Ambulatory Care - Patient Stories

Thank you for taking the time to fill out this survey. It is designed how to best tell one of your patient's experiences with the pharmacist. If you would like to share more than one patient experience, please complete a new survey for each patient experience. PLEASE DO NOT INCLUDE ANY HIPAA-PROTECTED INFORMATION. If you have any questions about this survey, please first email AmbCareStories2021@gmail.com. If you do not receive a timely response, contact Larry Jones, PSHP Executive Director, pshp.execdir@pshp.org.

Question Title

* 1. You are an:

A. Outpatient Provider (e.g. Physician, Nurse Practitioner, Physician Assistant)

B. Outpatient Pharmacist - Ambulatory Care (eg. outpatient primary care office or clinic, specialty office or clinic)

C. Outpatient Pharmacist - Community "retail" Pharmacy (e.g. CVS, independent pharmacy)

D Inpatient Pharmacist (e.g. Acute Care, Discharge Medication Reconciliation)

E. Patient, family member, or caregiver

E. Other healthcare personnel [Free Text]