MEDICINAL OXYGENS OF COLOMBIA

Our main objective is to improve the quality of life of the patient oxygen dependent.
Neiva, Huila - Colombia.
Carolina Ramón, Eliana Herrera y Leidy M. Romero

Patient-dependent Oxygen survey

Good morning (or good afternoon).

My name is Carolina Ramón, I am a student of market management of the Seine

and I am conducting a survey on the characteristics of patients dependent oxygen.

Can you please help me answer some questions?

1.How long have you been using medical oxygen?
a. From 0 to 6 months
b. 6 months to 2 years
c. 3 to 5 years
d. More than 5 years

2. What health specialist prescribes medical oxygen

A. pulmonologist
b. Cardiologist
c. internist
d. Other: ________________
3. What pathology did you diagnose for medical oxygen prescription?
__________________________________________________________________
________________________________
4. What is your oxygen formulation (flow in liters per minute and hours per day)?
a. 0 a 1 lpm
b. 2 a 3 lpm
c. 4 a 5 lpm
d. 5 a 8 lpm
e. More than 8lpm

5. Do you attend medical checks, tests, or others that force you to move away from
home?
a. Yes___
b. No___

If your answer to the previous question was "Yes," follow questions 6.7, 8, 9, and
10. Otherwise go to question 11.

6. How often do you attend medical appointments, controls, exams, or others

outside the home?
a. 3 times per week
b. 2 times per week
c. 1 time per week
d. 2 times a month
e. 1 time per month
MEDICINAL OXYGENS OF COLOMBIA
Our main objective is to improve the quality of life of the patient oxygen dependent.
Neiva, Huila - Colombia.
Carolina Ramón, Eliana Herrera y Leidy M. Romero

f. Every 2 months
g. Every 3 monthsh

7. When you move away from home to controls, medical appointments, exams, or
others, what equipment do you use to ensure medical oxygen supply?
__________________________________________________________________
__________________________________________________________________

8. Which companies supplying medicinal oxygen do you know in Neiva?

__________________________________________________________________
__________________________________________________________________

9. On a scale of 1 to 5, where 1 is nothing satisfied and 5 is totally satisfied,

How satisfied are you with the service of the company supplying you with the
medical oxygen currently? and why?
1. Nothing satisfied
2. Little satisfied
3. Regularly met
4. Very satisfied
5. Totally satisfied
__________________________________________________________________
__________________________________________________________________
10Do you think being a dependent oxygen patient limits you to doing activities
outside the home?

a. Yes___
b. No___

11. What kind of activities? ___________________________________________

12. Have you heard about portable hubs?

a. Yes___
b. No___

13. How did you find out about this type of portable oxygen generator equipment?
__________________________________________________________________
__________________________________________________________________

14. A portable concentrator allows you to have more independence to do your

activities away from home. Would you like to buy or rent a portable concentrator?

a. Yes___
b. No___

Please help us with some data:

MEDICINAL OXYGENS OF COLOMBIA
Our main objective is to improve the quality of life of the patient oxygen dependent.
Neiva, Huila - Colombia.
Carolina Ramón, Eliana Herrera y Leidy M. Romero

15. Patient's name:__________________________

16. Gender:

a. Female ___
b. male ___

17. Age in Years:

a. from 0 to 18
b. From 18 to 30
c. From 30 to 50
d. From 50 to 70
e. More than 70

18. Health entity____________________________

19. Address ________________________

20. Quarter:__________________________

21. Estratum: ______

22. telephone number: _____________

23.Who answers the survey?

a.Relative:____ name______________________relationship : ________________

b. Patient: ___
c. another :
________________________________________________________________

I appreciate your all your cooperation. Have a happy day!