The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

3m7qrRuTfMasT9i7qA56Gs7ruwphkaUFw2TRuzX7LdvwKIzYJZQePo2oxCWi4vro4iresHitQDifsaqioiUxogBr

EBP Map Feedback Survey

Please complete the survey below if you have contacted an agency listed on the Center's EBP Map and they are no longer providing those EBP services, OR they have changed the accepted Medicaid plans.

If you have further questions please contact us at EvidencetoPractice@lsuhsc.edu.

Thank you!

What date did you contact the agency?

* must provide value

D-M-Y

Agency Name

* must provide value

Agency Street Address

Agency City

Agency State

Agency Zip Code

Agency Phone Number

What EBPs does the agency no longer offer?

Please select all that apply.

* must provide value

Child-Parent Psychotherapy (CPP)

Eye Movement Desensitization and Reprocessing (EMDR)

Functional Family Therapy (FFT)

Functional Family Therapy - Child Welfare (FFT-CW)

Homebuilders (HB)

Multi-Systemic Therapy (MST)

Nurse Family Partnership (NFP)

Parents as Teachers (PAT)

Parent-Child Interaction Therapy (PCIT)

Positive Parenting Program (Triple P)

Preschool PTSD Treatment (PPT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Youth PTSD Treatment (YPT)

What EBPs does the agency still offer?

Please select all that apply.

Child-Parent Psychotherapy (CPP)

Eye Movement Desensitization and Reprocessing (EMDR)

Functional Family Therapy (FFT)

Functional Family Therapy - Child Welfare (FFT-CW)

Homebuilders (HB)

Multi-Systemic Therapy (MST)

Nurse Family Partnership (NFP)

Parents as Teachers (PAT)

Parent-Child Interaction Therapy (PCIT)

Positive Parenting Program (Triple P)

Preschool PTSD Treatment (PPT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Youth PTSD Treatment (YPT)

10.

Did the agency indicate that they accept any additional Medicaid plans?

10a

What additional Medicaid plans did the agency indicate that they accept?

Please select all that apply.

Aetna

AmeriHealth Caritas

Healthy Blue

Humana

Louisiana Healthcare Connections

Magellan

United Healthcare

11.

Did the agency indicate that they do not accept any Medicaid plans that are listed on the Center's map?

11a.

What Medicaid plans did the agency indicate they no longer accept that are listed on the Center's map?

Please select all that apply.

Aetna

AmeriHealth Caritas

Healthy Blue

Humana

Louisiana Healthcare Connections

Magellan

United Healthcare

12.

How did you contact the agency?

Phone

Walk-in/In Person

Website

Other

reset

12a.

Please explain:

13.

Would you like to share more info about yourself (name, email, phone number)?

13a.

First Name

13b.

Last Name

13c.

Phone Number

13d.

Email Address

14.

Additional comments:

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