Facility Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hello,
Thank you for contacting us and your interest in Aged Care GP providing a GP service to your facility.

We are selective about who we work with. There is an application and interview process that we go through with you. The first step is to ensure that we are a good fit for one another. Please complete this short application:

Once the application form has been completed, we will contact you for a further conversation.

Email *

Your name *

Your best contact number *

Name of Facility *

Facility address *

What is your RAC ID Number *

Are you able to provide an appropriate consultation space or room for visiting GPs? *

Yes

Are you able to provide WiFi internet access for visiting GPs and the nurses from the Aged Care GP (ACGP) Team? *

Yes

Will the RACF accept that we send Pathology and Specialist referrals directly to pathology company and specialists and forward a copy to the facility via email? *

Yes

Are you able to provide ACGP a Generic email that is available to all your nurses in all areas of the facility for the purpose of sending through copies of referrals for Pathology, Radiology, Specialist and Visit Notes? *

Which Resident Management System do you use? *

So that you can get GP notes faster, ACGP has created integrations which allow automatic, secure transfer of notes straight into certain resident management systems. Are you open to allowing such an integration of Aged Care GP Electronic Clinical Software and your resident management system? *

Yes

Again, to ensure you get notes in a timely manner; where you use paper notes, or an integration does not exist, ACGP sends PDF versions of notes. Are you open to accepting PDF notes? *

Yes

Which pharmacy provides the bulk of your medications? *

Who is your RMMR Provider *

Which drug chart (or electronic medication management system) do you use? *

If using paper-based drug charts; are you planning to switch to an electronic system? *

Yes

We use electronic charts

To allow care to progress smoothly, getting prescriptions to pharmacies in a timely manner is very important. Do you have a secure place where GPs can leave prescriptions for the pharmacies to collect? *

Yes

GPs need a clear, concise and accurate handover at the start of their visit to provide the best care to residents. Are you able to ensure a nurse familiar with the residents’ condition is available during GP visits for handover? *

Yes

To allow prompt, efficient care and timely notes transfer (including by telehealth when the GP is not physically at your RACF), GPs need access to important information in your system. Are you able to provide the ACGP Team with offsite access to your EMR so that they are able to access Residents’ records from home or elsewhere. *

Yes

Should you have Electronic Drug Charts are you able to provide our GP with offsite access so that they able to access the Resident's drug chart to make the required changes from home or elsewhere. *

Yes

So that we can accurately plan and allocate resources, please provide an estimate of the number of residents that you would like for ACGP to arrange care for. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Aged Care GP. Report Abuse

Forms