19 Report information

OMB Number: 0915-0366; Expiration date: XX/XX/202X

Entities Survey: Module 19

Number of questions: 8

Report Information

Q 19.1. My organization understands all of the circumstances in which a report must be submitted to the NPDB.

Completely Agree

Agree

Neither Agree Nor Disagree

Disagree

Completely Disagree

Q 19.2. My organization seeks legal guidance to determine when a report should be filed.

Always

Often

Sometimes

Rarely

Never

Q 19.3. Do the NPDB reporting requirements impact the disciplinary actions your organization takes regarding a health care practitioner?

Yes

No

Not Applicable

If the response to 19.3 is “yes,” go to 19.4. Otherwise, skip to 19.5

Q 19.4. Please explain how the NPDB reporting requirements impact the disciplinary actions your organization takes regarding practitioners.

Text box

Survey Page Break

Q 19.5. During the past calendar year, my organization has submitted all NPDB reportable actions to the NPDB within 30 days.

Completely Agree

Agree

Neither Agree Nor Disagree

Disagree

Completely Disagree

Survey Page Break

Q 19.6. Has your organization ever been named in a civil lawsuit action by a practitioner regarding reporting to the NPDB?

Yes

No  end this module

Do not know  end this module

Other (Please Explain)_________  end this module

Q 19.7. Specify the number of times your organization has been named in such a civil lawsuit.

Select a number from the dropdown menu [1 to 100]

Survey Page Break

Q 19.8. What has been the outcome of these suit(s)? Select a number from the dropdown menu for each of the items below:

Number of times no report was filed [1 to 100]

Number of times report was filed unchanged [1 to 100]

Number of times report was modified before filing [1 to 100]

Number of times report was modified after filing [1 to 100]

Number of times report was voided [1 to 100]

Piping Logic:

Survey will be directed to Module 20 next.