Program Evaluation and Record of Attendance
To receive verification of your attendance and CME hours, COMPLETE this evaluation form.

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* 1. Address

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* 2. Medical-Legal Fee Schedule - What's Changing?

  Poor Fair Satisfactory Good Excellent
Basil Besh, M.D.
Saul Allweiss, Esq.

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* 3. Apportionment Issues - Upper Extremity

  Poor Fair Satisfactory Good Excellent
Richard Braun, M.D.

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* 4. Quality Reports - The Worst Mistakes Judges See

  Poor Fair Satisfactory Good Excellent
Judge Robert Rassp

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* 5. Contributory Factors to Disability & Impairment

  Poor Fair Satisfactory Good Excellent
Larry Dodge, M.D.
Richard Braun, M.D.
Peter Mandell, M.D.
Judge Robert Rassp

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* 6. Wounded Workers:  Beat Up & Fought Over

  Poor Fair Satisfactory Good Excellent
Robert Larsen, M.D.

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* 7. Functional Capacity Evaluations & Functional Restoration Programs

  Poor Fair Satisfactory Good Excellent
Rachael Feinberg, PT, DPT

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* 8. Know Your Rights - URAC Accredited UR Companies

  Poor Fair Satisfactory Good Excellent
Karen Watts - URAC

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* 9. Update on Billing/Coding Issues

  Poor Fair Satisfactory Good Excellent
Sarah Moray - DaisyBill
Educational Merit

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* 10. Please rate the extent of your knowledge of the subject matter covered before and after this meeting;

  No knowledge Fair Satisfactory Good Expert
Before the meeting
After the meeting
To what extent do you think you will be able to apply the information
from this meeting in your practice?

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* 11. Cultural Competency:

  Strongly Disagree Disagree Neutral  Agree Strongly Agree
Issues in cultural and linguistic competency (e.g. differences in prevalence, diagnosis, treatment in diverse population; linguistic skills; pertinent cultural data) were adequately addressed in this activity:

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* 12. Resources on cultural and linguistic competency have been included in the meeting presentations and materials. How can we further meet your educational needs in this area?

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* 13. What barriers do you see to implementing changes that you learned about during the presentations today:

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