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FIDELITY SCALE COVER SHEET

Date:_____________

Assessor(s) ____________________________________

Program Name:

_____________________________________________________

Agency Name:______________________________________________________

Contact Person:

_____________________________________________________

Phone:

____________________________

E-mail:_____________________________

Sources Used: ______ Chart review

______

Interview with program coordinator

______

Review of program documentation

______

Observation of a session

______

Interview with family member(s)

______

Interview with clinician(s) Interview with

______ Interview with

Number of clinicians:_________________________________________________

Number of families served in preceding year:

______________________________

Date program was started:

____________________________________________

Family Psychoeducation Toolkit

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