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2014
June
P
Physician- Test Site Feedback Survey
Physician- Test Site Feedback Survey
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Physician Name:
*
First Name
:
*
Last Name
:
Name of Practice:
Patient Number:
What is the date of the procedure?
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2024
Please complete after reading each patient's study.
Number of PillCam COLON studies you have read (not including training or e-learning).
studies
Reading the study:
min
Creating the report:
min
Please rate your
overall level of satisfaction
with the amount of time you spent reading and reporting on this study.
Not satisfied at all
Somewhat satisfied
Very satisfied
How would you rate the patient's bowel preparation as you read the study?
Good
Adequate
Poor
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