Focus Group Incentive (Fgi) Evaluation Form
Download a blank fillable Focus Group Incentive (Fgi) Evaluation Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Focus Group Incentive (Fgi) Evaluation Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3FOCUS GROUP INCENTIVE (FGI) EVALUATION FORM
Focus Group Incentive (FGI) Evaluations are required for all focus groups that offer
incentives. Evaluations are due 60 days after the last focus group was conducted.
Complete this form and email it to
MMCDHealthEducationMailbox@dhcs.ca.gov
and
cc your Contract Manager.
All FGI evaluations must be reviewed by the Managed Care Plan’s (MCP’s) qualified
health educator.
Email subject line must include: MCP name, purpose of focus group, FGI Evaluation
(e.g. HealthPlan_Member Satisfaction_FGI Evaluation). Include your originally
approved FGI request form with the email. For more information, see All Plan Letter 16
005.
A. Managed Care Plan:
B. Submission Date:
C. Contact Person:
a. Email:
b. Phone:
D. Qualified Health Educator:
E. Staff responsible for incentive program (if different from Contact Person):
a. Email:
b. Phone:
F. Is form being submitted on behalf of a subcontracting MCP? If yes, provide name of
MCP:
______________________________________________________________________
DHCS / Managed Care Quality and Monitoring Division
Focus Group Incentive Evaluation Form 3/7/2016
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business