Ind. Primary Health Care Association COVID Clinical Questionnaire Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Health Center Name Your role / job title Did your center activate your emergency operation plan (EOP)? Yes No What did the incident management structure look like/how did your center manage the incident? Does your EOP have a pandemic annex or section? Yes No How did you adjust operations to meet COVID guidelines? Did you activate and follow your communication plan? Yes No What platform(s) did your center use to communicate with staff and providers?Which was most effective? (Email, text, virtual, in person or a combination of them?)How did your center communicate with patients, families, and the public?How did the pandemic affect the daily patient visits of your organization from March to July?Describe the decision-making process to adjust daily operations to COVIDWhat team members were included?Are these the same people noted in your emergency operations plan?Were you able to leverage secondary contracts to obtain resources? (PPE/ Testing)What steps did you take when all contracted vendors were unable to meet your requests?What external partners did you contact? What were their responses to your request? (list of partners and location)What are some overall strengths from your center during the pandemic?Did you document responses or actions taken during COVID on a regular basis? Did you construct a timeline?Have you identified areas for improvement and made changes to your EOP based on your COVID response?Did you contact IPHCA for any needs? Yes No How did IPHCA assist your center during the incident?What could IPHCA improve for the upcoming months, future incidents, or pandemics?
