Quality Assessment & Improvement (QA&I) Process Provider Checklist Provider Name: Provider Name Date Submitted to ODP: Date Instructions: As part of the QA&I Process, documents are to be submitted in advance of QA&I review. Please provide this page along with the documents listed to your Assigned AE QA&I Lead no later than August 31, 2017. Please be sure to include your organization name on each page of the documentation you are submitting. Document Effective Date Quality Management Plan Restrictive Intervention Policy Annual Training Plan Name of Provider QA&I Contact Person(s): Provider QA&I Contact Name(s) Name of Staff completing the checklist: Staff Name
Quality Assessment & Improvement (QA&I) Process Provider Checklist Provider Name: Provider Name Date Submitted to ODP: Date Instructions: As part of the QA&I Process, documents are to be submitted in advance of QA&I review. Please provide this page along with the documents listed to your Assigned AE QA&I Lead no later than August 31, 2017. Please be sure to include your organization name on each page of the documentation you are submitting. Document Effective Date Quality Management Plan Restrictive Intervention Policy Annual Training Plan Name of Provider QA&I Contact Person(s): Provider QA&I Contact Name(s) Name of Staff completing the checklist: Staff Name
Provider+Submission+Checklist+07+10+17.docx