PANTHERTOOLS, Point-of-Care Clinic Tools
PANTHERTOOLs Feedback Form (thanks!)
Please complete the following survey after using one or more of the PANTHERTOOLs to help us enhance the tools further for other clinicians. Thanks in advance!
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1.
Please select the option that best describes you:
(Required.)
Endocrinologist
Physician (Peds, Internal, or Family Practice)
Nurse Practitioner
Physician's Assistant
Registered Nurse
Registered Dietitian
Other
2.
Which of the following best describes your work environment:
Primary Care or Community Health Center
Specialty Diabetes Clinic
Other
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3.
Describe the Type of Visit:
(Required.)
Clinic Visit
In person
Telehealth visit
Telephone Call
Other
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4.
Which tool did you use? (select 1)
(Required.)
Omnipod 5
Dexcom
FreeStyle Libre
5.
Did you use the tool on paper or online?
Online
On paper
6.
Which of the following sections of the Point of Care Tool did you use?
Section 1: CARES Overview
Section 2: Understanding Big Picture Patterns
Section 3: Understanding Why (Daily Basis)
Section 4: Make a Plan
Section 5: After Visit Summary- handout
7.
If you didn’t use some of the sections, please tell us why. (click all that apply)
Not enough time
Didn't need them
Didn't understand how to use them
Other
8.
Approximately how long did it take to use the Point of Care Tool as part of your visit?
Less than ten minutes
Ten to 20 minutes
20 minutes to 30 minutes
More than 30 minutes
9.
Please comment on what you found most useful or beneficial about the PANTHER tool.
10.
Were there any parts of the PANTHER Tool you found confusing, unclear or problematic? Please explain.
11.
What could we do to improve the PANTHER Tool?
12.
In your opinion, how useful was this tool?
5 (very useful)
4
3
2
1 (not useful)
13.
How likely would you be to recommend this tool to other healthcare professionals?
5 (very likely)
4
3
2
1 (unlikely)
14.
Would you be willing to have us contact you for more information? If so, please provide your preferred email.
