CGCAHPS Validation Form
Validator
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Aamer Ahmed
Allie Cabreza
Amy Kenny, MD
Angela Dement
Barbara Slawski, MD
Bob Havlick, MD
Carolyn Bellin
Chad Carlson, MD
Charles Harkins, MD
Chris Johnson, MD
Dale Heuer, MD
Dave DeDianous
David Del Toro, MD
Deborah Whitfield
Diane Book, MD
Erika Peterson, MD
Estil Strawn, MD
Gary Seabrook, MD
Gilbert Fareau, MD
Gunjan Srivastava
Hariprasad Trivedi, MD
Irina Konon, MD
Janet Rader, MD
Jennifer Oium
Jim Slawson, MD
John Charlson, MD
Johnny Hong, MD
Jon Gould, MD
Julie Mitchell, MD
Karen Brasel, MD
Kay Kastner
Kristi Castello
Malika Siker, MD
Marjorie Wang, MD
MaryBeth Grahm, MD
Michelle Noid
Michelle Shasha PhD
Mona Yashinsky
Morgan Meier
Nanjappareddy Reddy, MD
Paul Knechteges, MD
Paula Termuhlen, MD
Raj Rao, MD
Raul Nanchal, MD
Sam Hwang, MD
Santo Tomas, MD
Seema Menon, MD
Shannon Hersey MD
Stacey Gardiner MD
Steve Alper
Steven Denson, MD
William Waring, MD
Young Oh, MD
Other
Provider Name
Department
Please Select
Anesthesiology
Clinical Affairs
Clinical Ventures Group
Dermatology
Emergency Medicine
Family Medicine
Medicine
Neurology
Neurosurgery
Obstetrics and Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pathology
Physical Medicine and Rehabilitation
Plastic Surgery
Primary Care Initiative
Psychiatry
Radiology
Surgery
Urologic Surgery
Provider listened carefully to the patient.
Did not interrupt patient
Showed eye contact
Sat down facing patient
Leaned forward when sitting
Made patient aware if need to notate on PC
Other
Comments:
Provider showed respect for what patient had to say.
Did not interrupt patient
Verbally acknowledged concerns
Appropriate tone/ body language
Displayed empathy
Other
Comments:
Provider seemed to know the important information about the patient's medical history
Med history collected prior
Med history analyzed prior
Shared monitor
Asked for additional important info
Other
Comments:
Provider explained things in a way that was easy to understand
Avoided complex jargon
Simplified explanation
Used visuals or comparisons
Welcomed/ solicited questions
Other
Comments:
Provider gave patient easy to understand information about health questions or concerns.
Used diagrams/visuals
Referenced studied
Introduced AVS
Provided handouts
Other
Comments:
Provider spent enough time with patient.
Visit did not appear rushed
Actual Provider time was more than half of scheduled time
Patient concerns were addressed
Allowed family to ask questions (if applicable)
Other
Comments
Areas to focus on
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