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Practice Continuity Workbook FOR FAMILY PHYSICIANS Preparing your practice for an emergency or disaster WORKBOOK (BOOK 2 OF 2) a template to creating your own practice continuity plan Practice Continuity Plan INSERT PRACTICE NAME INSERT PRACTICE LOCATION LAST UPDATED: UPDATED BY: D D / M M / Y Y Y Y
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Practice Continuity Workbook for Family Physicians

Jul 25, 2016

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A companion to the Guide, this workbook walks family physicians through the steps required to prepare their own practice continuity plan in advance of an emergency or natural disaster.
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Page 1: Practice Continuity Workbook for Family Physicians

Practice Continuity WorkbookFOR FAMILY PHYSICIANSPreparing your practice for an emergency or disaster

WORKBOOK (BOOK 2 OF 2)

a template to creating your own practice continuity plan

Practice Continuity Plan

INSERT PRACTICE NAME

INSERT PRACTICE LOCATION

LAST UPDATED:

UPDATED BY:

D D / M M / Y Y Y Y

Page 2: Practice Continuity Workbook for Family Physicians

AcknowledgmentsThis Practice Continuity Guide for Family Physicians was developed in partnership with the B.C. Ministry of Health Emergency Management Unit and the Victoria Division of Family Practice.

We would like to thank all members of the Victoria Division of Family Practice and other partners who provided input and suggestions for the development of this guide.

Shawn Carby, Ministry of HealthKatja Magarin, Ministry of HealthSue Munro, Island Health/Provincial Health Services Authority Eileen Grant, District of Oak Bay

Catriona Park, Project CoordinatorCrystal Sawyer, Editing & Design

Dr. Ian Bekker, physician leadDr. Herbert DomkeDr. Ranald Donaldson Dr. Haydeh ErfanifarDr. George ForsterDr. Carol JenkenDr. Hana MasataDr. Peter MeyerDr. Tejinder SidhuDr. Ioana SmirnovDr. Lorne VerhulstDr. Jody Young

Page 3: Practice Continuity Workbook for Family Physicians

Purpose

Use this workbook’s companion, BOOK 1: GUIDE to understand how to create your own plan. Use this component, BOOK 2: WORKBOOK to create, alter and expand a plan to suit your practice — make it your own. Likely, you and your staff will have most information already available; it is a matter of compiling the information into one readily accessible document. By the time you are finished, you will have created an essential level Practice Continuity Plan.

Table of ContentsBOOK 1: GUIDE – Practice Continuity Plan Guidebook

1. Introduction 1

2. Plan Development 3

3. Before an Emergency 5

3.1 Prepare Different Types of Emergency Kits 5

3.2 Emergency Office Procedures 7

3.3 Insurance 9

3.4 Staff Contact List and Communication Plan 11

3.5 Identify Essential Services 11

3.6 Critical Records Inventory 13

3.7 External Services and Suppliers—Contacts 13

3.8 Updating Your Plan 14

4. During and After an Emergency 15

4.1 Rapid Damage Assessment 15

Checklist 16

5. Putting the Plan Together 16

6. Resources 17

BOOK 2: WORKBOOK – Practice Continuity Plan Template

7.0 Creating Your Practice Continuity Plan 1–5

7.0.1 Preparing Different Types of Emergency Kits 2

7.0.2 Emergency Office Procedures 3

7.0.3 Insurance 4–5

7.1 Staff Contact List and Communication Plan 6–11

7.2 Essential Services 12–13

7.3 Critical Records Inventory 14–15

7.4 External Services and Suppliers - Contacts 16–21

7.5 During and After an Emergency 22–24

7.6 Completion Form 25

Page 4: Practice Continuity Workbook for Family Physicians

4 6Communication Plan Critical Records

Inventory

Steps in Creating Your Practice Continuity Plan

1Emergency Kits

2Office Procedures

3Insurance

5Essential Services

7External Suppliers

Note: steps may be added in future editions of this Guide and Workbook.

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Practice Continuity Workbook for Family Physicians | 1

7.0 Creating Your Practice Continuity PlanNow that you’ve read through the Practice Continuity Guide that you received with this workbook, you’re ready to move through the templates to create a plan that is customized to your needs. This workbook will help you to gather all key information so it’s ready if you ever need it. You will build emergency kits, review office procedures, and prepare information to support an insurance claim.

Clear communication between all members is essential during a crisis. By the time you’ve completed this workbook, you’ll have contact information for all of your colleagues, and the plan regarding who will contact whom.

You’ll assess all of your essential services and determine how long you can cope without them, as well as strategies to minimize disruption. Your critical records inventory will help you locate, track, and protect your valuable data.

This workbook also includes space to organize contact information for external suppliers, introduces basic steps in conducting a Rapid Damage Assessment (RDA), and finishes with a handy checklist to follow if an event does occur.

By working with your whole team to develop your plan, together you will increase resiliency within your workplace and your homes, and you will be well prepared to address an emergency, natural disaster, or spike in demand for patient care.

Continuity

Plan

Practice

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2 | Victoria Division of Family Practice

Items you might include in an emergency kit:

Practice Continuity Guide

dynamo am/fm radio-style flashlight

standard flashlights for all members

spare batteries for all devices

adapters for cell phones and other devices

basic tools (crowbar, utility knife, wrench)

8-hour glow sticks

temporary shelter, i.e. tube tents + tarps

work gloves, rubber gloves

food (ready-to-eat, non-perishable, freeze-dried)

water (4L/person/day)

collapsible 8L water container

water purification tablets

20L bucket

toilet seat, chemicals, liners, toilet paper

heavy gauge garbage bags

biohazard bag

hand disinfectant

4L resealable storage bags

N95 masks

emergency blankets

rain ponchos

duct tape

signal whistles

military-style can opener

sturdy shoes (at desk, for broken glass or evacuation)

whistle & mask (taped under desk)

7.0.1 Prepare Different Types of Emergency KitsSee Section 3.1 of your Guide for more information on preparing your shelter-in-place and grab-and-go kits.

Have each person on your team prepare their own Grab & Go Kits: one for office, one for home.

Include personalized items like important documents, medication, or prescription glasses.

Accommodate special needs and food sensitivities.

Think about patients who may need to shelter with you in your office, or visitors to your home.

Don’t forget your pets.

Activity

Work with your colleagues to develop a robust shelter-in-place kit for your office (see Section 3.1 of the Guide for details).

Use the list on the left of this page as a guide, and think about your environment’s specific needs.

Be sure that you and all staff prepare a similar shelter-in-place kit for your homes.

Activity

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Practice Continuity Workbook for Family Physicians | 3

FIRE Pull the fire alarm and evacuate. Ensure staff and patient safety.

_____________________________

_____________________________

_____________________________

_____________________________

EARTHQUAKE Drop! Cover! Hold On! Be aware of aftershocks. do not

evacuate unless necessary due to fire, gas leaks, or unsafe building.

_____________________________

_____________________________

_____________________________

_____________________________

7.0.2 Office Procedures (Add as necessary)

Your staff members need to know what to do before an event occurs.

Complete this worksheet with basic procedures you would take in each emergency situation. Add as necessary.

Activity

OFFICE DISRUPTIONS OR THREATS Discuss how to react to a dangerous

patient or a bomb threat. Plan and practice the best way to call

for help.

_____________________________

_____________________________

_____________________________

_____________________________

MEDICAL EMERGENCIES Detail procedures for your office

when a medical emergency occurs in your practice.

_____________________________

_____________________________

_____________________________

_____________________________

SHELTER-IN-PLACE A hazardous airborne substance

incident may require you to stay within your office, requiring you to shut off HVAC and close doors and windows.

_____________________________

_____________________________

_____________________________

_____________________________

UTILITIES Know how to shut off gas, water,

electricity, and HVAC.

_____________________________

_____________________________

_____________________________

_____________________________

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4 | Victoria Division of Family Practice

7.0.3 InsuranceValid and adequate insurance can protect your practice from financial hardship and substantial losses. Every business carries insurance.

Answer the following questions, and confirm with your insurance agent. If necessary, upgrade your coverage.

1. Does your policy provide replacement or current value? Yes No

2. Will your insurance provide enough funds to bring your practice back to operation? Yes No

3. Does your policy cover earthquakes, floods, and other natural events? Yes No

4. Do you need business income/interruption insurance to cover monthly bills and payroll? Yes No

5. Do you thoroughly understand earthquake insurance deductibles, and the difference between the deductible and damage amounts? Yes No

Activity

Activity Make a list of insured items and their replacement values.

Item Value

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Practice Continuity Workbook for Family Physicians | 5

your insurance company’s 24/7 phone number:

___________________________________

your policy number:

______________________________

a copy of your insurance policy

type of insurance: _______________

photos or video of your practice and inventory

other important information and documents

Keep at least two digital copies of these records off-site.

Item Value Activity

Prepare a fireproof, waterproof safety box or a bank safety deposit box with the following items:

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6 | Victoria Division of Family Practice

7.1 Staff Contact List and Communication PlanIt is essential for staff members to communicate with one another following

an emergency. Communicate with staff:

• immediately following an emergency to ensure that they are safe and aware of any immediate safety issues;

• throughout the emergency to keep them apprised of response and recovery efforts and for their participation in practice continuity efforts; and,

• following an emergency to hear views on how the response went, and lessons learned to improve future emergency preparedness efforts.

Fill in the worksheets on the following pages with contact details for each of the people who work in your office. In the space provided, indicate who will contact whom within your team.

Activity

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Practice Continuity Workbook for Family Physicians | 7

Staff Contact List and Communication Plan

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

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8 | Victoria Division of Family Practice

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Staff Contact List and Communication Plan

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Practice Continuity Workbook for Family Physicians | 9

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Staff Contact List and Communication Plan

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10 | Victoria Division of Family Practice

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Staff Contact List and Communication Plan

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Practice Continuity Workbook for Family Physicians | 11

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

NAME ______________________________________________________

POSITION / BACKUP POSITION _________________________________

MOBILE NUMBER ____________________________________________

HOME NUMBER ______________________________________________

EMAIL ______________________________________________________

HOME ADDRESS _____________________________________________

CITY/TOWN _________________________________________________

EMERGENCY CONTACT NAME _________________________________

EMERGENCY CONTACT RELATIONSHIP __________________________

EMERGENCY CONTACT NUMBER _______________________________

COMMENTS _________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

*THIS PERSON SHOULD CONTACT THE FOLLOWING IN THE PLAN:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Staff Contact List and Communication Plan

Last update: _______________________ Updated by: ________________________ Next scheduled update: _____________D D / M M / Y Y Y Y D D / M M / YYYY

Page 16: Practice Continuity Workbook for Family Physicians

12 | Victoria Division of Family Practice

7.2 Essential Services

The following pages can be used to prioritize your continuity efforts following an emergency. Before an emergency, they will assist you in planning your potential mitigation strategies. Add as necessary. Remember that some things are nice to have, while others are essential.

Determine how long you can cope without each service (e.g. one day, one week, one month). Consider how you will work without this

service. What can you do to lessen the impact?

Fill in the worksheet on the following page to prioritize the most critical services, and determine how you can minimize problems if you have to operate without them.

Activity

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Practice Continuity Workbook for Family Physicians | 13

Essential Services

Essential Service How long can you cope without it? Mitigation Strategies (how can you lessen the impact?)

STAFF

INFORMATION TECHNOLOGY

CRITICAL RECORDS

PATIENT FILES

OFFICE SPACE

EQUIPMENT

FURNISHINGS

SUPPLIERS

BC HYDRO (ELECTRICITY)

HVAC

WATER

FORTIS (GAS)

TELEPHONE

INTERNET

Last update: ___________________ Updated by: ______________________ Next scheduled update: _____________

D D / M M / Y Y Y Y D D / M M / YYYY

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14 | Victoria Division of Family Practice

7.3 Critical Records Inventory

The table on the following page can be used in an emergency to assist staff in locating key documents and records. Add as necessary.

Fill in the worksheet on the following page with details about the different kinds of critical records you maintain for your practice.

Activity

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Practice Continuity Workbook for Family Physicians | 15

Critical Records Inventory (Add as necessary)

Type of Information Media Type Manager of Data Alternate Staff Back-up Location Back-up Cycle

paper/electronic off-site/on-site, exact location daily, weekly

PATIENT FILES

EMR

BILLING INFORMATION

CONTACT LIST

Last update: ___________________ Updated by: ______________________ Next scheduled update: _____________D D / M M / Y Y Y Y D D / M M / YYYY

Page 20: Practice Continuity Workbook for Family Physicians

16 | Victoria Division of Family Practice

7.4 External Services and Suppliers — Contacts

Your practice relies on key service providers to function in the event of an emergency. Add as necessary.

Fill in the worksheets on the following pages with contact details for all of your external suppliers.

Activity

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Practice Continuity Workbook for Family Physicians | 17

External Services and Suppliers — Contacts

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

Electricity

Gas

Computer System

HVAC

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18 | Victoria Division of Family Practice

External Services and Suppliers — Contacts

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

Janitorial Service

Medical Supplies

Laboratory Services

Moving Company

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Practice Continuity Workbook for Family Physicians | 19

External Services and Suppliers — Contacts

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

Nearest Clinic

Office Supplies

Nearest Hospital

Property Management Company

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20 | Victoria Division of Family Practice

External Services and Suppliers — Contacts

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

Restoration Company

Telephone Company

Security Company

Water Supplier

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Practice Continuity Workbook for Family Physicians | 21

External Services and Suppliers — Contacts (Add as necessary)

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

VENDOR TYPE _______________________________________________

VENDOR OR CONTRACTOR NAME ______________________________

BUSINESS PHONE ____________________________________________

ALTERNATE 24/7 PHONE ______________________________________

CONTRACT OR ACCOUNT NUMBER _____________________________

EMAIL ADDRESS _____________________________________________

OTHER _____________________________________________________

COMMENTS _________________________________________________

____________________________________________________________

Last update: _______________________ Updated by: ________________________ Next scheduled update: _____________D D / M M / Y Y Y Y D D / M M / YYYY

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22 | Victoria Division of Family Practice

7.5 During and After an EmergencyIn the midst of an emergency situation, it can be difficult to keep calm and follow an established plan. This section will help you to act quickly when an emergency or disaster strikes.

By conducting a basic rapid damage assessment, you can assess the extent of the damage to your workplace, and determine whether it is safe to continue or reopen your practice. The checklist on page 24 will help to ensure you cover all necessary steps. Add as necessary.

It did happen and you actually have to use your plan. Now what?

Work through the checklist on the following page to help you during an emergency.

In the event of an emergency, use the handy checklist on page 24 to help you navigate each step in your plan.

Activity

In the event of an emergency, note any damage to structures or services on your Rapid Damage Assessment worksheet on page 23. Determine if it safe to practice.

Activity

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Practice Continuity Workbook for Family Physicians | 23

Rapid Damage Assessment (Add as necessary)

Structures & Services Description of Damage

COLLAPSED/PARTIALLY COLLAPSED/LEANING BUILDING

CRACKS IN WALLS OR CEILING

STRUCTURAL DAMAGE/BEAMS OR WALLS COLLAPSED

FALLING HAZARDS (CHIMNEY, FURNITURE, ETC)

GROUND MOVEMENT/EROSION/SLOPE FAILURE

DAMAGED SERVICES (ELECTRICITY, GAS, WATER)

SMELL OF ROTTEN EGGS (INDICATES GAS LEAK)

SPARKS OR SMOKING

BROKEN GLASS/TOPPLED FURNITURE/OTHER HAZARDS

Last update: ___________________ Updated by: ______________________ Next scheduled update: _____________

Safe to Practice?

YES/NO

D D / M M / Y Y Y Y D D / M M / YYYY

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24 | Victoria Division of Family Practice

Stop and assess the situation

Are you OK? Is your family OK?

Contact your staff members. Are they OK?

Are you able to get to your office?

Is your office available?

If the event occurs during office hours, protect yourself and your staff and evacuate immediately if necessary.

Do you have electricity, water, and heat?

Do you have access to a telephone?

Do you have access to your patient files, with their current email and phone contacts?

Do you have enough supplies?

During and After an Emergency

Assess the damage and the extent of time your practice won’t be available.

Contact your landlord or property manager.

Contact your utility providers.

Contact your insurance provider.

Re-route phone calls.

Re-route your mail and couriers. You could use a PO Box.

Document and track all your associated costs for insurance purposes.

Contact all key vendors and suppliers.

Contact patients who have appointments scheduled in the near future.

After damage has been assessed by insurance firm, contact a salvaging or restoration company.

Obtain new office space.

Determine equipment needs for your new office space.

Contact all other patients.

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

Update your plan with the lessons

you have learned.

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Practice Continuity Workbook for Family Physicians | 25

Completion Form

NAME _______________________________________________

PHONE ______________________________________________

CLINIC ADDRESS (No./Street) ______________________________

EMAIL _______________________________________________

I have completed the workbook and now have a Practice Continuity Plan. Yes No

If no, please explain why you didn’t complete the workbook:

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

Was your office staff involved? Yes No

If yes, how many people worked on the plan? _____________

How much time did you (GP) spend on the plan? ___________

How much time did your MOA spend on the plan? __________

Upon receipt on this form, the VDFP will issue Verification of Completion to display in your office. Questions about the guide and workbook can be directed to [email protected].

Which section was the hardest/took the longest to complete?

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What section did you think was most useful? ________________

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What other information would you include in this Practice

Continuity Guide and Workbook? _________________________

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Would you recommend the guide and workbook to colleagues?

Yes No Why/Why not? _________________________

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Other comments? ______________________________________

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Please return this form to the Victoria Division of Family Practice by fax 1-250-597-0889 or email [email protected].

Activity Your feedback is important to us. Completion of this form helps us to know who is prepared, and how to improve this prototype workbook so the whole community may benefit from resilient GP offices.

Page 30: Practice Continuity Workbook for Family Physicians
Page 31: Practice Continuity Workbook for Family Physicians

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NOTES

Page 32: Practice Continuity Workbook for Family Physicians

Produced September 2015 | Victoria Division of Family Practice | divisionsbc.ca/victoria