Evaluation Form: Stepping into the Cost of Care Conversation

Learning Objectives

At the conclusion of this webinar, participants will be able to... 1. Better understand the need for systematic, patient-friendly, culturally relevant CoC tools for patients, and for insightful CoC staff training that encourages and enables proactive exploration of CoC concerns; 2. Understand the principles of shared decision making and patient-centered care; 3. Explore current and best practices for conducting cost-of-care (CoC) conversations in primary care among vulnerable patients, and optimal methods for training FQHC staff members on this emerging CoC issue.

1. Did the training meet all of the stated learning objectives?

1 - The learning objectives were not met 2 - The learning objectives were rarely met 3 - The learning objectives were sometimes met 4 - The learning objectives were mostly met 5 - The learning objectives were completely met

2. The scholarship and expertise of Deliana Garcia, MA?

1 - None 2 - Slight 3 - Moderate 4 - Considerable 5 - Complete

3. Your overall satisfaction with this webinar training?

1 - Dissatisfied 2 - Slightly satisfied 3 - Moderately satisfied 4 - Predominantly satisfied 5 - Completely satisfied

4. The webinar presented new areas of knowledge, and/or new ideas/methods to implement.

1 - Disagree 2 - Slightly agreee 3- Moderately agree 4 - Mostly agree 5 - Completely agree

5. The webinar contained information at a level commensurate with my training and experience.

1 - Disagree 2 - Slightly agree 3 - Moderately agree 4 - Predominantly agree 5 - Completely agree

6. How helpful was the information you learned today in enhancing the performance and operations of your health center or organization?

N/A - Not applicable 1 - Not helpful 2 - Slightly helpful 3 - Moderately helpful 4 - Predominantly helpful 5 - Completely helpful

7. If applicable, how do you intend to use the information learned in your daily work?

If you have nothing to enter please type "N/A"

8. Was the content balanced and free of commercial bias?

1 - Yes 2 - No

9. Did the speaker(s) fully disclose any conflict of interest and/discussion of off-label usage of medications and/or medical devices?

1 - Yes 2 - No

10. Please mentioned one thing you learned during this webinar training.

If you have nothing to enter please type "N/A"

11. Are there any additional resources, technical assistance, or training that would be helpful to you or your organization?

If you have nothing to enter please type "N/A"

12. What is the biggest challenge for you or your organization in providing quality care or services?

If you have nothing to enter please type "N/A"

13. Please state any additional comments, questions, or suggestions below.

If you have none enter "N/A"

CERTIFICATES FOR THIS TRAINING WILL BE SENT ELECTRONICALLY. IF YOU WISH TO RECEIVE A HARD-COPY OF YOUR CERTIFICATE, PLEASE BE SURE TO PROVIDE A MAILING ADDRESS IN THE APPROPRIATE FIELD(S) BELOW.

14. Name (as it should appear on your certificate)

15. Would you like to receive a hard-copy of your certificate?

16. Mailing Address (street # or P.O. Box)

17. City

18. State

19. Zip Code

20. Please identify the type of certificate you would like to recieve.

NOTE: TEXAS CHW CERTIFICATES WILL NOT BE MADE AVAILABLE FOR THIS TRAINING. 1 - Continuing Medical Education (CME) 2 - Continuing Nursing Education (CNE) 3 - Texas CHW Certificate 4 - Certificate of Attendance

21. Email Address

22. Phone Number

Please enter your phone number in one of the following formats: (123) 456-7890 or 123-456-7890

23. Please indicate the type of phone number you provided.

1 - Cell/Mobile 2 - Home 3 - Work/Office

THANK YOU FOR COMPLETING THE EVALUATION. YOUR ELECTRONIC CERTIFICATE WILL BE SENT OUT 1 - 2 WEEKS POST TRAINING DATE.

Send me a copy of my responses

Report Abuse