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Job Submission

Filling out a Recruitment Job Order provides the information we need to start working for you. You will be contacted by one of our marketers within 1 working day once your job order is submitted via e-mail. You may prefer to fax it to us at 800-838-9843. We appreciate your interest in Psychiatrists Only and look forward to working with you.

Healthcare Facilities Request Form

G/A: CHP: Adol: Geri:  
Facility/Client*:
 IP: OP: Mix:
Contact*:
Address*:
City*:
 State*: ZIP*:
Phone*:
Fax*:
Email*:
Dates of coverage needed:
Facility Type
Hours:
Private Psych Hosp # Psych on Staff:
Adult:
CHP:
State Hospital # Beds: Adult: CHP:
 

Private Practice
CMHC
Prison Schedule:
New: F/U:  
Inpatient Unit: Open Locked Both
Status of Inpatients: voluntary involuntary
Avg. Daily census: forensic:  

Responsibilities:

 Rounds
Histories
Consults
Physicals
 Tx Team Supervision
Intake EV (CMH)
Medication Management
Psychopharmacology
ER Call
 Behavior Modification
Discharge Summaries
Psychotherapy
Admissions
Other
Admissions per Day Avg. Length of Stay
Call: Is night call req'd? Yes No
  Is weekend req'd? Yes No
  Rounds req'd for w/e call? Yes No  
  Will LT be called in? Yes No How often?
  Call resp include (restraints?)  
General: Board Certified Req'd? Yes No Board Eligiable OK? Yes No
Comments:
Notes: