New Client Intake

CLINICAL SCRIBES LLC

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New Client Intake

* Indicates required field

Clinic Name *

Street Address *

City *

Zip Code *

Contact Person *

First

Last

Email *

Phone Number *

Desired start date (please remember there is some lead time for scribe training and other preparation. If your site has specific training for new staff, or other internal procedures we need to follow, please leave us a comment in the box below) *

Number of providers wanting to use scribe services *

provider(s) name *

Does your clinic operate during typical Monday-Friday business hours? *

Yes No

if no, please describe a typical weekly schedule. (To maintain scribe consistency and quality, we typically assign no fewer than 20 hours per week for each scribe.) *

only include the hours when a scribe will be needed

If more than one provider is actively seeking to use a scribe, please include additional schedule(s) here: *

does your clinic have specific scribe needs? For instance, an Ob/Gyn provider may prefer a female scribe. *

Does your clinic provide badges? If not, Clinical Scribes LLC will provide ID badges. *

Yes No

What is the dress code at your site? *

Business casual Scrubs

Is there free parking adjacent to your facility? *

Yes No

If free parking is not available, what is the daily parking fee? *

Does your clinic have laptops or other computers dedicated to charting? Will the scribe have access to these for charting? *

Yes No

What EMR does your clinic use? *

scribes will need EMR access for training. is remote access possible? *

Our scribes will need access to the EMR for charting purposes. Often your IT department has specific requirements in order to gain access. Are there certain forms or training that scribes must complete before they are granted EMR access? *

Templates can help make it easier for scribes to work with different providers. Do you have any templates at your site? *

Yes No

Comments? *

Submit

About Us
For Providers
For Scribes
Contact Us
Employee Portal
Privacy Policy