FSQAP Provider Feedack Survey

FSQAP Provider Feedback Survey

We are seeking your feedback on Delmarva Foundation’s Provider Discovery Review (PDR) process. Your feedback is very important to us. Thank you for participating.

Question Title

* 1. Type of Provider

Agency

Solo

Question Title

* 2. APD Area

Question Title

* 3. APD Region

Northeast

Northwest

Central

Southeast

Southern

Suncoast

Question Title

* 4. Month of Review

January

February

March

April

May

June

July

August

September

October

November

December

Question Title

* 5. Year of Review

2013

2014

2015

Question Title

* 6. Please check the box that best describes your answers to the following:

	Yes	No	NA
Did the Quality Assurance Reviewer (QAR) identify the documents needed to complete the review?	Did the Quality Assurance Reviewer (QAR) identify the documents needed to complete the review? Yes	Did the Quality Assurance Reviewer (QAR) identify the documents needed to complete the review? No	Did the Quality Assurance Reviewer (QAR) identify the documents needed to complete the review? NA
Did the QAR explain the purpose of the review?	Did the QAR explain the purpose of the review? Yes	Did the QAR explain the purpose of the review? No	Did the QAR explain the purpose of the review? NA
Did the QAR explain the review process?	Did the QAR explain the review process? Yes	Did the QAR explain the review process? No	Did the QAR explain the review process? NA
Did the QAR answer any questions you had in preparation for the review?	Did the QAR answer any questions you had in preparation for the review? Yes	Did the QAR answer any questions you had in preparation for the review? No	Did the QAR answer any questions you had in preparation for the review? NA
Did the QAR refer you to the FSQAP website, including the tools and procedures?	Did the QAR refer you to the FSQAP website, including the tools and procedures? Yes	Did the QAR refer you to the FSQAP website, including the tools and procedures? No	Did the QAR refer you to the FSQAP website, including the tools and procedures? NA
Did the QAR arrive at the review at the scheduled time?	Did the QAR arrive at the review at the scheduled time? Yes	Did the QAR arrive at the review at the scheduled time? No	Did the QAR arrive at the review at the scheduled time? NA
If no, did the QAR call to notify you he/she might be a little late?	If no, did the QAR call to notify you he/she might be a little late? Yes	If no, did the QAR call to notify you he/she might be a little late? No	If no, did the QAR call to notify you he/she might be a little late? NA
Did the QAR provide you with the preliminary findings of your Provider Discovery Review before leaving?	Did the QAR provide you with the preliminary findings of your Provider Discovery Review before leaving? Yes	Did the QAR provide you with the preliminary findings of your Provider Discovery Review before leaving? No	Did the QAR provide you with the preliminary findings of your Provider Discovery Review before leaving? NA
If you scored Not Met on any of the standards, did the QAR explain why?	If you scored Not Met on any of the standards, did the QAR explain why? Yes	If you scored Not Met on any of the standards, did the QAR explain why? No	If you scored Not Met on any of the standards, did the QAR explain why? NA

FSQAP Provider Feedack Survey

FSQAP Provider Feedback Survey

Question Title

* 1. Type of Provider

Question Title

* 2. APD Area

Question Title

* 3. APD Region

Question Title

* 4. Month of Review

Question Title

* 5. Year of Review

Question Title

* 6. Please check the box that best describes your answers to the following:

Question Title

* 7. Comments? Is there anything about the process you would like to see changed?

Question Title

* 8. Thank you for your feedback! Would you like a return phone call from a manager? If so, please leave your name and contact number.