Free Compliance Assessment

Name:

Email:

Phone:

Preferred Contact Method?

	Telephone
	Email

Do you have a written compliance program?

Do you have a compliance officer?

Do you conduct routine compliance training?

	Yes
	No

Do your employees know how to report compliance violations?

Do you have an open-door policy to safely report violations?

Do you conduct routine audits of your documentation?

Do you review and update your compliance manual on a regular basis?

Do you have a fair and consistent discipline policy for compliance violations?

	Yes
	No

Do you take timely corrective actions when violations occur?

	Yes
	No

Do you need help implementing a compliance program?

	Yes
	No

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Gold Star Medical Business Services
105 Burr Oak,
Horseshoe Bay, Texas 78657
Tel: (866) 942-5655