COVID-19 Member Needs Survey January 2021

Question Title

1. Which of the following best describes your primary practice setting? Check all that apply.

Independent Practice (Solo)

Independent Practice (2 to 5 physicians/providers)

Independent Practice (more than 5 physicians/providers)

FQHC

I am an employee of a hospital

I am an employee of an academic-affiliated institution

I am an employee of an organization-affiliated institution

I am retired

I am not in clinical practice

Other (please specify)

Question Title

2. Have you personally tested positive for COVID-19 (or had a positive test for COVID antibodies) anytime since February 2020?

Yes

Question Title

3. If you have been diagnosed with COVID-19, were you hospitalized?

Yes

Not Applicable

Comments

Question Title

4. Have you presently received at least one dose of the COVID-19 vaccine?

Yes

Comments

Question Title

5. If you have not yet had the vaccine, do you plan to get it?

Yes

Not Applicable

Comments

Question Title

6. If applicable, how far did you have to travel from your facility/clinic to receive the vaccine?

I had the vaccine locally

I had to travel LESS than 1 hour each way for the vaccine

I had to travel MORE than 1 hour each way for the vaccine

Not Applicable

Comments

Question Title

7. Have you or your facility already signed up with the MS State Department of Health to administer the COVID-19 vaccine?

Yes

Question Title

8. Does your practice, group or employer CURRENTLY have in place any of the following? Select all that apply.

layoffs/furloughs

reduced salaries

reduced hours

forced unpaid leave

CME budget has been decreased

Comments:

Question Title

9. What is the current financial status of your practice?

serious cash flow issues and looking for assistance

times are tough, but we are sustainable for now

our head is still above water

we are on solid ground financially

not applicable or unsure

Comments

Question Title

10. This past year, did you receive Paycheck Protection Program funds/grants that helped you make it through the year financially?

Yes

Comments:

Question Title

11. If applicable, what is your current percentage of Telehealth (video) visits?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

12. Have you faced any of the following challenges in your practice during the COVID-19 pandemic? Check all that apply.

Lack of access to Remdesivir

Lack of access to ventilators

Lack of access to BAM infusions

Lack of access to hospital beds/ICU beds

Difficulty Accessing COVID-19 Vaccine - FOR HEALTH CARE WORKERS

Difficulty triaging patients/Rationing of care

OTHER CHALLENGE(S) -- please describe

COVID-19 Member Needs Survey January 2021

Question Title

1. Which of the following best describes your primary practice setting? Check all that apply.

Question Title

2. Have you personally tested positive for COVID-19 (or had a positive test for COVID antibodies) anytime since February 2020?

Question Title

3. If you have been diagnosed with COVID-19, were you hospitalized?

Question Title

4. Have you presently received at least one dose of the COVID-19 vaccine?

Question Title

5. If you have not yet had the vaccine, do you plan to get it?

Question Title

6. If applicable, how far did you have to travel from your facility/clinic to receive the vaccine?

Question Title

7. Have you or your facility already signed up with the MS State Department of Health to administer the COVID-19 vaccine?

Question Title

8. Does your practice, group or employer CURRENTLY have in place any of the following? Select all that apply.

Question Title

9. What is the current financial status of your practice?

Question Title

10. This past year, did you receive Paycheck Protection Program funds/grants that helped you make it through the year financially?

Question Title

11. If applicable, what is your current percentage of Telehealth (video) visits?

Question Title

12. Have you faced any of the following challenges in your practice during the COVID-19 pandemic? Check all that apply.

Question Title

13. Do you have any suggestions for the Mississippi State Department of Health regarding the distribution of the COVID-19 vaccine?

Question Title

14. Is there anything else you'd like to share with MAFP about your current situation?

COVID-19 Member Needs Survey January 2021

Question Title

* 1. Which of the following best describes your primary practice setting? Check all that apply.

Question Title

* 2. Have you personally tested positive for COVID-19 (or had a positive test for COVID antibodies) anytime since February 2020?

Question Title

* 3. If you have been diagnosed with COVID-19, were you hospitalized?

Question Title

* 4. Have you presently received at least one dose of the COVID-19 vaccine?

Question Title

* 5. If you have not yet had the vaccine, do you plan to get it?

Question Title

* 6. If applicable, how far did you have to travel from your facility/clinic to receive the vaccine?

Question Title

* 7. Have you or your facility already signed up with the MS State Department of Health to administer the COVID-19 vaccine?

Question Title

* 8. Does your practice, group or employer CURRENTLY have in place any of the following? Select all that apply.

Question Title

* 9. What is the current financial status of your practice?

Question Title

* 10. This past year, did you receive Paycheck Protection Program funds/grants that helped you make it through the year financially?

Question Title

* 11. If applicable, what is your current percentage of Telehealth (video) visits?

Question Title

* 12. Have you faced any of the following challenges in your practice during the COVID-19 pandemic? Check all that apply.

Question Title

* 13. Do you have any suggestions for the Mississippi State Department of Health regarding the distribution of the COVID-19 vaccine?

Question Title

* 14. Is there anything else you'd like to share with MAFP about your current situation?

1. Which of the following best describes your primary practice setting? Check all that apply.

2. Have you personally tested positive for COVID-19 (or had a positive test for COVID antibodies) anytime since February 2020?

3. If you have been diagnosed with COVID-19, were you hospitalized?

4. Have you presently received at least one dose of the COVID-19 vaccine?

5. If you have not yet had the vaccine, do you plan to get it?

6. If applicable, how far did you have to travel from your facility/clinic to receive the vaccine?

7. Have you or your facility already signed up with the MS State Department of Health to administer the COVID-19 vaccine?

8. Does your practice, group or employer CURRENTLY have in place any of the following? Select all that apply.

9. What is the current financial status of your practice?

10. This past year, did you receive Paycheck Protection Program funds/grants that helped you make it through the year financially?

11. If applicable, what is your current percentage of Telehealth (video) visits?

12. Have you faced any of the following challenges in your practice during the COVID-19 pandemic? Check all that apply.

13. Do you have any suggestions for the Mississippi State Department of Health regarding the distribution of the COVID-19 vaccine?

14. Is there anything else you'd like to share with MAFP about your current situation?