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Transcription Services Application Form

Personal Information

Name *

Adress(line1) *

Adress(line2)

Adress(line3)

Daytime Phone *

Evening Phone *

Fax

E-mail *

Experience

Years of experience *

Do you have experience in the following?

In-house hospital work?
Yes No

Hospital work through a transcription service?
Yes No

Home-based work?
Yes No

Foreign accents?
Yes No

How much medical transcription experience do you have with the following (years, months):

In-house hospital work?

Hospital work through a transcription service?

Home-based work?

Medical Office work?

Which of the following types of reports have you transcribed in a hospital setting? (Check all that apply.)

Cardiology/Cardiovascular Surgery
Gastroenterology
OB/GYN
Hematology/Oncology
Ophthalmology
Otolaryngology/Oral Surgery
Pediatrics
Pulmonology
Neurology/Neurosurgery
Urology
Orthopedics/Rehabilitation Medicine
Operative Reports
History & Physical Reports
Consultation Reports
Discharge Summaries
Psychiatry/Psychology
Pathology
Radiology
Nuclear Medicine
Emergency Room
Clinic

Which of the following types of reports have you transcribed in a medical office setting? (Check all that apply.)

Cardiology
Gastroenterology
OB/GYN
Hematology/Oncology
Ophthalmology
Otolaryngology/Oral Surgery
Pediatrics
Pulmonology
Neurology/Neurosurgery
Urology
Orthopedics/Rehabilitation Medicine
Operative Reports
History & Physical Reports
Consultation Reports
Discharge Summaries
Psychiatry/Psychology
Pathology
Radiology
Nuclear Medicine
Emergency Room
Clinic

Which software programs have you used for transcription? (ie. word processing, spell checkers, word expanders, etc.)

 

Training

How much training have you had? (Weeks, months, years?)

 

What type of training do you have? (ie. College courses, seminars, on-the-job training, etc.)

General Information

What specialties are your favorite?

What specialties do you not like?

Which reports do you consider to be the easiest?

 

Which reports do you consider to be the most difficult?

 

How many words per minute do you transcribe?

 

What would you say is your percentage of accuracy?

%
 

Do you regularly use or own any medical reference materials? (Check all that apply)

Medical Dictionary
Drug Reference Books
Specialty Books
CD-Rom
Periodicals (eg. JAAMT, Monthly Prescribing Reference, etc,)
Other

If you chose "other" in the above question, please list your medical reference materials (such as Internet sites, newsgroups, mailing lists, etc.)

Commitment

What level of commitment are you interested in?

Full time (5,000 lines/week minimum)
Part time(3,500 lines/week minimum)
Part time at first, then full time
Not sure

How much time do you want to invest?

Which times and days do you want to work? (Check all that apply)

Days
Evenings
Weekdays
Weekends
Not sure

Approximately how many lines per week do you want to transcribe?

 

Please add any additional qualifications, certifications (such as CMT) or comments you may have:

How did you hear about our website? (Choose all that apply)

An Internet search through a "search engine" (Yahoo, Excite, AltaVista, etc.)
A link from another website
A friend
Other (Please see below)

If you chose "Other," please explain below:

If you were referred by another website, please list referring address here:

http://
 

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