The purpose of this survey is to collect information about ambulatory care pharmacists in the state of Washington and to create a directory. This information will be accessible to the WSPA Ambulatory Care Academy members and will create opportunity to learn about what other institutions are doing. This will update all previous versions. Please reach out to mylinh@wsparx.org if you have any questions.

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* 1. Answering survey as

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* 2. Have you taken this survey before?

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* 3. Name

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* 4. Email

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* 5. Name of organization and city

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* 6. Federally qualified health center?

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* 7. Pharmacy director (or chief pharmacy operator)

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* 8. Pharmacy director email (or chief pharmacy operator)

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* 9. Ambulatory pharmacy manager/lead

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* 10. Ambulatory pharmacy manager/lead email

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* 11. What specialty do you primarily work in? (select all that apply)

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* 12. Disease states managed/services provided by you (individual pharmacist) or pharmacists you manage (clinical manager) (select all that apply)

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* 13. Delivery of care platform (select all that apply; if select, please check the box on the right to indicate if billing for service)

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* 14. Billing (select all that apply)

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* 15. If you bill for professional fees, what is the majority of the billing?

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* 16. Type of electronic health record? (i.e. Epic, Cerner)

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* 17. Support staff (please choose which service they are assisting with)

  Rooming Scheduling Taking vitals Collecting medication history PA assistance
Medical assistant
Pharmacy technicians
Other (please specify in the comment section below)

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* 18. Does your system have a pharmacist run refill authorization center?

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* 19. Do you/ your pharmacists perform MTM visits? (Med reviews, med list updates, Outcomes MTM, etc)

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* 20. Do you accept referrals from providers outside of your clinic or healthcare system?

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* 21. Does your clinic/health system have a Chronic Disease Self Management Education or Diabetes Self Management Education Service?

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* 22. Do you participate or support payor sponsored care gap closure or quality incentive programs?

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* 23. Questions for clinical managers only; individual pharmacists can skip

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* 24. Do you consent to have your contact information posted on the WSPA ambulatory care directory?

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* 25. Can other pharmacists contact you to learn about how to expand services that you currently offer?

Thank you for your contribution!

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