Table of Contents Table of Contents
Previous Page  80 / 130 Next Page
Information
Show Menu
Previous Page 80 / 130 Next Page
Page Background

80

TOC

T

O:

Dr. **

DATE:

October 3, 2012

RE:

Assessment Package for Dr. **

Assessment Date:

**

A. For your own use/information:

1.

Pre-Visit Questionnaire Report (Q2R) and copy of privileges

2.

Patient Questionnaire Summary Report (Q1R)

3.

Referred Specialist Questionnaire Summary Report (Q5R)

4.

Physical Facilities & Practice Organization Questionnaire Report (Q4R).

A copy will be provided to the assessee with the Final Report.

5.

* Medical Office Assessment Form (R-2)

6.

Final Report format (R-4)

7.

* Guidelines for Chart Review (CR-1)

8.

Chart Review Form

9.

Outline for Physician Interview

10. Assessor’s Expense Claim Form

11. PEP Business Cards

12. XPRESS Post Return Envelope

13. Cassette tape

B. For the physician you are assessing:

1. MSB Report

2. Patient Questionnaire Summary Report (Q1R)

3. Referred Specialist Questionnaire Summary Report (Q5R)

I look forward to receiving your Final Report. Please submit it to the PEP office

within

two weeks

of the completion of the assessment

Sincerely,

Joanne Peat

Enclosures

Items *5 and *7 are now being entered into the PEP database for research purposes

– please complete and return these documents. Thank you.

P.E.P.

for

Saskatchewan

Physicians

P

R

A

C

T

I

C

E

E

N

H

A

N

C

E

M

E

N

T

P

R

O

G

R

A

M

6.a Assessment Package

Outline