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Assisted Living Medical Service Survey
1.
What is your state of practice?
2.
What is your professional licensing?
Physician
Nurse Practitioner
Physician Assistant
3.
Do you provide medical care to residents of assisted living communities on-site?
Yes - Proceed to question #4
No - Proceed to question #7
4.
What is the number of assisted living communities where you provide on-site medical care?
5.
Can the assisted living staff assist in telemedicine visits with residents?
Yes
No
6.
Please indicate which of the following duties that are performed by the assisted living staff in preparation for your visits (select all that apply):
Patients brought to central area for visit
Vital signs performed
Weight log provided
Medication administration record prepared
State forms prepared
Other (please specify)
7.
Number of assisted living communities where you serve as a Medical Director (if 0, please proceed to #11)
8.
If you answered yes to the question above, do you have a formal contract with the Assisted Living Community?
Yes
No
9.
How many times a month do you meet with the Assisted Living Administration in your role as Medical Director?
Every day
A few times a week
About once a week
A few times a month
Once a month
Less than once a month
10.
What is the average number of hours per month you dedicate to Medical Direction for each Assisted Living community that you work with?:
11.
Please indicate which of the following administrative duties you perform in Assisted Living (select all that apply):
Attend Quality Assurance review meetings
Data collection/analysis of accidents/incidents
Chart review
Staff training/in-services
Policy/procedure oversight and review to ensure compliance with state and federal regulations
Lab director role
On-call consultation for acute issues
Assist in development of emergency treatment procedures for residents
Review challenging resident issues
Review admissions or discharges from facility
Serve as medical representative for the facility
Infection control oversight
Interface with health care systems like hospitals and skilled nursing facilities
Communication with residents’ primary care providers
Communication with the Department of Health
Medication management/review
Immunization management
No Administrative Duties
Other (please specify)
