Provider Telehealth Survey

Technology-related Items

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* 1. Please provide your first and last name.

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* 2. What is your email address?

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* 3. What is the name of your organization?

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* 4. Please indicate for which specific services your agency has implemented Telehealth. Please select all that apply.

MHOP Individual Therapy

MHOP Group Therapy

MHOP Medication Visit

MHOP Partial Hospital

MHOP Assertive Community Treatment (ACT)

Outpatient D&A Individual Therapy

Outpatient D&A Group Therapy

Outpatient D&A Medication Assisted Treatment

MH Case Management

Psychiatric Rehabilitation Individual Services

Psychiatric Rehabilitation Group Services

Adult Residential Treatment

Children’s Residential Treatment (PRTF, RTF)

Psychiatric Inpatient Treatment

Family-Based Mental Health Services

Intensive Behavioral Health Services (IBHS)/ Behavioral Health Rehabilitation Services (BHRS)

Peer Support Services Certified Peer Support Specialists

Peer Support Services Certified Recovery Specialist Services

Other (please specify)

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* 5. What specific equipment is being predominately utilized by direct care staff of your organization to facilitate Telehealth (e.g. agency laptop computers, cell phone, etc.)

Company-issued laptop

Personal laptop

Company-issued desktop computer

Personal desktop computer

Company-issued tablet

Personal tablet

Company-issued cell phone

Personal cell phone

Company landline

Personal landline

Other (please specify):

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* 6. What Telehealth platform is being utilized by your organization to offer Telehealth?

Zoom for Healthcare

Skype

Doxy

GoToMeeting

thera-LINK

FaceTime

VSee

Other (please specify):

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* 7. Is this Telehealth platform HIPAA-compliant?

Yes

Not sure

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* 8. Has your organization implemented an Electronic Health Record (EHR)?

Yes