Clinical Site Evaluation

Clinical Site Evaluation

Answer questions as they relate to you. For most answers, check the boxes most applicable to you or fill in the blanks.

survey questions

1.	Uintah Care Center

	Excellent
	Good
	Poor-Please explain in the space below

2.	Uintah Care Center-Please Explain

3.	Uintah Basin Care and Rehab

	Excellent
	Good
	Poor-Please explain in the space below

4.	Uintah Basin Care and Rehab-Please Explain

5.

Applegate

	Excellent
	Good
	Poor-Please explain in the space below

6.	Applegate-Please Explain

7.

UBMC-PT

	Excellent
	Good
	Poor-Please explain in the space below

8.	UBMC-PT-Please Explain

9.

Dialysis

	Excellent
	Good
	Poor-Please explain in the space below

10.	Dialysis-Please Explain

11.

UBMC-RT

	Excellent
	Good
	Poor-Please explain in the space below

12.	UBMC-RT-Please Explain

13.

UBMC-LAB

	Excellent
	Good
	Poor-Please explain in the space below

14.	UBMC-LAB- Please Explain

15.	UBMC-X-RAY

	Excellent
	Good
	Poor-Please explain in the space below

16.	UBMC-X-RAY-Please Explain

17.

AVMC-PT

	Excellent
	Good
	Poor-Please explain in the space below

18.	AVMC-PT-Please Explain

19.

AVMC-RT

	Excellent
	Good
	Poor-Please explain in the space below

20.	AVMC-RT-Please Explain

21.

AVMC-LAB

	Excellent
	Good
	Poor-Please explain in the space below

22.	AVMC-LAB-Please Explain

23.	AVMC-X-RAY

	Excellent
	Good
	Poor-Please explain in the space below

24.	AVMC-X-RAY-Please Explain

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