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Quote Request Physicians

Transcription Client Questionnaire for Physicians

Please provide us with the following information so that we can offer you a customized quote for your transcription services.

Organization:
Physical Address:
City:
State, Zip:  ,   
Phone:
Fax:
Office Hours:
Entity Type:
Office-Single   Office-Multiple   Clinic
Specialty:
Contact Person:
Contact Title:
Contact Phone:
Contact Email:
What are you looking for in a transcription service?
Browser-based access (including electronic signature) dictation input via telephone
Voice recognition/self edit. Dictation input at workstation
Traditional transcription (dictation input by phone, document delivery by email)
  
Current Process
How is your patient care currently being documented? (check all that apply)
Hand-writing directly on charts
In-house transcriptionist(s)
   Number of transcriptionists:
Service (select type) Total Outsource Overflow Only
   
If using a service, what is your average volume?
Billing Period: Bi-Weekly      Semi-Monthly    Monthly
   
Do you know how your service defines a "line"? (check all that apply)
Includes spaces
Includes pre-formatted text
A line = characters
Any single line on a report, no matter how many characters are present
Other
No idea
   
By what increment are you billed by your service?
Character
Line
Bytes
Page
Report
Minute
Don't Know
Other     
   
Current method of dictation: (Check all that apply)
Do Not Dictate
Tapes
Digital Dictation System
  If digital dictation is used, do you own the system? Yes     No
  If yes, what is the name of the system?
   
Do all providers dictate? Yes     No
How many providers will be utilizing the service?
What is your average number of visits?


/per: day   week   month   year

Days we can expect to receive dictation:

 

Mon   Tue   Wed   Thur

Fri   Sat   Sun

   
What is your current turn-around time?    days   hours   minutes
Your current STAT turn-around time?    days   hours   minutes
 
What's your preferred turn-around time?    days   hours   minutes
Your preferred STAT turn-around time?    days   hours   minutes
   
Do you have multiple locations/satellites?   Yes     No
Are all locations on a single network (LAN)?   Yes     No
Does everyone have Internet access?   Yes     No
What information will the doctors enter?   ID   WT   MRN  
Other?
What is your desired start date? *
*start date may be delayed based on receipt of required information by MAG Mutual HSI
   
Please provide us with the corporate decision tree
CEO:
CFO:
Medical Record Director:
Practice Administrator:
Lead Transcriptionist:


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