Physician Satisfaction. Summarize your Facility's Physician Satisfaction Reports and submit a copy of your Physician Satisfaction Questionnaire. SCHEDULE G (Continued) Complication Rates (including nosocomial infections and major surgical complications): Please provide the following: Intraoperatively Postoperatively Procedure Type Procedure Type Change of Ownership or Control Has there been any change of ownership or control of your Facility since the Service Agreement with the Calgary Health Region was originally signed? Yes No Preventative Maintenance of Equipment The signature below will confirm that the equipment involved in the delivery of Services under the Service Agreement with the Calgary Health Region has been maintained, as per manufacturer specifications and guidelines, and that your Facility would be willing to have Calgary Health Region audit your records in this area. Date: Signature:
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