COVID-19 Testing Survey 2020 COVID-19 Testing Survey Contact InformationNumber of pharmacy locations represented: Pharmacy Name: Point of Contact First Last Pharmacy Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email PhoneCOVID-19 Diagnostic TestingDo you currently have or could rapidly ramp up to have staff to perform COVID-19 diagnostic testing? Yes No Do you currently have or could rapidly ramp up to have staff perform COVID-19 diagnostic testing follow-up? Yes No I am interested in performing COVID-19 diagnostic testing if a point of care test becomes available: Yes, pharmacist swabbing and analyzing the test on-site Yes, pharmacist swabbing and sending results to a lab Yes, if the patient swabs and analyzing the test on-site Yes, if the patient swabs and sending results to a lab Maybe, if adequate PPE is available Maybe, if adequate payment is available No, not currently but maybe in the future No Are you currently investigating the possibility of providing testing for COVID-19 in your pharmacy? Yes No Do you currently have access to quantities of PPE in order for you to facilitate testing in your location? Yes No My pharmacy would conduct COVID-19 diagnostic tests: Through a drive-thru in the parking lot Through a walk-up in the parking lot Through the drive-thru window Through a walk-up in the pharmacy Would you be interested in being a public health COVID-19 diagnostic community testing partner? Yes No What resources would you need to conduct COVID-19 diagnostic testing? Education/training Increased staffing PPE NPI Technology to document intervention Technology to report results Technology to bill for services provided Other (respond below): If you selected 'other' above, what resources would you need to conduct COVID-19 diagnostic testing?COVID-19 Serology (Antibody) TestingI am interested in performing COVID-19 serology (antibody) testing if a point of care test becomes available: Yes, pharmacist swabbing and analyzing the test on-site Yes, pharmacist swabbing and sending results to a lab Yes, if the patient swabs and analyzing the test on-site Yes, if the patient swabs and sending results to a lab Maybe, if adequate PPE is available Maybe, if adequate payment is available No, not currently but maybe in the future No What resources would you need to conduct COVID-19 serology (antibody) testing? Education/training Increased staffing PPE NPI Technology to document intervention Technology to report results Technology to bill for services provided Other (respond below): If you selected 'other' above, what resources would you need to conduct COVID-19 serology (antibody) testing?General QuestionsMy pharmacy has a current CLIA waiver: Yes No No, but an application has been submitted Would you be interested in prescribing antiviral therapy, if treatments for COVID-19 became available? Yes, if a standing order existed with reimbursement for time to test and treat individuals like other providers Yes, if a standing order existed and supports were provided to bill (can’t test and treat and bill at the provider level) Maybe, would need additional training and supports No, do not have the resources or capacity to provide What resources would you need in order to prescribe antiviral therapy for COVID-19 at your facility? Education/training Increased staffing PPE NPI Technology to document intervention Technology to report results Technology to bill for services provided Select all that apply.Would you be interested in administering and/or prescribing immunizations for COVID-19 when they become available? Yes, but I need to be reimbursed for time to administer and prescribe and document like other providers Yes, if supports were provided to bill (can’t prescribe, document, and bill for service) No, not interested in administering or prescribing Would you like any other information materials to display at the pharmacy would be helpful for your community? Infographics about what pharmacists can provide Infographics about emergency preparedness and healthcare service utilization Infographics for COVID-19 risk Infographics for COVID-19 testing Infographics about COVID-19 immunity and testing Other- Respond below Select all that apply.If you selected 'other' above, what information materials to display at the pharmacy would be helpful for your community?Are you aware of the Virginia Department of Health COVID Check? Yes No Δ
