NW2 Support Gainful Employment (VR) QIA Mid-Point Webinar
Post Assessment 2019

Please complete the following information.

This for is being used to assess understanding of the QIA Interventions and Activities in the 2019 Support Gainful Employment (VR) Quality Improvement Activity. Please review the Webinar Recording and/or webinar slides prior to competing this form.

Please complete by July 31, 2019.

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* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

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* 2. Contact:

Name

Email Address

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* 3. This webinar was over 1 hour long

Yes

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* 4. This QIA requires developing a relationship with staff at Access-VR, EN or other job skills development agencies accessible (in person or online) to your dialysis facility's patients

Yes

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* 5. It is required for at least 1 staff member to attend quarterly National QIA LAN Calls

Yes

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* 6. The goal(s) of these QIA(s) is/are:

10% VR/EN Referral and 5% VR/EN Utilization

Facility staff being aware of VR/EN Resources

All Patients understating their VR/EN options

Standardizing the process of patient education on Vocational Rehabilitation

All of the above

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* 7. Do you feel your facility can meet the QIA(s) goals?

Yes

Comment

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* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

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* 2. Contact:

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* 3. This webinar was over 1 hour long

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* 4. This QIA requires developing a relationship with staff at Access-VR, EN or other job skills development agencies accessible (in person or online) to your dialysis facility's patients

Question Title

* 5. It is required for at least 1 staff member to attend quarterly National QIA LAN Calls

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* 6. The goal(s) of these QIA(s) is/are:

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* 7. Do you feel your facility can meet the QIA(s) goals?

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* 8. Do you have any other comments, questions, or concerns?