NCFT Access to Care Survey Question Title 1. How do you obtain physical health information on your consumers? Consumer Self Report Fax Communication Record Request Other (please specify) OK Question Title 2. To what degree do you coordiante with primary care physicians to obtain annual physical information? Very frequently Frequently As needed Rarely Not at all OK Question Title 3. Do you have an established protocol or agency procedure for obtaining physical health information? Yes No In process of establishing OK Question Title 4. Do you have an established protocol or agency procedure for medication reconciliation? Yes No In process of establishing OK Question Title 5. Does your agency track on Biometric or HEDIS Measures? Yes No If yes, please list, or if there are many, please list the three most important to your implementation. OK Question Title 6. Are you willing to consider adopting protocols that demonstrate intentional coordination with Primary Care physicians? Yes No Need more information OK Question Title 7. How do you address recurring acute conditions in your established consumer base? OK THANK YOU FOR YOUR FEEDBACK