Please complete the following information and check the box attesting that you have reviewed the Grievance Quality Improvement Activity Webinar.
(Only for those facilities that did not attend the live webinar onĀ April 13, 2017)

* 1. Facility Name:

* 2. Six-digit CMS Certification number (begins with a 45 or 67):

* 3. First and Last name of the person completing this survey:

* 4. Title of the person completing this survey:

* 5. Phone Number:

* 6. I have reviewed the Grievance Quality Improvement Activity Webinar recording and slides.

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