Follow Up Certification Survey Form Thank you for taking the time to participate in this survey. Feedback is an important part of ensuring the continuing quality of our certification program. Please be as specific as you can when leaving comments so we can better implement changes based on your comments and suggestions. 1. Which of the following reflect your current job responsibilities? (select all that apply)*CommunityHospitalAcademiaRegulatoryShort-and long-term CareHome Health CareMail ServicePBM / HMO 2. Which of the following categories best describes your employment status?*Employed, working 40 or more hours per weekEmployed, working 1-39 hours per weekNot employed, looking for workNot employed, NOT looking for work 3. Do you provide Medication Therapy Management or Care Management to patients via telephone or other telehealth technologies (such as video conference).YesNo 4. How would you rate your overall experience using the application portal?*Very positivePositiveNeutralNegativeVery negative 5. Do you have any other comments about how we can improve our board certification program?* 6. Do you speak more than one language?*YesNoSelect your second language*AbkhazAdygheAfrikaansAkanAlbanianAmerican Sign LanguageAmharicArabicAragoneseAramaicArmenianAssameseAymaraBalineseBasqueBetawiBosnianBretonBulgarianCantoneseCatalanCherokeeChickasawChineseCopticCornishCorsicanCrimean TatarCroatianCzechDanishDutchDawroEsperantoEstonianEweFiji HindiFilipinoFinnishFrenchGalicianGeorgianGermanGreekAncient GreekGreenlandicHaitian CreoleHawaiianHebrewHindiHungarianIcelandicIndonesianInuktitutInterlinguaIrishItalianJapaneseJavaneseKabardianKalashaKannadaKashubianKhmerKinyarwandaKoreanKurdish/KurdîLadinLatgalianLatinLingalaLivonianLojbanLower SorbianLow GermanMacedonianMalayMalayalamMandarinManxMaoriMauritian CreoleMiddle EnglishMiddle Low GermanMin NanMongolianNorwegianOld ArmenianOld EnglishOld FrenchOld JavaneseOld NorseOld PrussianOriyaPangasinanPapiamentuPashtoPersianPitjantjatjaraPolishPortugueseProto-SlavicQuenyaRajasthaniRapa NuiRomanianRussianSanskritScotsScottish GaelicSemaiSerbianSerbo-CroatianSlovakSloveneSpanishSinhaleseSwahiliSwedishTagalogTajikTamilTarantinoTeluguThaiTok PisinTurkishTwiUkrainianUpper SorbianUrduUyghurUzbekVenetianVietnameseVilamovianVolapükVõroWelshXhosaYiddishZazakiZulu 7. How do you measure the impact of MTM certification?*UnsignificantSomewhat significantSignificantVery SignificantProvides a respected credential that can be incorporated into your career ladder and professional enhancementLeads to increased earning potentialEnhances your confidence and validates your expertise and clinical decision-makingGives priority to job applicants in hiring certified pharmacistsLeads to positive impact in clinical outcomes (i.e. patient outcomes and patient satisfaction)Allows opportunity to manage patients with more complex conditions 8. How do you rate your knowledge and skills needed to successfully fulfill your job?*Strongly disagreeDisagreeNeutralAgreeStrongly agreeProviding clinical recommendations pertaining to gaps in care, high risk medications, compliance and adherence, and drug interactions.Keeping current with new and emerging evidence-based medicine and therapeutic recommendations.Utilizing clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review.Maintaining proper documentation of MTM activities.Possessing knowledge of clinical standards of care, preventive health, Stars and HEDIS measuresDisplaying sensitive, empathetic, and effective communication with patients. This iframe contains the logic required to handle Ajax powered Gravity Forms.
