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6. FORMS & TOOLS USED FOR GP ASSESSMENTS

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Assessment Package Outline

Chart Review Form

CR – 1

Chart Review Checklist

R – 2

Assessment Checklist

Outline for Physician Interview

R – 4

Final Report Description

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Format

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Requirements

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Recommendation Summary

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Sample

R - 1 (MCIB) MCIB Report (numeric format)

Certificate of Participation

EX - 1 Assessor’s Expense Claim Form