Pediatric AUC MOC 4 Questionnaire

Baseline

Please complete entire questionnaire including data from the baseline, Cycle 1 and Cycle 2.

Question Title

* 1. Enter the Start and End Date of the Baseline Phase

Start

Date

End

Date

Question Title

* 2. How many NEW patients did you evaluate for a possible TTE during the baseline phase?

20

200

Question Title

* 3. Of the patients included in the above number, how many had a TTE ordered?

0

200

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* 4. Of the TTEs not ordered, how many were rated:

Appropriate

May be appropriate

Rarely appropriate

Unclassifiable

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* 5. Of the TTEs ordered, how many were rated:

Appropriate

May be appropriate

Rarely appropriate

Unclassifiable

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* 6. What activities were used to improve AUC rating performance? (Select all that apply)

Read AUC document completely

Listened to the IAC webinar

Made pocket card for common AUC indications and their ratings

Placed AUC tables in a visible place in my clinic

Attended or delivered a lecture on the use of pediatric AUC

Other (please specify)

Question Title

* 7. Please enter any comments