Practice Efficiency Assessment Form
Assess how your practice operates today so efficiency strengths, bottlenecks, and improvement priorities can be identified.
Practice Profile
Practice Name / Organization Name
*
Role / Title
*
Practice Type / Specialty
*
Please Select
Primary Care
Family Medicine
Internal Medicine
Pediatrics
Dentistry
Orthopedics
Cardiology
Dermatology
Behavioral Health
Physical Therapy
Other
Number of Providers / Team Size
*
Years in Operation
*
Efficiency Assessment
Overall Efficiency Rating
*
1
2
3
4
5
Appointment Scheduling Efficiency
*
Very Inefficient
1
2
3
4
5
6
7
8
9
Highly Efficient
10
1 is Very Inefficient, 10 is Highly Efficient
Patient Intake Workflow Efficiency
*
Very Inefficient
1
2
3
4
5
6
7
8
9
Highly Efficient
10
1 is Very Inefficient, 10 is Highly Efficient
Documentation/Charting Efficiency
*
Very Inefficient
1
2
3
4
5
6
7
8
9
Highly Efficient
10
1 is Very Inefficient, 10 is Highly Efficient
Billing/Claims Workflow Efficiency
*
Very Inefficient
1
2
3
4
5
6
7
8
9
Highly Efficient
10
1 is Very Inefficient, 10 is Highly Efficient
Common Bottlenecks and Time-Consuming Tasks
Rows
Frequency
Impact
Appointment scheduling
1
2
Patient check-in/intake
3
4
Documentation/charting
5
6
Billing/claims processing
7
8
Communication/coordination
9
10
Referral follow-up
11
12
Improvement Priorities
Top efficiency improvement area
*
Scheduling and appointments
Patient intake and registration
Documentation and charting
Billing and claims workflow
Communication and follow-up
Inventory and supplies management
Reporting and analytics
Staff coordination and task management
Other
Current tools or systems used
Electronic health record (EHR)
Practice management system
Online scheduling tool
Patient portal
Billing/claims software
Spreadsheet-based tracking
Paper forms and manual logs
Communication platform
Inventory management system
Other
Additional comments or specific workflow details
Submit Assessment
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