Impact of COVID-19 on the Healthcare Workplace

As a practice administrator, we greatly appreciate your valuable input on the impact to your individual healthcare workplace. Your input will help to provide a better-defined landscape of the current state and needs of healthcare practices during this pandemic.

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* 1. How many patients are seen per week at your facility?

<50

51-100

101-150

151-200

200-300

300-400

>400

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* 2. How many providers currently practice at your facility?

2-3

4-5

6-7

8-9

10-11

>11

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* 3. Has your practice applied for government-funded assistance for small businesses?

Yes

Unsure

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* 4. Did your practice receive an emergency payment/deposit from CMS?

Yes

Unsure

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* 5. Estimate the quantities of PPE supplies you currently have available at your practice for staff and patients.

	<1 week	1-2 weeks	3-4 weeks	1 month	2 months	>2 months
Gloves	Gloves <1 week	Gloves 1-2 weeks	Gloves 3-4 weeks	Gloves 1 month	Gloves 2 months	Gloves >2 months
Gowns	Gowns <1 week	Gowns 1-2 weeks	Gowns 3-4 weeks	Gowns 1 month	Gowns 2 months	Gowns >2 months
Surgical Masks	Surgical Masks <1 week	Surgical Masks 1-2 weeks	Surgical Masks 3-4 weeks	Surgical Masks 1 month	Surgical Masks 2 months	Surgical Masks >2 months
N-95 Respirators	N-95 Respirators <1 week	N-95 Respirators 1-2 weeks	N-95 Respirators 3-4 weeks	N-95 Respirators 1 month	N-95 Respirators 2 months	N-95 Respirators >2 months
Hand sanitizer	Hand sanitizer <1 week	Hand sanitizer 1-2 weeks	Hand sanitizer 3-4 weeks	Hand sanitizer 1 month	Hand sanitizer 2 months	Hand sanitizer >2 months
Disinfectant/Sanitizer	Disinfectant/Sanitizer <1 week	Disinfectant/Sanitizer 1-2 weeks	Disinfectant/Sanitizer 3-4 weeks	Disinfectant/Sanitizer 1 month	Disinfectant/Sanitizer 2 months	Disinfectant/Sanitizer >2 months

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* 6. Please list current vendors for Personal Protection Equipment PPE supplies and any contact information:

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* 7. Is your practice conducting patient visits through telemedicine?

Yes

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* 8. Are you having difficulty conducting telemedicine with your office internet connectivity during the COVID-19 pandemic?

Yes

Not applicable

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* 9. What telehealth platform do you use?

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* 10. Who is your internet provider?

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* 11. Are you having difficulty with reimbursement for telemedicine visits?

Yes

Not applicable

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* 12. How much difficulty are patients reporting in accessing the internet for telemedicine visits?

None at all

Slightly difficult

Moderately difficult

Difficult

Extremely difficult

Not applicable

Impact of COVID-19 on the Healthcare Workplace

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* 1. How many patients are seen per week at your facility?

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* 2. How many providers currently practice at your facility?

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* 3. Has your practice applied for government-funded assistance for small businesses?

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* 4. Did your practice receive an emergency payment/deposit from CMS?

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* 5. Estimate the quantities of PPE supplies you currently have available at your practice for staff and patients.

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* 6. Please list current vendors for Personal Protection Equipment PPE supplies and any contact information:

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* 7. Is your practice conducting patient visits through telemedicine?

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* 8. Are you having difficulty conducting telemedicine with your office internet connectivity during the COVID-19 pandemic?

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* 9. What telehealth platform do you use?

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* 10. Who is your internet provider?

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* 11. Are you having difficulty with reimbursement for telemedicine visits?

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* 12. How much difficulty are patients reporting in accessing the internet for telemedicine visits?

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* 13. First Name:

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* 14. Last Name:

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* 15. Please enter your email to receive survey results and educational content on COVID-19:

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* 16. Practice Name:

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* 17. What is your zip code?

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* 18. What state do you practice in?