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Pharmacy Services Survey
1.
Pharmacy name
2.
Pharmacy Address
3.
Pharmacy Phone number
4.
Pharmacy Email Address (For WSPA Use Only)
5.
Pharmacy Website
6.
Preventative Screening and Services you provide
Blood pressure kiosk
Immunizations
Emergency Contraception Counseling
Sexually Transmitted Disease Screening
Tobacco Cessation Service
If you vaccinate, what is your minimum patient age, if any?
7.
Pharmacist Prescribing for:
Anticoagulation
Clinical community pharmacist/acute conditions
Hormonal Contraception
Depression
Diabetes
Emergency contraception
HIV pre-exposure prophylaxis
Hypercholesterolemia/hypertension
Influenza treatment with antivirals
Naloxone for home use
Strep throat treatment
Travel Consults
8.
Point-of-Care Testing
Blood glucose
Blood pressure tests by pharmacist
Bone mineral density
Hemoglobin A1c
Hepatitis C virus
HIV
Influenza
Lipids
Group-A-Streptococcus (Strep Throat)
Tuberculin Skin Testing
9.
Pharmacy Services
Compounding: Non-sterile
Compounding: Sterile
Diabetes prevention program
Diabetes self-management courses
Drive-through
Medication reviews
Long-acting anti-psychotic administration
Medical device fittings
Medication compliance packaging (for general public)
Medication delivery services (routinely, not just during COVID-19)
Medication reviews: Outcomes
Medication reviews: Appointment based (non-outcomes)
Medication synchronization
Naltrexone administration
Secure medication services
Specialty medication services
Veterinary medication services
Other (please specify)
10.
Provider Status
We are billing medical insurance for pharmacist provided care
We are applying for credentials and a contract with medical plans
Not yet billing or applying, but we hope to work on this in the next year
Not yet billing, no plans to
11.
Other services and prescribing provided in your pharmacy:
Current Progress,
0 of 11 answered