Provider Review Information

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

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* 3. Month of Review

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* 4. Year of Review (YYYY)

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* 5. Provider's Name (Optional)

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* 6. Reviewer's Name (Optional)

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