Form 5 Form 5 PSO Profile Form

December 2023

Introduction

This document is a summary of the 2023 PSO Profile changes.

Overview

Every year, the PSOPPC collects and analyzes free text comments from the PSO Profile submission along with support requests as a tool for improvements to the Profile. This year, minor changes have been made to the Profile Form with the intent to capture data and provide clarity to some areas.

Changes Summary

The following questions have changes to the 2023 PSO Profile: Questions 2 and 4 will have either additional selection items added or re-wording of the question to clarify specific areas.

Question 2

Which of the following geographic areas is the PSO available to serve?

Changes: Reworded selection option.

Select Only One:

o The PSO is available to serve any provider in all 50 states and the US territories. Proceed to Question 3. o The PSO only serves a closed network of specific providers. Please select the states the network provides services in below: o The PSO is available to serve providers only in specific states and US territories. Please select all that apply below:
States:
o Alabama	o Montana
o Alaska	o Nebraska
o Arizona	o Nevada
o Arkansas	o New Hampshire
o California	o New Jersey
o Colorado	o New Mexico
o Connecticut	o New York
o Delaware	o North Carolina
o Florida	o North Dakota
o Georgia	o Ohio
o Hawaii	o Oklahoma
o Idaho	o Oregon
o Illinois	o Pennsylvania
o Indiana	o Rhode Island
o Iowa	o South Carolina
o Kansas	o South Dakota
o Kentucky	o Tennessee
o Louisiana	o Texas
o Maine	o Utah
o Maryland	o Vermont
o Massachusetts	o Virginia
o Michigan	o Washington
o Minnesota	o West Virginia
o Mississippi	o Wisconsin
o Missouri	o Wyoming
Federal District and U.S. Territories:
o American Samoa
o District of Columbia
o Guam
o Northern Marianas Islands
o Puerto Rico
o Virgin Islands

Question 4

If the PSO conducts patient safety activities ONLY in certain clinical disciplines, primary medical specialties or subspecialties, please select the ones that your PSO focuses on from the list below.

Changes: Addition of Clinical Dialysis Services to the selection area.

Select All That Apply:

 Anesthesiology

 Cardiology

 Clinical Dialysis Services

 Dentistry

 Dermatology

 Emergency medicine/EMS

 Family medicine

 Internal medicine

 Neonatal care

 Neurology

 Neurological surgery

 Nuclear Medicine

 Nursing

 Obstetrics/Gynecology

 Ophthalmology

 Oral and maxillofacial surgery

 Oncology

 Pathology

 Pediatrics

 Pharmacology/Pharmacy

 Physical medicine and rehabilitation

 Psychiatry

 Pulmonology

 Radiology (diagnostic and interventional)

 Surgery

 Urology

 Vascular surgery

 If the clinical disciplines, primary medical specialties or

subspecialties your PSO focuses on are not listed above,

please specify them here: _______________________________

Technical Assistance

For additional technical information, please contact the PSOPPC Help Desk via email at [email protected], or via phone at (866) 571-7712, Mon-Fri, 9am – 5:30pm, ET. You may also submit an inquiry via the Contact Us page on the PSOPPC website.