SURVEY REGARDING BRIDGING THE GAP BETWEEN PRIMARY AND SPECIALTY CARE

What is your Practice Name?

In what county is your practice located?

If more than one location, please only enter the county of your primary site

What is your role in the clinic?

CLINICIAN (MD, DO, FNP, PA)

ADMINISTRATOR

SPECIFIC ROLE

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Are there any specific challenges you face when collaborating with specialists?

Select all that apply

TIMELY ACCESS TO CARE

KNOWING WHAT THE SPECIALIST NEEDS FOR THE REFERRAL

HOW TO MANAGE THE PATIENT DURING THE WAIT TIME FOR THE REFERRAL APPOINTMENT

RECEIVING TIMELY OFFICE VISIT RECORDS AFTER REFERRAL APPOINTMENT

HOW TO MANAGE COST OF CARE

OTHER

Enter challenges not listed

Enter specialists not listed

Enter specialist collaborations not listed

Would you be interested in participating in a professional development series focused on collaboration with specialists?

YES

Select all that apply

Select or enter value

How do you think a professional development series around bridging the gap between primary and specialty care providers could improve your collaboration with specialists?

Select all that apply

BETTER PATIENT OUTCOMES

IMPROVE COMMUNICATION WITH SPECIALISTS

BETTER MANAGE CERTAIN DISEASE PROCESSES WITHOUT REFERRING

MORE EFFICIENT WORKFLOWS

UNDERSTANDING SPECIALISTS' EXPECTATIONS

IMPROVING RELATIONSHIPS WITH SPECIALISTS

OTHER

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What topics would you like to see covered in a professional development series around bridging the gap between primary and specialty care providers?

Select all that apply

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