Hospital Oncology Capacity Assessment Form
Please complete this form to assess your oncology department's current operational capacity. Provide accurate data for the reporting period specified.
Oncology Department Name
*
Reporting Period
*
Please Select
Q1 (Jan-Mar)
Q2 (Apr-Jun)
Q3 (Jul-Sep)
Q4 (Oct-Dec)
Full Year
Current Bed/Space Capacity
*
Current Oncology Staffing (FTEs)
*
Rows
Number of Staff
Physicians
Nurses
Pharmacists
Support Staff
Average Weekly Treatment/Session Volume
*
Availability of Key Oncology Equipment
*
Rows
Available
Functional
Linear Accelerator
1
2
CT Simulator
3
4
Infusion Pumps
5
6
Radiation Shielding
7
8
Patient Wait Time Pressure (How would you rate the current wait times for oncology services?)
*
1
2
3
4
5
Current Inpatient vs Outpatient Load
*
Rows
Average Daily Census
Inpatient
Outpatient
Escalation Needs (Select the areas where escalation/support is needed)
*
Staffing
Equipment
Space
Patient Flow
Other
Additional Comments or Notes
Submit Assessment
Should be Empty: