Transcription Services Application Form

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Transcription Services Application Form

Personal Information

Name
Address (line1)
Address (line2)
Address (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 Medical office 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 Pediatrics Pulmonology Neurology Urology Orthopedics/Rehabilitation Medicine General Surgery (OP Reports) Psychiatry/Psychology Pathology Radiology Nuclear Medicine
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://

Oracle Transcription, INC

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7.3: Application Form

Personal Information

Experience

Training

General Information

Commitment