Medical Director Center Assessment Tool
Center Name
Medical Director Name
Contract Start Date
Assessment Date
This is a confidential Center Assessment and will not be shared with the Center Team. When completed, this Medical Director Assessment will be sent electronically to the SHCM Corporate Medical Director for review and appropriate follow up.
Please Rate Your Center Satisfaction In The Following Areas:
Center QA Meeting Readiness and Communication
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
Centers Responsiveness To Return Phone Calls Timely
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
Centers Support With Timely Follow Up Of Patient Orders
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
Center Reputation For Resident Care In The Community
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
Centers Professional Partnership With Medical Director
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
What Is Your Satisfaction Level With The Telemedicine Program?
Unsatisfied
Somewhat Satisfied
Improving
Satisfied
Very Satisfied
Which Of The Following Would You Improve?
Equipment Reliability
Wi-Fi Connection
Log On Process
Other
What Else Would You Improve?
How Many Community Relation Events Have You Been Invited to?
0
1
2-3
3-4
4-5
How Many New Physicians In Your Network Did You Introduce To The Center?
0
1
2-3
3-4
4-5
Other Comments or Concerns Regarding The Centers Clinical Team:
Post Custom Field