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Outpatient Clinician Survey
Evaluation of the CMS Network of Quality Improvement and Innovation Contractors Program (NQIIC) (CMS-10769)
OMB: 0938-1424
IC ID: 264722
OMB.report
HHS/CMS
OMB 0938-1424
ICR 202401-0938-008
IC 264722
( )
Documents and Forms
Document Name
Document Type
Form CMS-10769
Outpatient Clinician Survey
Form and Instruction
CMS-10769 Outpatient Clinicians Online Survey Instrument
CMS-10769_App_C_Outpatient Clinicians Survey_062922_508c.docx
Form and Instruction
CMS-10769_App_D.5_Survey_Pre-Notification_OP Clinician_Communication_10262022_508c.docx
Pre-Notification Communication Outpatient Clinician Letter
IC Document
CMS-10769_App_D.6_OP_Clinicians_follow-up_VM_and_email_062922_508c.docx
Voicemail and Email Messages for Outpatient Clinicians
IC Document
Information Collection (IC) Details
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