Telehealth Professional Care Shift Report Form
Complete this form to document your telehealth shift summary and key activities.
Shift Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Professional Name
*
First Name
Last Name
Role/Title
*
Shift Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Shift End Time
*
Hour Minutes
AM
PM
AM/PM Option
Telehealth Platform Used
*
Please Select
Zoom
Microsoft Teams
Doxy.me
Amwell
Other
Number of Patient Interactions Handled
*
Brief Summary of Care Provided
*
Incidents or Escalation Notes
Follow-up Tasks or Handoff Notes
Submit Shift Report
Should be Empty: