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80

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

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