Assisted Living Medical Service Survey Question Title * 1. What is your state of practice? Question Title * 2. What is your professional licensing? Physician Nurse Practitioner Physician Assistant Question Title * 3. Do you provide medical care to residents of assisted living communities on-site? Yes - Proceed to question #4 No - Proceed to question #7 Question Title * 4. What is the number of assisted living communities where you provide on-site medical care? Question Title * 5. Can the assisted living staff assist in telemedicine visits with residents? Yes No Question Title * 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) Question Title * 7. Number of assisted living communities where you serve as a Medical Director (if 0, please proceed to #11) Question Title * 8. If you answered yes to the question above, do you have a formal contract with the Assisted Living Community? Yes No Question Title * 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 Question Title * 10. What is the average number of hours per month you dedicate to Medical Direction for each Assisted Living community that you work with?: Question Title * 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) Done