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Physician Pre-Assessment Questionnaire for Diagnostic Imagining Nuclear Medicine Mobile App

The Physician Pre-Assessment Questionnaire for Diagnostic Imagining Nuclear Medicine mobile app allows physicians to evaluate the skills required for diagnostic imagining used in nuclear medicine. A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance you can contact our Sales team to help you at Sales@GoCanvas.com. If you would like to enable HIPAA on your GoCanvas account please follow the instructions below: 1. Log onto your Account 2. Click “My Account” in the top right corner of the screen 3. Click “Customize” on the left 4. The third option is for HIPAA Compliance, click “Edit” on the right 5. Check the “Enable HIPAA Compliance” box and select “Save”

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Physician Pre-Assessment Questionnaire for Diagnostic Imagining Nuclear Medicine Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    I certify that the information provided on this questionnaire is correct and complete

  • Ico signature

    Signature of Physician

  • Ico date

    Date

  • Ico statictext

    Please ensure that a copy of your curriculum vitae and the written agreement between the owner/op...

  • Ico textbox

    Surname (as given on CPSO register):

  • Ico textbox

    Given name(s) (as given on CPSO register):

  • Ico textbox

    CPSO #

  • Ico date

    Date of Birth

  • Ico dropdown

    Sex

  • Ico textbox

    Medical Degree from University of:

  • Ico integer

    Year:

  • Ico textbox

    Speciality

  • Ico textbox

    Facility Name

  • Ico multiline

    Address

  • Ico textbox

    E-mail address

  • Ico textbox

    Office Telephone #

  • Ico textbox

    Home Telephone#

  • Ico textbox

    Cell Phone #

  • Ico multiline

    How often do you visit the facility and how do you document this?

  • Ico date

    When was the last visit?

  • Ico checkbox

    Do you have regular contact and interaction with peers?

  • Ico checkbox

    Have you chosen to focus, subspecialise or restrict your practice?

  • Ico multiline

    If yes, please specify

  • Ico checkbox

    Do you have regular contact and interaction with referring clinicians and specialists?

  • Ico checkbox

    Do you have regular contact and interaction with the owner/operator/licensee?

  • Ico dropdown

    Examinations

  • Ico multiline

    # of Examinations read or procedures performed

  • Ico statictext

    Please indicate the types of examinations that you perform/interpret in a typical work-week at th...

  • ...and More!

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