PFE Monthly Survey Question Title * 1. Please complete this survey for the months of June, July, August and September. Thank you. OK Question Title * 2. Name of person completing form OK Question Title * 3. CMS CCN/Provider Number (6 digits, PA begins with 39, DE with 08) OK Question Title * 4. Do you have a patient rep? if yes how many reps? OK Question Title * 5. If you have a patient rep, does he/she attend your monthly QAPI meeting? If not what are you doing this month to achieve this goal? OK Question Title * 6. Do you have a support group or use an outside support group? If not are you or the patient rep providing the other patients with monthly information on different support group options? OK Question Title * 7. Have you provided grievance education to your patients? If not what are you doing this month to complete your patient education? OK Question Title * 8. Provide a success and/or barrier that you experienced since including your patient rep in your facility activities. OK DONE