Forms
Assorted Topics
Care Gaps
Competency Checklist
Flu
100
  • What form(s) MUST be completed prior to being seen?
  • Conditions of Treatment
  • Consent to treat a minor
100

Can you make a copy of a copy?


True or Flase

What is False. All forms must be printed from the HMG portal

100
  • What 2 tests make up the KED measure?

What is CMP & Urine Microalbumin

100

Rank the communication methods from highest to lowest frequency used.

    o Secure chat
    o Teams
    o Hoag individual email

100

When are flu shots required by?

If you choose not to receive a flu shot from, what dates do you need to wear a mask for?

What is Flu shots are required by November 17, 2025 to avoid wearing a mask starting

What is December 1 through March 31, 2026.

200
  • What form must be checked when calling a patient/parent?

What is Auth to share

200

What age group must give consent to a parent for Proxy to have access to their medical records?

What is age group 12-17 yrs old

200
  • What form is a patient to complete for a depression screen?
  • PHQ-9 /PHQ-A
200

 Tell me 2 workflows that help you identify when to create a self-pay estimate?
     

a. The MSO report (daily) if a patient has no insurance

b. When chart prepping you notice that a patient has no insurance

c. When you schedule a follow-up appt. with a self-pay patient

200

All Flu vaccines for the 2025-2026 season are Quadrivalent OR Influenza vaccines for the 2025-2026 season is a quadrivalent (4-component) formulation.

True or false

What is False – they are Trivalent

300

What form must be signed when a patient comes in for a CPX/WWE?

What is the Annual Preventative Care Visit Acknowledgement 

300
  • Name the in-basket pool we send messages to inform of updated/completed care gap?
  • p Hoag Quality
300

Ask the staff what type of consent is needed from a patient for the use of AI Scribe

  1. Both written and verbal consent must be obtained
300
  • Where can you find the updated standing orders for Flu and Covid vaccines?

What is HMG Portal

400

What form allows a parent to designate other people who they trust to make healthcare decisions for their child, in their absence?

What is Authorization for third Party to consent to the treatment of a minor

400
  • Give me 1 talking point for a patient asking about what an AHA entails.
  • $50 Gift Card
400

What type of insurance does a patient need to have to qualify for an Annual Wellness Visit?

Medicare HMO Part A and B

500

What does Ad HOC mean?

What is as needed

500

When do the MSO reports need to be completed?

What does the green, blue and yellow highlights stand for? 


What is daily

What is green highlight - no issues

What is yellow highlight - had to call

What is blue highlight - in progress

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