Healing Touch Clinical Use Survey Healthcare Providers Question Title * 1. Are you a Healthcare Professional? Physician Nurse No Other Healthcare Professional Question Title * 2. Is your primary employment in a healthcare facility? Yes No Question Title * 3. Status of your employment if employed in a healthcare facility. Full time Part time Independent contract None Other (please specify) Question Title * 4. Do you provide Healing Touch in a healthcare setting? Yes No Question Title * 5. If yes, is it provided as part of your regular job duties? Yes No Question Title * 6. Do you document/chart Healing Touch treatments on a facility's patient medical records? Yes No Question Title * 7. If you document Healing Touch sessions your records are: (check all that apply) Electronic Health Records (EHR) that are integrated into your facility system Paper Records Other (please specify) Question Title * 8. How is Healing Touch treatment initiated? Check all that apply. Physician order Nurse order Other health professional Patient request Family request Other (please specify) Question Title * 9. Who pays for the Healing Touch services. Check all that apply. Hospital Service Nursing Service Billed through Insurance HSA Reimbursement Self pay Volunteer - no pay Question Title * 10. Have you received any insurance reimbursement for Healing Touch sessions? Yes No Question Title * 11. If yes, what insurance companies have paid for providing Healing Touch? 1 2 3 4 5 6 Next
