We are seeking your feedback on the Provider Discovery Review (PDR) Qlarant recently completed with your organization.  Your input is very important to us.  Thank you for participating.

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* 1. Type of Provider (choose one)

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* 2. APD Region/Area

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* 3. Month/Year of Review (MM/YYYY)

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* 4. Did the Quality Assurance Reviewer explain the review process?

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* 5. Did the Quality Assurance Reviewer share with you the names of the potential people chosen to participate in the review?

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* 6. Did the Quality Assurance Reviewer explain the person's participation in the interview is voluntary?

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* 7. Did the Quality Assurance Reviewer refer you to the Qlarant website that includes the tools and procedures?

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* 8. Were the tools accessible on the Qlarant website?

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* 9. Did you find the tools helpful when preparing for the review?

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* 10. Did the Quality Assurance Reviewer answer your questions in preparation for the review?

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* 11. Did the Quality Assurance Reviewer arrive on time?

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* 12. If not, were you notified the Quality Assurance Reviewer would be late?

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* 13. Did the Quality Assurance Reviewer give you enough time to find the information requested?

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* 14. Do you feel the Quality Assurance Reviewer was prepared for the review?

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* 15. Did the review process go as explained by the Quality Assurance Reviewer?

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* 16. Did the Quality Assurance Reviewer answer the questions you had during the review?

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* 17. If applicable, did the Quality Assurance Reviewer explain why a standard was Not Met?

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* 18. If an alert was identified, did the Quality Assurance Reviewer inform you of the follow up process? (Score N/A if no alerts were identified)

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* 19. Did the Quality Assurance Reviewer provide you with the preliminary findings of your review before leaving?

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* 20. Comment: What did you like best about the Provider Discovery Review? What would you like to see changed?

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* 21. Would you like a manager to contact you? If so, please include your name and contact information.

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