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Standards Feedback Form
This form is designed to collect comments or feedback on a single program standard.
If you would like to provide feedback on more than one standard,
please submit a separate form for each additional standard
.
You can download the revised program standards by clicking
here
.
First name
*
Last name
*
Email
*
Facility Name
*
Facility ID
Standard Manual Program Type
*
Please select the program standards manual(s) that apply.
Office-Based Procedural (OBP)
Office-Based Surgical (OBS)
Ambulatory Surgery Center
Oral Maxillofacial Surgery (OMS)
Pediatric Dentistry
Rural Health Clinic (RHC)
Outpatient Physical Therapy (OPT)
International
Standard ID Number
*
If you have comments on multiple standards, complete this form, then resubmit a new form for each additional standard.
Feedback is related to which of the following RUMBA category(ies):
*
Please select all that apply.
Relevance of Standard
Understandability of Standard
Measurability of Standard
Benefit of Standard
Achievability of Standard
Scoring Methodology of Standard
Other
Standards Feedback Comments
*
Please enter your comments below.
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