* 1. Case Manager/Provider Name

* 2. Case Management Agency/Provider Agency

* 3. Waiver type CA is the.....

* 4. The new section in the plan of care is......

* 5. What option under the circle of supports section requires you to list number of roommates?

* 6. The Supervision Needs in the Needs and Risks section replaces the Habilitation page?

* 7. Case management services are now listed in a separate box.

* 8. I must add a back up case manager to the plan of care.

* 9. Was the training content beneficial?

* 10. Was training length and pace was appropriate for the topic?

* 11. Was the material presented well? (easy to understand, spoken clearly, right tone, easy to read, etc.)

* 12. Was the training useful and worth your time?

* 13. Your overall satisfaction with this training.

* 14. I would recommend this training to others.

* 15. Additional comments:

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