Exit this survey Domestic Violence Webinar Evaluation 1. Default Section Question Title * 1. Please rate the following aspects of the webinar. Excellent Good Sataisfactory Poor N/A Overall webinar Overall webinar Excellent Overall webinar Good Overall webinar Sataisfactory Overall webinar Poor Overall webinar N/A Program content fulfilled the goals/objectives Program content fulfilled the goals/objectives Excellent Program content fulfilled the goals/objectives Good Program content fulfilled the goals/objectives Sataisfactory Program content fulfilled the goals/objectives Poor Program content fulfilled the goals/objectives N/A Format/Organization of presentation Format/Organization of presentation Excellent Format/Organization of presentation Good Format/Organization of presentation Sataisfactory Format/Organization of presentation Poor Format/Organization of presentation N/A Time Allotted Time Allotted Excellent Time Allotted Good Time Allotted Sataisfactory Time Allotted Poor Time Allotted N/A Speaker communicated clearly Speaker communicated clearly Excellent Speaker communicated clearly Good Speaker communicated clearly Sataisfactory Speaker communicated clearly Poor Speaker communicated clearly N/A Speaker effectively used examples/illustrations Speaker effectively used examples/illustrations Excellent Speaker effectively used examples/illustrations Good Speaker effectively used examples/illustrations Sataisfactory Speaker effectively used examples/illustrations Poor Speaker effectively used examples/illustrations N/A Speaker knowledge of subject Speaker knowledge of subject Excellent Speaker knowledge of subject Good Speaker knowledge of subject Sataisfactory Speaker knowledge of subject Poor Speaker knowledge of subject N/A Overall speaker effectiveness Overall speaker effectiveness Excellent Overall speaker effectiveness Good Overall speaker effectiveness Sataisfactory Overall speaker effectiveness Poor Overall speaker effectiveness N/A Question Title * 2. Please answer the following questions related to the ISMA staff and registration process. Excellent Good Satisfactory Poor N/A Registration process Registration process Excellent Registration process Good Registration process Satisfactory Registration process Poor Registration process N/A ISMA staff at program helpful/friendly ISMA staff at program helpful/friendly Excellent ISMA staff at program helpful/friendly Good ISMA staff at program helpful/friendly Satisfactory ISMA staff at program helpful/friendly Poor ISMA staff at program helpful/friendly N/A ISMA staff helpful when called with questions ISMA staff helpful when called with questions Excellent ISMA staff helpful when called with questions Good ISMA staff helpful when called with questions Satisfactory ISMA staff helpful when called with questions Poor ISMA staff helpful when called with questions N/A Question Title * 3. How did you hear of this workshop? (Select all that apply) ISMA Professional Development Catalog ISMA Reports Fax from ISMA Supervisor/practice manager Co-worker/Colleague Physician Other Question Title * 4. Suggestions for future ISMA workshop topics: Documentation in the Medical Record Documentation Guidelines for E&M services General CPT coding General ICD-9-CM coding Specific billing problems - problem area? Specialty coding - what specialty? GI, OB/GYN Medical Office Management Patient Satisfaction Strategies Collection Strategies Medicare Issues Marketing Your Practice Legal Issues-specifically Contract Negotiation Fraud & Abuse & Compliance Issues Accounting/Finance for Physicians Human Resource Management Ethics, Ethical Decision-making Medicaid Managed Care HIPAA Electronic Records Leadership Skills Communication Skills Budgeting for Medical Practice Skills for the Front Office Disease Management Other (please specify) Question Title * 5. Additional suggestions or comments about today’s program: Question Title * 6. Please provide any of the following information so that ISMA Staff can follow-up on any concerns or questions (Optional): Name: Practice: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Done