Please complete the following information.

This for is being used to assess understanding of purpose, facility role, and Network role in the 2018 Home Therapies Quality Improvement Activity. Please review the Webinar Recording and/or webinar slides prior to competing this form.
Please complete by February 9, 2018.
 

Contact:

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* 2. Contact:

This webinar was over 1 hour long

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* 3. This webinar was over 1 hour long

There are __ steps to Home Therapy Training being tracked in this project:

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* 4. There are __ steps to Home Therapy Training being tracked in this project:

The Network is requiring a 14 Question Root Cause Analysis to be completed for this project

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* 5. The Network is requiring a 14 Question Root Cause Analysis to be completed for this project

The goal(s) of this QIA is/are:

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

What is the name of the Network staff member who is leading this QIA?

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* 7. What is the name of the Network staff member who is leading this QIA?

Do you have any other comments, questions, or concerns?

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

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