Post-VR QIA Project Assessment Question Title * 1. Please rate the following statement:I am aware of VR/EN services in my area Not at all Slightly Moderately Very much so Extremely Not at all Slightly Moderately Very much so Extremely OK Question Title * 2. Please rate the following statement: I know which of my patients are candidates for VR/EN services referral Not at all Slightly Moderately Very much so Extremely Not at all Slightly Moderately Very much so Extremely OK Question Title * 3. Please rate the following statement on your current actions :I actively discuss VR/EN services with my patients more than once a year Not at all Small amount Moderately Very much so Greatly Not at all Small amount Moderately Very much so Greatly OK Question Title * 4. Please rate the following statement: I either update or direct a colleague to update, at least monthly, patients' VR status in CROWNWeb Yes No OK Question Title * 5. When a patients' VR status changes I update the patient's VR status in my organization's internal reporting system within 30 days of the status change Yes No OK Question Title * 6. My facility has a Patient Representative Yes - Answer question #7 No - Skip to questions #8 OK Question Title * 7. If Yes to Question #6: Does your facility's Patient Representative attend QAPI meetings? Yes No - Skip to question #9 OK Question Title * 8. If No to Question #6: Is your facility's Patient Representative active in quality improvement activities? Yes No OK Question Title * 9. If your facility's Patient Representative is NOT active in quality activities, please explain why. OK Question Title * 10. Your first and last name OK Question Title * 11. Facility name or 6-digit CCN OK SUBMIT