Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Virtual Visit Checklist- Clinicians (DHMG -Sierra Nevada) Question Title * 1. Contact Information Clinician full name OK Question Title * 2. Prior to or during the video visit, does your MA/Clinical staff perform any of the following? Always Usually Sometimes Never Chart prep (obtain specialist notes, diagnostic and laboratory studies, etc) Chart prep (obtain specialist notes, diagnostic and laboratory studies, etc) Always Chart prep (obtain specialist notes, diagnostic and laboratory studies, etc) Usually Chart prep (obtain specialist notes, diagnostic and laboratory studies, etc) Sometimes Chart prep (obtain specialist notes, diagnostic and laboratory studies, etc) Never "Room" the patient in the virtual visit room, get vitals, update medications & allergies "Room" the patient in the virtual visit room, get vitals, update medications & allergies Always "Room" the patient in the virtual visit room, get vitals, update medications & allergies Usually "Room" the patient in the virtual visit room, get vitals, update medications & allergies Sometimes "Room" the patient in the virtual visit room, get vitals, update medications & allergies Never Comments: OK Question Title * 3. Does your MA/clinical staff have adequate time to complete question 2 (chart prep and virtual rooming)? No time at all Adequate time Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 4. In regards to Virtual visits, has your MA/clinical staff been trained on the newer check in process? Yes No OK Question Title * 5. Does your MA/clinical staff have a camera and a computer headset to check the patient in to the video visit? Yes No OK Question Title * 6. Does your MA/clinical staff perform a full audio & video check and put the patient in the virtual waiting room? Always Usually Sometimes Never Always Usually Sometimes Never OK Question Title * 7. While scheduling the video visit, is your contact information masked/privacy protected? (i.e. When sending the video invite, is your email/phone number masked?) Yes No Not sure Other (please specify) OK Question Title * 8. What platform are you using to perform virtual visits? Zoom FaceTime DOXY.me DOXIMITY Primary Choice (Please select one) Primary Choice (Please select one) Zoom Primary Choice (Please select one) FaceTime Primary Choice (Please select one) DOXY.me Primary Choice (Please select one) DOXIMITY Secondary Choice (Check all that apply) Secondary Choice (Check all that apply) Zoom Secondary Choice (Check all that apply) FaceTime Secondary Choice (Check all that apply) DOXY.me Secondary Choice (Check all that apply) DOXIMITY Other (please specify) OK Question Title * 9. Please answer the following: Yes No Is your e-mail exposed when an appointment is made by you or the clinic staff? Is your e-mail exposed when an appointment is made by you or the clinic staff? Yes Is your e-mail exposed when an appointment is made by you or the clinic staff? No Can patient self-schedule a video visit appointment? Can patient self-schedule a video visit appointment? Yes Can patient self-schedule a video visit appointment? No OK Question Title * 10. Do you offer after hours virtual visits? Yes No OK Question Title * 11. What is your virtual visit checkout/follow up process? Physician generates follow up task Patient is asked to call the office Patient routed back to MA/clinical staff in Zoom Other (please specify) OK Question Title * 12. Did you as a clinician receive adequate training and support for your virtual visits? Yes No Somewhat Other (please specify) OK Question Title * 13. Any additional comments: OK DONE