Surveys 2013 October C CBONotes

CBONotes CBO Notes

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Exit Survey

Hey guys and girls, this is a first stab at an online note page. This program does not allow me to make a table with all open ended notes so you will find a box for each visit. Let me know if this will work. Play around with phony data, I can delete it when we start.       Who are you?   Nelson Grit   Susan Steinke   John Weir   Other         First Visit Date:       Participant Name:       Participant Address:       Waiver Agent:   A&D Home Health   AAA of Western Michigan   Area Agency on Aging 1B   Blue Water CIL   Detroit Area Agency on Aging   Disability Advocates of Kent County   Disability Connection of West Michigan DC   Disability Connections Jackson DCJ   Disability Network Lakeshore DN/L   Disability Network Mid-Michigan DN/MM   Disability Network Southwest DN/SW   Disability Network Wayne County-Detroit DN/WCD   HHS, Inc.   MORC   Northern Lakes CMH   Region 11   Region 2 Area Agency on Aging   Region 3B Area Agency on Aging   Region 9 Area Agency on Aging   Area Agency on Aging IV   Region VII Area Agency on Aging   Senior Resources   Senior Services, Inc.   Superior Alliance for Independent Living (SAIL)   The Disability Network, Flint (TDN)   The Information Center   The Senior Alliance   Tri-county Office on Aging   Valley Area Agency on Agin       Issue:       Outcome:       Date Time Notes ((include title/descriptor with names)       Date Time Notes ((include title/descriptor with names)       Date Time Notes ((include title/descriptor with names)       Date Time Notes ((include title/descriptor with names)       This will be end of the survey. if you submit you will not be able to change your answers.