New CHDP Provider Orientation

Course Evaluation

Date of Orientation: * +

I am a: *

1. After participating in this orientation, I feel I have a good understanding of the CHDP program, including the Gateway Process. *

2. After participating in this orientation, I have a good understanding of the CHDP care coordination/referral process requirements. *

3. After participating in this orientation, I am more familiar with my responsibilities as a CHDP provider. *

4. The information presented on Key Assessment Areas met my educational needs. *

5. Overall, the orientation was: *

Describe at least one thing you learned from the orientation that will be helpful to you at your clinic: *

Additional comments:

Attendee name: *

Clinic: *

Address: *

City: *

Zip Code: *

Work Email: *

Work Phone: *