Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity
| Community Resource Name: | Interview By: | ||
|---|---|---|---|
| Questions | Responses | ||
| What evidence-based programs do you offer for patients with ________________? | |||
| Please tell me more about the program. | |||
| Who is the main contact person for the program and how can I get hold of them? | |||
| Do you currently work with other medical groups or practices, or have you in the past? | |||
| Do you have a way to securely send and receive electronic fax information? | |||
| Are there eligibility criteria for your program and if so, how do you assess it? | |||
| Do you have some kind of financial assistance for low-income patients? | |||
| Can you send me program information that I can share with my practice? | |||
| On a scale of 1 to 10... | Poor | Average | Excellent |
| How patient-centered does this organization seem? Notes: |
1 2 3 4 5 6 7 8 9 10 | ||
| Not at All | Moderate | Very | |
| How confident would I feel sending my patients to organization—do I think they will receive high-quality and credible assistance? Notes: |
1 2 3 4 5 6 7 8 9 10 | ||
| Not at All | Moderate | Very | |
| How prepared does this organization seem to be for working closely with a medical practice like ours? Notes: |
1 2 3 4 5 6 7 8 9 10 | ||
