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New CHDP Provider Orientation
Course Evaluation
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Date of Orientation:
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I am a:
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Physician
PA
NP
RN
MA
Other:
Other:
1. After participating in this orientation, I feel I have a good understanding of the CHDP program, including the Gateway Process.
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Strongly agree
Agree
Somewhat agree
Disagree
Strongly disagree
2. After participating in this orientation, I have a good understanding of the CHDP care coordination/referral process requirements.
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Strongly agree
Agree
Somewhat agree
Disagree
Strongly disagree
3. After participating in this orientation, I am more familiar with my responsibilities as a CHDP provider.
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Strongly agree
Agree
Somewhat agree
Disagree
Strongly disagree
4. The information presented on Key Assessment Areas met my educational needs.
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Strongly agree
Agree
Somewhat agree
Disagree
Strongly disagree
5. Overall, the orientation was:
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Excellent
Very good
Good
Fair
Poor
Describe at least one thing you learned from the orientation that will be helpful to you at your clinic:
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Additional comments:
Attendee name:
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Clinic:
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Address:
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City:
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Zip Code:
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Work Email:
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Work Phone:
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