How is COVID-19 affecting you?

As emergency physicians, residents and students, our members are on the front lines of the COVID-19 pandemic. Please tell us how COVID-19 is directly impacting you.

*The information shared here will not be distributed in any way and is intended to better assist Ohio ACEP in service to our membership and the advocacy we do on your behalf.. Your input is greatly appreciated!*

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* 1. Your information (optional):

Name

Email Address

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* 2. Describe your situation. (check all that apply)

I am an attending physician working in a practice group working in an Emergency Department.

I am an attending emergency physician employed by the hospital or health system and working in the Emergency Department

I am an emergency physician and my schedule has been disrupted

I am an emergency physician providing care via telehealth

I'm a student and my education has been disrupted

I'm a resident and my training has been disrupted

It is affecting me/my practice financially

Other (please explain)

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* 3. To get a general idea of workforce issues, are you or have you been quarantined?

Yes

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* 4. What do you need now? (select all that apply)

PPE

Information/Resources

COVID-19 Tests or Testing Resources

Financial Resources/Loans/Grants

Other (please specify)

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* 5. Do you have any additional Comments?

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* 6. Please contact me:
Be sure to include your name and e-mail address above.

Yes

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* 1. Your information (optional):

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* 2. Describe your situation. (check all that apply)

Question Title

* 3. To get a general idea of workforce issues, are you or have you been quarantined?

Question Title

* 4. What do you need now? (select all that apply)

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* 5. Do you have any additional Comments?

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* 6. Please contact me:Be sure to include your name and e-mail address above.

* 6. Please contact me:
Be sure to include your name and e-mail address above.