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DQA Post Survey Questionnaire - F-62579 (02/2017)

Thank you for completing the DQA Post Survey Questionnaire. Your comments and responses to the questions will be used to evaluate and review the survey system and to improve the quality of the survey process.

Data provided in your response to the questionnaire will not influence state licensure or certification status. The identity of the provider/supplier and survey staff will remain anonymous throughout the analysis and interpretation of the data. Although every effort will be made to maintain anonymity, be aware that the DQA Post Survey Questionnaire responses are subject to disclosure under the Wisconsin Open Records Law.

We ask that each provider complete only one questionnaire per survey event.
5. DQA Region
This question requires a valid date format of MM/DD/YYYY.
7. Type of Onsite Survey (Select all that apply)