Outcomes Monitoring: 5 Day Survey - LIFE2000 Ventilation System

Fill out the form below and a member of the Baxter Respiratory Health team will be in contact with you.

Patient Name*

Patient Phone Number*

LIFE2000 Ventilation System serial number can be found on the device’s information page by selecting the Wrench icon from the menu.

Serial Number (seven digit number)

How would you rate your overall experience with the in-home training? What would your likelihood to recommend the trainer for future trainings? On a scale of 0-10 (0 least likely to recommend and 10 most likely to recommend)*

Can you expand on the reasoning for your rating?

What, if anything, could have improved your training experience? (Choose all that apply)* On Time
Professionalism (represent Baxter appropriately)
Product Knowledge
Appropriate Time Spent on Training
Soft Skills (attitude, build a report)
Nothing - everything went great
Other

Please explain the reasoning of your choices.

How many hours have you been using the LIFE2000 Ventilation System daily?*

When are you using the LIFE2000 Ventilation System?*

How are you using the LIFE2000 Ventilation System?*

Do you have any barriers or challenges with using the LIFE2000 Ventilation System?*

If Yes, please explain.

If Other, please explain.

Please rate how you feel the 3 LIFE2000 Ventilation System settings are meeting your needs. On a scale of 1-5 (5 being the best)

Low Setting*

Medium Setting*

High Setting*

8. Do you know how to contact Baxter?*

*required

Respiratory Health

Advancing respiratory health through innovative therapies

Hill-Rom® Respiratory Care