Member Survey

Identify range of care management practices related to staffing, service offerings, marketing and administration.

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* 1. How long has your organization been providing care management services?

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* 2. What NAPGCM Mid-Atlantic Chapter Unit do you belong to?

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* 3. What services does your organization provide and by whom?

  MSW MSW-LCSW RN BSW LPN Other (please specify below)
General Care Management
Bill Payment/Money Management
Companion/Friendly Visiting
Care Management Consultation
Psychotherapy
Homecare
Capacity Reports
Initial Assessments
Guardianship
Other (please specify below)

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* 4. If you checked "Other", please specify the services you provide and by whom:

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* 5. Please indicate below the general range your organization charges on an hourly basis for each service. Please check all that apply:

  < $75 $76 - $100 $101 - $125 $126 - $150 $151 - 175 > $175 Other (please specify below)
General Care Management
Bill Payment/Money Management
Companion/Friendly Visiting
Care Management Consultation
Psychotherapy
Homecare
Capacity Reports
Initial Assessments
Guardianship
Other (please specify below)

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* 6. If you checked "Other", please specify the services you provide and the price range:

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* 7. How many full-time equivalent employees does your organization employ?

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* 8. If you checked "Other", please specify the type of employees:

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* 9. How many full-time equivalent contractors does your organization employ?

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* 10. If you checked "Other", please specify the type of contractors:

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* 11. What type of clientele does your organization typically serve? Please check all that apply:

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* 12. If you checked "Other", please specify the type of clientele:

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* 13. Does your organization charge clients for travel time?

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