www.fhpl.net
Open in
urlscan Pro
2606:4700:10::6816:3fc9
Public Scan
Submitted URL: https://fhpl.co/q10ce53x
Effective URL: https://www.fhpl.net/HospitalRatingFeedback/HospitalRating_Survey.aspx?Id=c5kI9Qx51iHuC1sC41JI/A==
Submission: On January 23 via manual from US — Scanned from DE
Effective URL: https://www.fhpl.net/HospitalRatingFeedback/HospitalRating_Survey.aspx?Id=c5kI9Qx51iHuC1sC41JI/A==
Submission: On January 23 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST ./HospitalRating_Survey.aspx?Id=c5kI9Qx51iHuC1sC41JI%2fA%3d%3d
<form method="post" action="./HospitalRating_Survey.aspx?Id=c5kI9Qx51iHuC1sC41JI%2fA%3d%3d" id="ctl00">
<div class="aspNetHidden">
<input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE"
value="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">
</div>
<div class="aspNetHidden">
<input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="09DB05D3">
<input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION"
value="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">
</div>
<input type="hidden" name="hdnfldId" id="hdnfldId" value="252201">
<div style="background-color:#f7f7f2;">
<a href="#"><img src="images/footerlogo.png" id="LogoImg" class="img-responsive" style="width:180px;height:90px;padding:10px;"></a>
</div>
<div id="masterDiv" class="col-12">
<h2 style="text-align:center"><b><u>IRDAI Hospital Experience Survey</u></b></h2>
<div id="errorDiv" style="color:Red"></div>
<div class="well" style="background-image:url(Images/fb.png)">
<div class="table-responsive">
<div id="DataTableBox">
<table class="table" border="1" style="width: 100 % ">
<tbody>
<tr>
<td> POLICY NUMBER: </td>
<td>411601/48/2023/1232</td>
</tr>
<tr>
<td> UHID OF PATIENT : </td>
<td>OIC46825713</td>
</tr>
<tr>
<td> NAME OF PATIENT : </td>
<td>Pradeepa S</td>
</tr>
<tr>
<td> HOSPITAL NAME: </td>
<td>Dr Rela Institute & Medical Centre(A unit of JR Super Speciality Hospital Pvt ltd)</td>
</tr>
<tr>
<td> ROHINI ID [HOSPITAL ID]:</td>
<td>8900080401297</td>
</tr>
<tr>
<td> DATE AND TIME OF DISCHARGE [mm/dd/yyyy] : </td>
<td>1/3/2024 11:59:59 PM</td>
</tr>
</tbody>
</table>
</div>
<table class="table" border="1" style="width: 100%">
<tbody>
<tr>
<td colspan="2" style="background-color: #9378b1; color: white; align: center;">
<h4>Please take few minutes to fill out this survey on the relevance and quality of service you have received. Each parameter may be given rating on the scale of 1 to 5. It may be noted that the best experience may be rated as 5 and
worst may be rated as 1.All questions are mandatory.</h4>
</td>
</tr>
<tr>
<td>
<h5>1) Process of booking an appointment with your doctor at the hospital.*</h5>
</td>
<td>
<table id="rblAppointment" style="width:100%;">
<tbody>
<tr>
<td><input id="rblAppointment_0" type="radio" name="rblAppointment" value="1"><label for="rblAppointment_0"> 1</label></td>
<td><input id="rblAppointment_1" type="radio" name="rblAppointment" value="2"><label for="rblAppointment_1"> 2</label></td>
<td><input id="rblAppointment_2" type="radio" name="rblAppointment" value="3"><label for="rblAppointment_2"> 3</label></td>
<td><input id="rblAppointment_3" type="radio" name="rblAppointment" value="4"><label for="rblAppointment_3"> 4</label></td>
<td><input id="rblAppointment_4" type="radio" name="rblAppointment" value="5"><label for="rblAppointment_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>2) Level of satisfaction on the time spent by the doctor.* </h5>
</td>
<td>
<table id="rblSatisfaction" style="width:100%;">
<tbody>
<tr>
<td><input id="rblSatisfaction_0" type="radio" name="rblSatisfaction" value="1"><label for="rblSatisfaction_0"> 1</label></td>
<td><input id="rblSatisfaction_1" type="radio" name="rblSatisfaction" value="2"><label for="rblSatisfaction_1"> 2</label></td>
<td><input id="rblSatisfaction_2" type="radio" name="rblSatisfaction" value="3"><label for="rblSatisfaction_2"> 3</label></td>
<td><input id="rblSatisfaction_3" type="radio" name="rblSatisfaction" value="4"><label for="rblSatisfaction_3"> 4</label></td>
<td><input id="rblSatisfaction_4" type="radio" name="rblSatisfaction" value="5"><label for="rblSatisfaction_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>3) Professionalism of the staff.* </h5>
</td>
<td>
<table id="rblProfessionalism" style="width:100%;">
<tbody>
<tr>
<td><input id="rblProfessionalism_0" type="radio" name="rblProfessionalism" value="1"><label for="rblProfessionalism_0"> 1</label></td>
<td><input id="rblProfessionalism_1" type="radio" name="rblProfessionalism" value="2"><label for="rblProfessionalism_1"> 2</label></td>
<td><input id="rblProfessionalism_2" type="radio" name="rblProfessionalism" value="3"><label for="rblProfessionalism_2"> 3</label></td>
<td><input id="rblProfessionalism_3" type="radio" name="rblProfessionalism" value="4"><label for="rblProfessionalism_3"> 4</label></td>
<td><input id="rblProfessionalism_4" type="radio" name="rblProfessionalism" value="5"><label for="rblProfessionalism_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>4) Hygiene at the Hospital.* </h5>
</td>
<td>
<table id="rblHygiene" style="width:100%;">
<tbody>
<tr>
<td><input id="rblHygiene_0" type="radio" name="rblHygiene" value="1"><label for="rblHygiene_0"> 1</label></td>
<td><input id="rblHygiene_1" type="radio" name="rblHygiene" value="2"><label for="rblHygiene_1"> 2</label></td>
<td><input id="rblHygiene_2" type="radio" name="rblHygiene" value="3"><label for="rblHygiene_2"> 3</label></td>
<td><input id="rblHygiene_3" type="radio" name="rblHygiene" value="4"><label for="rblHygiene_3"> 4</label></td>
<td><input id="rblHygiene_4" type="radio" name="rblHygiene" value="5"><label for="rblHygiene_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>5) Care provided by medical personnel.* </h5>
</td>
<td>
<table id="rblCare" style="width:100%;">
<tbody>
<tr>
<td><input id="rblCare_0" type="radio" name="rblCare" value="1"><label for="rblCare_0"> 1</label></td>
<td><input id="rblCare_1" type="radio" name="rblCare" value="2"><label for="rblCare_1"> 2</label></td>
<td><input id="rblCare_2" type="radio" name="rblCare" value="3"><label for="rblCare_2"> 3</label></td>
<td><input id="rblCare_3" type="radio" name="rblCare" value="4"><label for="rblCare_3"> 4</label></td>
<td><input id="rblCare_4" type="radio" name="rblCare" value="5"><label for="rblCare_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>6) Overall experience while obtaining pre-authorization.* </h5>
</td>
<td>
<table id="rblPreauth" style="width:100%;">
<tbody>
<tr>
<td><input id="rblPreauth_0" type="radio" name="rblPreauth" value="1"><label for="rblPreauth_0"> 1</label></td>
<td><input id="rblPreauth_1" type="radio" name="rblPreauth" value="2"><label for="rblPreauth_1"> 2</label></td>
<td><input id="rblPreauth_2" type="radio" name="rblPreauth" value="3"><label for="rblPreauth_2"> 3</label></td>
<td><input id="rblPreauth_3" type="radio" name="rblPreauth" value="4"><label for="rblPreauth_3"> 4</label></td>
<td><input id="rblPreauth_4" type="radio" name="rblPreauth" value="5"><label for="rblPreauth_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td>
<h5>7) Overall experience during the discharge from hospital.* </h5>
</td>
<td>
<table id="rblDischarge" style="width:100%;">
<tbody>
<tr>
<td><input id="rblDischarge_0" type="radio" name="rblDischarge" value="1"><label for="rblDischarge_0"> 1</label></td>
<td><input id="rblDischarge_1" type="radio" name="rblDischarge" value="2"><label for="rblDischarge_1"> 2</label></td>
<td><input id="rblDischarge_2" type="radio" name="rblDischarge" value="3"><label for="rblDischarge_2"> 3</label></td>
<td><input id="rblDischarge_3" type="radio" name="rblDischarge" value="4"><label for="rblDischarge_3"> 4</label></td>
<td><input id="rblDischarge_4" type="radio" name="rblDischarge" value="5"><label for="rblDischarge_4"> 5</label></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="col-12" align="center">
<input type="submit" name="btnSubmit" value="Submit" id="btnSubmit" class="btn btn-info">
</div>
<div class="clearfix">
</div>
<div class="col-12" align="center">
<span id="lblError" class="text-danger"></span>
</div>
</div>
</form>Text Content
Hospital Rating Survey IRDAI HOSPITAL EXPERIENCE SURVEY POLICY NUMBER: 411601/48/2023/1232 UHID OF PATIENT : OIC46825713 NAME OF PATIENT : Pradeepa S HOSPITAL NAME: Dr Rela Institute & Medical Centre(A unit of JR Super Speciality Hospital Pvt ltd) ROHINI ID [HOSPITAL ID]:8900080401297 DATE AND TIME OF DISCHARGE [mm/dd/yyyy] : 1/3/2024 11:59:59 PM PLEASE TAKE FEW MINUTES TO FILL OUT THIS SURVEY ON THE RELEVANCE AND QUALITY OF SERVICE YOU HAVE RECEIVED. EACH PARAMETER MAY BE GIVEN RATING ON THE SCALE OF 1 TO 5. IT MAY BE NOTED THAT THE BEST EXPERIENCE MAY BE RATED AS 5 AND WORST MAY BE RATED AS 1.ALL QUESTIONS ARE MANDATORY. 1) PROCESS OF BOOKING AN APPOINTMENT WITH YOUR DOCTOR AT THE HOSPITAL.* 1 2 3 4 5 2) LEVEL OF SATISFACTION ON THE TIME SPENT BY THE DOCTOR.* 1 2 3 4 5 3) PROFESSIONALISM OF THE STAFF.* 1 2 3 4 5 4) HYGIENE AT THE HOSPITAL.* 1 2 3 4 5 5) CARE PROVIDED BY MEDICAL PERSONNEL.* 1 2 3 4 5 6) OVERALL EXPERIENCE WHILE OBTAINING PRE-AUTHORIZATION.* 1 2 3 4 5 7) OVERALL EXPERIENCE DURING THE DISCHARGE FROM HOSPITAL.* 1 2 3 4 5