Nursing Home COVID-19 Point of Care Testing Feedback Form

We are soliciting feedback from nursing homes on point of care testing. Your feedback is valuable and will help inform our planning efforts. Please answer the below questions as they apply to your facility and COVID-19 related point of care testing. Please submit your response by COB on 10/2/20.

Today's Date

Facility Name*

Please enter the name of your nursing home facility.

First Name

Last Name

Email Address*

How familiar are you with COVID-19 point of care testing?

Select

Have you or staff in your facility administered a COVID-19 point of care test?*

Select

Please indicate the type(s) of COVID-19 point of care tests your facility has received.*

Please select all that apply. If you have not received any, please select "Have not received any yet"

Select

Please specify the other type of COVID-19 point of care test(s) your facility has received:

Please list any other types of COVID-19 point of care test(s) your facility has received in the space provided.

Has your facility confirmed its ability to reorder COIVID-19 point of care tests?*

Select

Please describe your facility's experience reordering and/or coordinating the reorder of COVID-19 point of care tests:

Please put "N/A" if you don't have experience in this area.

Please indicate any current use cases in your facility:*

Please select all that apply.

Select

Comments:

Please include any comments regarding current use cases in the space provided.

Are you currently doing OR considering doing COVID-19 point of care testing of individuals visiting residents of your facility?*

Select

Please describe any concerns or experiences you have regarding training, skills, and instruction of your staff for COVID-19 point of care testing:

Please describe any concerns or experience you have regarding staffing levels and support for COVID-19 point of care testing in your facility:

Please include any other questions, comments, or concerns in the space below:

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