2021 Annual Meeting - QME Course

Program Evaluation and Record of Attendance

To receive verification of your attendance and CME hours, COMPLETE this evaluation form.

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* 1. Personal Information

Name

Email Address

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* 2. Changes to the Medical-Legal Fee Schedule

	Poor	Fair	Satisfactory	Good	Excellent
George Parisotto, AD, DWC	George Parisotto, AD, DWC Poor	George Parisotto, AD, DWC Fair	George Parisotto, AD, DWC Satisfactory	George Parisotto, AD, DWC Good	George Parisotto, AD, DWC Excellent
Basil Besh, M.D.	Basil Besh, M.D. Poor	Basil Besh, M.D. Fair	Basil Besh, M.D. Satisfactory	Basil Besh, M.D. Good	Basil Besh, M.D. Excellent
Michael Klassen, M.D.	Michael Klassen, M.D. Poor	Michael Klassen, M.D. Fair	Michael Klassen, M.D. Satisfactory	Michael Klassen, M.D. Good	Michael Klassen, M.D. Excellent

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* 3. Telehealth MSK Evaluations

	Poor	Fair	Satisfactory	Good	Excellent
Peter Mandell, M.D., Moderator	Peter Mandell, M.D., Moderator Poor	Peter Mandell, M.D., Moderator Fair	Peter Mandell, M.D., Moderator Satisfactory	Peter Mandell, M.D., Moderator Good	Peter Mandell, M.D., Moderator Excellent
Edward Laskowski, M.D.	Edward Laskowski, M.D. Poor	Edward Laskowski, M.D. Fair	Edward Laskowski, M.D. Satisfactory	Edward Laskowski, M.D. Good	Edward Laskowski, M.D. Excellent
Judge Robert Rassp	Judge Robert Rassp Poor	Judge Robert Rassp Fair	Judge Robert Rassp Satisfactory	Judge Robert Rassp Good	Judge Robert Rassp Excellent
Bill Zachry	Bill Zachry Poor	Bill Zachry Fair	Bill Zachry Satisfactory	Bill Zachry Good	Bill Zachry Excellent

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* 4. On-Demand Sessions
Improving the Quality of Reports

	Poor	Fair	Satisfactory	Good	Excellent
Judge Robert Rassp	Judge Robert Rassp Poor	Judge Robert Rassp Fair	Judge Robert Rassp Satisfactory	Judge Robert Rassp Good	Judge Robert Rassp Excellent

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* 5. New Case Laws and How and When to Apply to your Evaluations

	Poor	Fair	Satisfactory	Good	Excellent
Paul Wakim, DO - Moderator	Paul Wakim, DO - Moderator Poor	Paul Wakim, DO - Moderator Fair	Paul Wakim, DO - Moderator Satisfactory	Paul Wakim, DO - Moderator Good	Paul Wakim, DO - Moderator Excellent
Charles Rondeau, Esq.	Charles Rondeau, Esq. Poor	Charles Rondeau, Esq. Fair	Charles Rondeau, Esq. Satisfactory	Charles Rondeau, Esq. Good	Charles Rondeau, Esq. Excellent
Michael McConville, Esq.	Michael McConville, Esq. Poor	Michael McConville, Esq. Fair	Michael McConville, Esq. Satisfactory	Michael McConville, Esq. Good	Michael McConville, Esq. Excellent

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* 6. Do Impairments Overlap

	Poor	Fair	Satisfactory	Good	Excellent
Peter Mandell, M.D. - Moderator	Peter Mandell, M.D. - Moderator Poor	Peter Mandell, M.D. - Moderator Fair	Peter Mandell, M.D. - Moderator Satisfactory	Peter Mandell, M.D. - Moderator Good	Peter Mandell, M.D. - Moderator Excellent
Richard Levy, M.D.	Richard Levy, M.D. Poor	Richard Levy, M.D. Fair	Richard Levy, M.D. Satisfactory	Richard Levy, M.D. Good	Richard Levy, M.D. Excellent
Steven Feinberg, M.D.	Steven Feinberg, M.D. Poor	Steven Feinberg, M.D. Fair	Steven Feinberg, M.D. Satisfactory	Steven Feinberg, M.D. Good	Steven Feinberg, M.D. Excellent

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* 7. Musculoskeletal Impairments and Adverse Childhood Experiences (ACEs)

	Poor	Fair	Satisfactory	Good	Excellent
Christine Thang, M.D.	Christine Thang, M.D. Poor	Christine Thang, M.D. Fair	Christine Thang, M.D. Satisfactory	Christine Thang, M.D. Good	Christine Thang, M.D. Excellent

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* 8. Coding/Billing New Medical-Legal Fee Schedule

	Poor	Fair	Satisfactory	Good	Excellent
Sarah Moray	Sarah Moray Poor	Sarah Moray Fair	Sarah Moray Satisfactory	Sarah Moray Good	Sarah Moray Excellent

Educational merit:

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* 9. Please rate the extent of your knowledge of the subject matter covered before and after this meeting;

	No knowledge	Fair	Satisfactory	Good	Expert
Before the meeting	Before the meeting No knowledge	Before the meeting Fair	Before the meeting Satisfactory	Before the meeting Good	Before the meeting Expert
After the meeting	After the meeting No knowledge	After the meeting Fair	After the meeting Satisfactory	After the meeting Good	After the meeting Expert
To what extent do you think you will be able to apply the information from this meeting in your practice?	To what extent do you think you will be able to apply the information from this meeting in your practice? No knowledge	To what extent do you think you will be able to apply the information from this meeting in your practice? Fair	To what extent do you think you will be able to apply the information from this meeting in your practice? Satisfactory	To what extent do you think you will be able to apply the information from this meeting in your practice? Good	To what extent do you think you will be able to apply the information from this meeting in your practice? Expert

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* 10. What barriers do you see to implementing changes that you learned about during the presentations today: