Monthly CPPCC Data Collection Survey

It is important that the person completing the clinic hours and pharmacist hours has accurate information to submit. This will be used for stipend payments and corrections will not be able to be made until the following month, should the info be inaccurate.

The survey is to be completed on the first Monday of each calendar month. If your survey is completed after the 5th day of the month, we will not be able to process your stipend payment until the following month. Please ensure all team members are trained and able to do submit the survey and upload the required report if usual team members are on vacation.

1.CPPCC Pharmacy Name(Required.)

2.Reporting Month(Required.)

3.How many hours is your clinic allocated/approved to be open per week?
For example: are you approved for 16 hours/week, 20, 24, 32, 40, 48, 60?(Required.)

4.How many hours were you open for appointments this month ?
Do not include lunch. If two pharmacists had patient appointments at the same time in different rooms, add the hours for the second pharmacist. Ex: If one pharmacist saw patients for 7.5 hours and another pharmacist saw patients for 4 hours, total = 11.5 hours for that day(Required.)

5.How many pharmacist administrative hours were used this month? These are hours outside of appointment times. However, do not include no shows or patients triaged out during the appointment.
For example, if you came in early/stayed late/booked off 30 minutes to review labs or finish documenting.(Required.)

6.How many hours was the clinic open in the evening (after 4pm) or on a weekend over the month?(Required.)

7.How many appointment minutes were available that were NOT booked?
For example, 2 x 15 minute blocks = 30 minutes available but not booked(Required.)

8.How many appointment minutes were NO SHOWS?
For example, 1 no show for an AMR, 2 minor ailments = 60+15+15 = 90 minutes(Required.)

9.How many appointment minutes were triaged out before the appointment? (estimate the number of minutes it would have been booked for)
For example, 2 strep appointments and 1 AMR (triaged out because patient wasn't eligible for the service) = 15+15+60 = 90 minutes(Required.)

10.How many appointment minutes were triaged out during the appointment?
For example, patient is booked for a UTI assessment but when they arrive you determine they have red flags = 15 minutes(Required.)

11.# of appointments that were no shows for appointments booked directly by 811?
Include only those for which you received a fax directly from 811(Required.)

12.# of appointments referred out that were booked by 811?
For example, if 811 booked in a UTI apt for a male or a strep assessment for a child who is <2 years old which was noticed and triaged out before appointment = 15 + 15 = 30min)(Required.)

13.# of appointments for attached patients?(Required.)

14.# of appointments for unattached patients?(Required.)

15.# of appointments released same day / next day.(Required.)

16.Number of appointments that were booked directly by 811?
You would receive a fax from 811 if they booked it.(Required.)

17.# of appointments COMPELETED for patients booked by 811?(Required.)