_7\" value=\"Satisfied\" \/><label for=\"quform_26_85_15b798_7\" class=\"quform-option-label quform-option-label-26_85_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_85\" id=\"quform_26_85_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_85 quform-field-26_85_8\" value=\"Neutral\" \/><label for=\"quform_26_85_15b798_8\" class=\"quform-option-label quform-option-label-26_85_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_85\" id=\"quform_26_85_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_85 quform-field-26_85_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_85_15b798_9\" class=\"quform-option-label quform-option-label-26_85_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_85\" id=\"quform_26_85_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_85 quform-field-26_85_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_85_15b798_10\" class=\"quform-option-label quform-option-label-26_85_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_86 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_86\"><label class=\"quform-label-text\" id=\"quform_26_86_15b798_label\"><strong style=\"color:green\">Doctor<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_86\"><div class=\"quform-input quform-input-radio quform-input-26_86 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_86_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_86\" id=\"quform_26_86_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_86 quform-field-26_86_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_86_15b798_6\" class=\"quform-option-label quform-option-label-26_86_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_86\" id=\"quform_26_86_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_86 quform-field-26_86_7\" value=\"Satisfied\" \/><label for=\"quform_26_86_15b798_7\" class=\"quform-option-label quform-option-label-26_86_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_86\" id=\"quform_26_86_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_86 quform-field-26_86_8\" value=\"Neutral\" \/><label for=\"quform_26_86_15b798_8\" class=\"quform-option-label quform-option-label-26_86_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_86\" id=\"quform_26_86_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_86 quform-field-26_86_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_86_15b798_9\" class=\"quform-option-label quform-option-label-26_86_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_86\" id=\"quform_26_86_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_86 quform-field-26_86_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_86_15b798_10\" class=\"quform-option-label quform-option-label-26_86_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_87 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_87\"><label class=\"quform-label-text\" id=\"quform_26_87_15b798_label\"><strong style=\"color:green\">Nurse<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_87\"><div class=\"quform-input quform-input-radio quform-input-26_87 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_87_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_87\" id=\"quform_26_87_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_87 quform-field-26_87_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_87_15b798_6\" class=\"quform-option-label quform-option-label-26_87_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_87\" id=\"quform_26_87_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_87 quform-field-26_87_7\" value=\"Satisfied\" \/><label for=\"quform_26_87_15b798_7\" class=\"quform-option-label quform-option-label-26_87_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_87\" id=\"quform_26_87_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_87 quform-field-26_87_8\" value=\"Neutral\" \/><label for=\"quform_26_87_15b798_8\" class=\"quform-option-label quform-option-label-26_87_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_87\" id=\"quform_26_87_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_87 quform-field-26_87_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_87_15b798_9\" class=\"quform-option-label quform-option-label-26_87_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_87\" id=\"quform_26_87_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_87 quform-field-26_87_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_87_15b798_10\" class=\"quform-option-label quform-option-label-26_87_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_88 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_88\"><label class=\"quform-label-text\" id=\"quform_26_88_15b798_label\"><strong style=\"color:green\">Other Medical Personnel<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_88\"><div class=\"quform-input quform-input-radio quform-input-26_88 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_88_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_88\" id=\"quform_26_88_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_88 quform-field-26_88_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_88_15b798_6\" class=\"quform-option-label quform-option-label-26_88_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_88\" id=\"quform_26_88_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_88 quform-field-26_88_7\" value=\"Satisfied\" \/><label for=\"quform_26_88_15b798_7\" class=\"quform-option-label quform-option-label-26_88_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_88\" id=\"quform_26_88_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_88 quform-field-26_88_8\" value=\"Neutral\" \/><label for=\"quform_26_88_15b798_8\" class=\"quform-option-label quform-option-label-26_88_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_88\" id=\"quform_26_88_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_88 quform-field-26_88_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_88_15b798_9\" class=\"quform-option-label quform-option-label-26_88_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_88\" id=\"quform_26_88_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_88 quform-field-26_88_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_88_15b798_10\" class=\"quform-option-label quform-option-label-26_88_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_89 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_89\"><label class=\"quform-label-text\" id=\"quform_26_89_15b798_label\"><strong style=\"color:green\">Cashier \/ Administration Department<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_89\"><div class=\"quform-input quform-input-radio quform-input-26_89 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_89_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_89\" id=\"quform_26_89_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_89 quform-field-26_89_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_89_15b798_6\" class=\"quform-option-label quform-option-label-26_89_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_89\" id=\"quform_26_89_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_89 quform-field-26_89_7\" value=\"Satisfied\" \/><label for=\"quform_26_89_15b798_7\" class=\"quform-option-label quform-option-label-26_89_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_89\" id=\"quform_26_89_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_89 quform-field-26_89_8\" value=\"Neutral\" \/><label for=\"quform_26_89_15b798_8\" class=\"quform-option-label quform-option-label-26_89_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_89\" id=\"quform_26_89_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_89 quform-field-26_89_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_89_15b798_9\" class=\"quform-option-label quform-option-label-26_89_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_89\" id=\"quform_26_89_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_89 quform-field-26_89_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_89_15b798_10\" class=\"quform-option-label quform-option-label-26_89_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-26_91 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_91\"><label class=\"quform-label-text\" for=\"quform_26_91_15b798\"><strong style=\"color: green;font-weight:700\">Other Staff \/ Personnel (please specify, if any) :<\/strong><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_91\"><div class=\"quform-input quform-input-text quform-input-26_91 quform-cf\"><input type=\"text\" id=\"quform_26_91_15b798\" name=\"quform_26_91\" class=\"quform-field quform-field-text quform-field-26_91\" placeholder=\"Enter other staff \/ personnel\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_90 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-radio quform-inner-26_90\"><div class=\"quform-input quform-input-radio quform-input-26_90 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_90\" id=\"quform_26_90_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_90 quform-field-26_90_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_90_15b798_6\" class=\"quform-option-label quform-option-label-26_90_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_90\" id=\"quform_26_90_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_90 quform-field-26_90_7\" value=\"Satisfied\" \/><label for=\"quform_26_90_15b798_7\" class=\"quform-option-label quform-option-label-26_90_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_90\" id=\"quform_26_90_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_90 quform-field-26_90_8\" value=\"Neutral\" \/><label for=\"quform_26_90_15b798_8\" class=\"quform-option-label quform-option-label-26_90_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_90\" id=\"quform_26_90_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_90 quform-field-26_90_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_90_15b798_9\" class=\"quform-option-label quform-option-label-26_90_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_90\" id=\"quform_26_90_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_90 quform-field-26_90_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_90_15b798_10\" class=\"quform-option-label quform-option-label-26_90_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_92 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_92\"><label class=\"quform-label-text\" id=\"quform_26_92_15b798_label\"><strong style=\"color:green\">Cleaning Staff<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_92\"><div class=\"quform-input quform-input-radio quform-input-26_92 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_92_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_92\" id=\"quform_26_92_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_92 quform-field-26_92_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_92_15b798_6\" class=\"quform-option-label quform-option-label-26_92_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_92\" id=\"quform_26_92_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_92 quform-field-26_92_7\" value=\"Satisfied\" \/><label for=\"quform_26_92_15b798_7\" class=\"quform-option-label quform-option-label-26_92_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_92\" id=\"quform_26_92_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_92 quform-field-26_92_8\" value=\"Neutral\" \/><label for=\"quform_26_92_15b798_8\" class=\"quform-option-label quform-option-label-26_92_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_92\" id=\"quform_26_92_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_92 quform-field-26_92_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_92_15b798_9\" class=\"quform-option-label quform-option-label-26_92_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_92\" id=\"quform_26_92_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_92 quform-field-26_92_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_92_15b798_10\" class=\"quform-option-label quform-option-label-26_92_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_93 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_93\"><label class=\"quform-label-text\" id=\"quform_26_93_15b798_label\"><strong style=\"color:green\">Security Staff<\/strong><span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_93\"><div class=\"quform-input quform-input-radio quform-input-26_93 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_93_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_93\" id=\"quform_26_93_15b798_6\" class=\"quform-field quform-field-radio quform-field-26_93 quform-field-26_93_6\" value=\"Very Satisfied\" \/><label for=\"quform_26_93_15b798_6\" class=\"quform-option-label quform-option-label-26_93_6\"><span class=\"quform-option-text\">Very Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_93\" id=\"quform_26_93_15b798_7\" class=\"quform-field quform-field-radio quform-field-26_93 quform-field-26_93_7\" value=\"Satisfied\" \/><label for=\"quform_26_93_15b798_7\" class=\"quform-option-label quform-option-label-26_93_7\"><span class=\"quform-option-text\">Satisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_93\" id=\"quform_26_93_15b798_8\" class=\"quform-field quform-field-radio quform-field-26_93 quform-field-26_93_8\" value=\"Neutral\" \/><label for=\"quform_26_93_15b798_8\" class=\"quform-option-label quform-option-label-26_93_8\"><span class=\"quform-option-text\">Neutral<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_93\" id=\"quform_26_93_15b798_9\" class=\"quform-field quform-field-radio quform-field-26_93 quform-field-26_93_9\" value=\"Dissatisfied\" \/><label for=\"quform_26_93_15b798_9\" class=\"quform-option-label quform-option-label-26_93_9\"><span class=\"quform-option-text\">Dissatisfied<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_93\" id=\"quform_26_93_15b798_10\" class=\"quform-field quform-field-radio quform-field-26_93 quform-field-26_93_10\" value=\"Very Dissatisfied\" \/><label for=\"quform_26_93_15b798_10\" class=\"quform-option-label quform-option-label-26_93_10\"><span class=\"quform-option-text\">Very Dissatisfied<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-26_58 quform-cf\"><div class=\"quform-spacer\"><strong style=\"color: green;font-weight:700\">Additional<\/strong><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-26_59 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_59\"><label class=\"quform-label-text\" id=\"quform_26_59_15b798_label\">Would you recommend our hospital to your family \/ friends \/ colleagues?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-26_59\"><div class=\"quform-input quform-input-radio quform-input-26_59 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_26_59_15b798_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_59\" id=\"quform_26_59_15b798_1\" class=\"quform-field quform-field-radio quform-field-26_59 quform-field-26_59_1\" value=\"Yes\" \/><label for=\"quform_26_59_15b798_1\" class=\"quform-option-label quform-option-label-26_59_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_26_59\" id=\"quform_26_59_15b798_2\" class=\"quform-field quform-field-radio quform-field-26_59 quform-field-26_59_2\" value=\"No\" \/><label for=\"quform_26_59_15b798_2\" class=\"quform-option-label quform-option-label-26_59_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_61 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_62\"><div class=\"quform-element quform-element-html quform-element-26_63 quform-cf\"><div class=\"quform-spacer\"><strong>Your feedback and appreciation are very valuable to us. You may share them in the space below.<\/strong><\/div><\/div><div class=\"quform-element quform-element-text quform-element-26_65 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-26_65\"><div class=\"quform-input quform-input-text quform-input-26_65 quform-cf\"><input type=\"text\" id=\"quform_26_65_15b798\" name=\"quform_26_65\" class=\"quform-field quform-field-text quform-field-26_65\" placeholder=\"Enter your feedback\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-26_7 quform-5-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-26_8\"><div class=\"quform-element quform-element-text quform-element-26_12 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_12\"><label class=\"quform-label-text\" for=\"quform_26_12_15b798\">Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_12\"><div class=\"quform-input quform-input-text quform-input-26_12 quform-cf\"><input type=\"text\" id=\"quform_26_12_15b798\" name=\"quform_26_12\" class=\"quform-field quform-field-text quform-field-26_12\" placeholder=\"Enter name\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-26_18\"><div class=\"quform-element quform-element-text quform-element-26_20 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_20\"><label class=\"quform-label-text\" for=\"quform_26_20_15b798\">Mobile Phone No<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_20\"><div class=\"quform-input quform-input-text quform-input-26_20 quform-cf\"><input type=\"text\" id=\"quform_26_20_15b798\" name=\"quform_26_20\" class=\"quform-field quform-field-text quform-field-26_20\" placeholder=\"Enter mobile phone no\" maxlength=\"12\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-26_9\"><div class=\"quform-element quform-element-text quform-element-26_67 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_67\"><label class=\"quform-label-text\" for=\"quform_26_67_15b798\">Date of Birth<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_67\"><div class=\"quform-input quform-input-text quform-input-26_67 quform-cf\"><input type=\"text\" id=\"quform_26_67_15b798\" name=\"quform_26_67\" class=\"quform-field quform-field-text quform-field-26_67\" placeholder=\"Example : 12-07-1987\" maxlength=\"10\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-26_10\"><div class=\"quform-element quform-element-text quform-element-26_14 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_14\"><label class=\"quform-label-text\" for=\"quform_26_14_15b798\">Medical Record No <b>(Opsional)<\/b><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-26_14\"><div class=\"quform-input quform-input-text quform-input-26_14 quform-cf\"><input type=\"text\" id=\"quform_26_14_15b798\" name=\"quform_26_14\" class=\"quform-field quform-field-text quform-field-26_14\" placeholder=\"Enter your medical record number\" maxlength=\"8\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-26_11\"><div class=\"quform-element quform-element-select quform-element-26_16 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-26_16\"><label class=\"quform-label-text\" for=\"quform_26_16_15b798\">Room<span class=\"quform-required\">*<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Silahkan Pilih<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-26_16\"><div class=\"quform-input quform-input-select quform-input-26_16 quform-cf\"><select id=\"quform_26_16_15b798\" name=\"quform_26_16\" class=\"quform-field quform-field-select quform-field-26_16\"><option value=\"\" selected=\"selected\">Choose Ward \/ Room<\/option><option value=\"Argo Room\">Argo Room<\/option><option value=\"Arkana Room\">Arkana Room<\/option><option value=\"Arya Room\">Arya Room<\/option><option value=\"Kirana 1 Room\">Kirana 1 Room<\/option><option value=\"Kirana 2 Room\">Kirana 2 Room<\/option><option value=\"Laksita Room\">Laksita Room<\/option><option value=\"Baby Room \">Baby Room <\/option><option value=\"ICU Room\">ICU Room<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-26_2 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-26_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Save<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Choose Language : Inpatient Questionnaire<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"class_list":["post-24072","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>INPATIENT SATISFACTION SURVEY - Abdi Waluyo Hospital<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/abdiwaluyo.com\/en\/inpatient-satisfaction-survey\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"INPATIENT SATISFACTION SURVEY - Abdi Waluyo Hospital\" \/>\n<meta property=\"og:description\" content=\"Choose Language : Inpatient 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