Medical Records Questionnaire
Please take a few moments to fill out this VMR Express Medical Records Questionnaire. Your answers to these questions will help us better serve your needs. Your responses will be used to determine the best possible solution for your center.
1. What Practice Management system do you use?
2. Are you managed by a development or management company?
Yes
No
3. How long has your surgery center been open for business?
Years
Months
4. How many physicians are at your facility?
1
2
3
4
5
6
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8
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10
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91
92
93
94
95
96
97
98
99
100+
5. How many cases per month do you process?
6. How many different forms does your facility utilize?
1-10
11-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91-100
101-150
151-250
250-500
7. On average, how many forms per patient chart?
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2
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81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100+
8. How many employees work in your medical records department?
0
1
2
3
4
5
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81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100+
9. How many employees does your facility use to prepare the patient charts?
1
2
3
4
5
6
7
8
9
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81
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83
84
85
86
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91
92
93
94
95
96
97
98
99
100+
10. How many minutes does it take to compile a typical patient chart?
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59
60
11. How many days in advance do you prepare charts before patient arrives?
On Demand
1
2
3
4
5
6
7
More than 7
12. Do you have digital copies of your forms?
Yes
No
13. Who do you use for transcription and coding?
14. How many employees will need to be trained?
1
2
3
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5
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81
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91
92
93
94
95
96
97
98
99
100+
15. How many computers will VMR Express be installed on?
1
2
3
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5
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91
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94
95
96
97
98
99
100+
16. Where is the PMS Server located and what type of access?
On Site Full Access
On Site Restricted Access
Offsite VPN Connectivity
Offsite Internet Connectivity
Unknown
17. Do you outsource your billing?
Yes
No
1. Estimated hourly wage for business office personnel?
$5 - $10 per hour
$11 - $15 per hour
$16 - $20 per hour
Over $20 per hour
2. Cost allocated for a box of sticky labels?
a) How many sheets of sticky labels per box?
50
100
150
200
250
300
350
400
450
500
550
600
650
700
750
800
850
900
950
1000
1500
2500
5000
3. Cost allocated for a box of Chart Folders?
a) How many folders per box?
50
100
150
200
250
300
350
400
450
500
550
600
650
700
750
800
850
900
950
1000
1500
2500
5000
4. Do you use preprinted forms?
Yes
No
a) Number of forms per patient?
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
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80
81
82
83
84
85
86
87
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89
90
91
92
93
94
95
96
97
98
99
100+
b) Approximate annual cost of preprinted forms?
c) Do you use self-adhesive labels?
Yes
No
d) How many sheets per patient?
e) How much do you pay per order of forms?
f) How many forms per order?
5. What is the average chart cost per case per month?
1. Where do you store your medical records?
If stored remotely, what is your estimated cost per month?
$5
$10
$15
$20
$25
$30
$35
$40
$45
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
2. How do you retrieve stored medical records?
If stored remotely, how many times per month do you retrieve your medical records?
1
2
3
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81
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83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
3. How long do you store standard medical records?
Years
Months
4. Approximately how many square feet is your medical records room?
Sq. Ft.
5. Have you received quotes for electronic document management services?
Yes
No
Please Rate the follow practice issues using a 1-5 scale. Let 1 be not a problem and 5 be a major operational challenge.
Chart Preparation
Not a Problem
1
2
3
4
5
Major Problem
Time to prepare
Not a Problem
1
2
3
4
5
Major Problem
Placing Sticky Labels
Not a Problem
1
2
3
4
5
Major Problem
Inaccurate Patient Information
Not a Problem
1
2
3
4
5
Major Problem
Training
Not a Problem
1
2
3
4
5
Major Problem
Cancellations
Not a Problem
1
2
3
4
5
Major Problem
Printing Costs
Not a Problem
1
2
3
4
5
Major Problem
Document Search/Retrieval
Not a Problem
1
2
3
4
5
Major Problem
Billings / Collections
Not a Problem
1
2
3
4
5
Major Problem
Lost and/or Missing Charts
Not a Problem
1
2
3
4
5
Major Problem
Document Storage
Not a Problem
1
2
3
4
5
Major Problem
Your Name
Title
Facility Name
Address
Suite / Address 2
City / State / ZIP
Office Telephone:
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Ext.
Electronic Mail:
Comments: