Conomikes—Forms for Your Use

Task Analysis
This form is to be filled out by each employee to assist the Practice Manager in updating Job Descriptions. Otherwise Job Descriptions can become outmoded. Annually, this form could be given to each employee. Since some elements of some employees’ jobs could have been changed—particularly, added or subtracted tasks. The input from each employee can help the manager review, and possibly redesign some of the employee Job Descriptions. It also provides a fairly accurate profile of where each of the employees is spending his/her time.

Patient Satisfaction
This Survey form would be most effective, and most objective, if it is mailed to patients post-visit, or handed to them on exiting the practice. In either case, provide them with a postage-paid envelope to return the cmpleted survey.

Job Standards—Examples
Job Descriptions describe the job to be done. Job Standards spell out expected performance criteria. These Standards can be defined for each of the tasks in any job description.

Work-In Data Analysis
It is a good idea to study your work-ins over a time-frame that will give you some reliable data. Illustrated here is a sample of how such data could be recorded over a 13-week period.

Personnel Policies & Rules—Subject Headings
The following subjects should be included in every practice’s Personnel Policies and Rules Handbook: ...more

Sample Employment Application
Feel free to use and modify this form as you wish. Note that the applicant does not have to fill out date of birth—it is optional. Also review the Disclosure and Release and Authorization wording. It is getting the applicant’s permission to undertake reference checking. Furthermore, it permits you to do background checking: criminal history, driving record, workers comp, etc. The applicant’s signature releases you and anyone you contact from liability.

Consultation Request Form
For consultations, some plans have a form that must be generated by the requesting physicians. In other situations, the requested practice, for strict documentation purposes, may wish to send a Consultation Request Form to the requesting practice. As part of the patient medical record it confirms that a bona fide request for consultation was made.

Guidelines for Review of Medical Practice Manager Performance
The following guidelines relate to performance goals for the practice manager that helps promote a well-run medical practice. One purpose of this review is to note areas where performance goals are being met. The second purpose is to address areas where performance goals are not being met. In this latter case, corrective actions should be sought and timetables established for meeting the stated goals.

Between You and Your Physician
The patient visit could also be helped if the patient, when checking in, is handed a “Between You and Your Physician” form, which is available by clilcking the title link. This allows the patient to let the physician know what the patient’s “agenda” is for the day’s visit. This is a great back-office time-saver and the form can, again, be modified to your practice needs.

Forms for your use: (click on title for document)