Free Clinic Relations with FQHCs Survey

1. Clinic you represent

Clinic you represent

2. Is there a FQHC in your area?

Is there a FQHC in your area? Yes

3. If yes, does your clinic have a relationship or history with the leadership and/or staff of the FQHC?

If yes, does your clinic have a relationship or history with the leadership and/or staff of the FQHC? Yes

4. If yes, what is the nature of this relationship?

If yes, what is the nature of this relationship? Positive

Negative

Mixed

Comments

5. Are you familiar with the services offered at the FQHC, eligibility requirements, and costs?

Are you familiar with the services offered at the FQHC, eligibility requirements, and costs? Yes

Comment

6. Do you have contact with the patient population of a local FQHC?

Do you have contact with the patient population of a local FQHC? Yes

7. If yes, what type of interactions have you had with FQHC patients? Check all that apply.

If yes, what type of interactions have you had with FQHC patients? Check all that apply. Referred patients to FQHC

Seen patients referred by FQHC

Seen patients refused service at FQHC (not referred to you)

Seen patients for services not offered at FQHC

Seen patients that claim poor service from FQHC

Comment on the above interactions. Provide as much detail as possible. Include number of events, dates of occurance, names of contacts at the free clinic and FQHC involved in a disputed matter, etc. (do not include patient names or identifying information)

8. Do you have a procedure for verifying incidences brought to your attention by a patient in regards to obtaining services from a FQHC? (ex: if a patient claims to have been denied services, do you have a go to person at the FQHC with whom you can verify information?)

Do you have a procedure for verifying incidences brought to your attention by a patient in regards to obtaining services from a FQHC? (ex: if a patient claims to have been denied services, do you have a go to person at the FQHC with whom you can verify information?) Yes

Comment

9. Overall, do you feel that FQHCs are serving the underserved patient population to the best of their abilities and to the level expected of them? A presentation by Neil Colburn of the MPCA is available on the FCOM website for review of the mission and obligations of FQHCs.

Overall, do you feel that FQHCs are serving the underserved patient population to the best of their abilities and to the level expected of them? A presentation by Neil Colburn of the MPCA is available on the FCOM website for review of the mission and obligations of FQHCs. Yes

Comment

Free Clinic Relations with FQHCs
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1. Default Section

1. Clinic you represent

2. Is there a FQHC in your area?

3. If yes, does your clinic have a relationship or history with the leadership and/or staff of the FQHC?

4. If yes, what is the nature of this relationship?

5. Are you familiar with the services offered at the FQHC, eligibility requirements, and costs?

6. Do you have contact with the patient population of a local FQHC?

7. If yes, what type of interactions have you had with FQHC patients? Check all that apply.

8. Do you have a procedure for verifying incidences brought to your attention by a patient in regards to obtaining services from a FQHC? (ex: if a patient claims to have been denied services, do you have a go to person at the FQHC with whom you can verify information?)

9. Overall, do you feel that FQHCs are serving the underserved patient population to the best of their abilities and to the level expected of them? A presentation by Neil Colburn of the MPCA is available on the FCOM website for review of the mission and obligations of FQHCs.

Free Clinic Relations with FQHCsExit this survey

1. Default Section

1. Clinic you represent

2. Is there a FQHC in your area?

3. If yes, does your clinic have a relationship or history with the leadership and/or staff of the FQHC?

4. If yes, what is the nature of this relationship?

5. Are you familiar with the services offered at the FQHC, eligibility requirements, and costs?

6. Do you have contact with the patient population of a local FQHC?

7. If yes, what type of interactions have you had with FQHC patients? Check all that apply.

8. Do you have a procedure for verifying incidences brought to your attention by a patient in regards to obtaining services from a FQHC? (ex: if a patient claims to have been denied services, do you have a go to person at the FQHC with whom you can verify information?)

9. Overall, do you feel that FQHCs are serving the underserved patient population to the best of their abilities and to the level expected of them? A presentation by Neil Colburn of the MPCA is available on the FCOM website for review of the mission and obligations of FQHCs.

Free Clinic Relations with FQHCs
Exit this survey