Evaluation Form And Acknowledgement Of Training

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EVALUATION FORM AND ACKNOWLEDGEMENT OF TRAINING
The Iowa Medicaid Enterprise (IME) would like to thank you for viewing the CDAC Documentation
Training DVD.
Please take a few moments to complete this evaluation form. Let us know what you thought of the
information presented, the level of your understanding after you have viewed the DVD, and any
suggestions for future trainings. Your feedback is vital to our ongoing training objectives at the IME.
Please circle the number that most closely represents your opinion for each category using the
following rating scale: 5 = Excellent, 4 = Above Average, 3 = Average, 2 = Poor, 1 = Very Poor.
Training Topic CDAC Documentation Forms
1. How useful do you think the CDAC Documentation Training DVD is in learning to document your
daily services?
Excellent
Above Average
Average
Poor
Very Poor
5
4
3
2
1
2. Rate your level of understanding on how to complete the Daily Service Record after viewing the
DVD.
Excellent
Above Average
Average
Poor
Very Poor
5
4
3
2
1
3. How satisfied are you with receiving a training DVD as opposed to other forms of training offered by
the IME?
Excellent
Above Average
Average
Poor
Very Poor
5
4
3
2
1
4. How comfortable are you with your understanding of how the CDAC Agreement, Daily Service
Record, and the Claim for Targeted Medical Care are related?
Excellent
Above Average
Average
Poor
Very Poor
5
4
3
2
1
5. Please rate the overall effectiveness of the skills of the presenters in the DVD
Excellent
Above Average
Average
Poor
Very Poor
Content
5
4
3
2
1
Delivery
5
4
3
2
1
Confidence
5
4
3
2
1
Attitude
5
4
3
2
1
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