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

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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