Provider Questionnaire - COVID-19 Connected Care Center

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The OAFP has been working with OHSU Family Medicine on OHSU’s COVID-19 Connected Care Center to support the needs of clinicians and all Oregonians.

On April 16, OHSU is launching a COVID-19 Connected Care Center to support the needs of clinicians and all Oregonians. A dedicated telephone number, 888-OHSU-CCC (888-647-8333) is available 8 AM to 8 PM, seven days a week, to support to your practices by:

• Answering your questions about COVID-19 ambulatory clinical management.
• Answering your questions about COVID-19 ambulatory practice operations.
• If desired, providing a dedicated hotline for your patients to call about COVID-19 related questions and
obtain virtual visits if indicated.

For patients that do not have PCPs or immediate access to primary care, the COVID-19 Connected Care Center will also:
• Answer patient questions about COVID-19 with a team of dedicated nurses.
• Direct patients to virtual visits with an OHSU provider if indicated.

Because the OHSU team anticipates that some patient callers from across the state will not have a primary care provider, they have asked OAFP to identify members who have practices open to new patients so that they may offer information to those patients for potential localized follow up. If you would like to be included in their list for potential referrals, please complete the form below.

Email *

May we share your email address with OHSU's Connected Care Center administrator? *

Yes

Other:

Provider Name *

Practice Name *

Practice Phone *

Practice Location: City/ZIP *

Are you accepting new patients? *

Commercially insured

Medicaid (Oregon Health Plan)

Medicare FFS

Medicare Advantage

TriCare

Cash only

Not accepting patients at this time

Other:

Required

Which of the following modalities of visit are you able to use? *

Phone visit

Video visit

In-person assessment of respiratory concerns

Required

Do you have access to COVID-19 testing? *

Yes

Maybe

Would a visit required before COVID-19 testing?

Yes

Maybe

Clear selection

Is there any other information you would like to share regarding your practice?

Comments

Send me a copy of my responses.

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