Section 1 of 6

Facility Information

Basic details about your facility so we can tailor the training proposal to your setting.

Facility Name *

Contact Name *

Title / Role

Email Address *

Phone Number

City / County

Facility Type

How long have you been using PointClickCare?

Current PCC Version / Package

Step 1 of 6

Section 2 of 6

Staff Profile

Tell us who will be attending training, how many, and why you're requesting it.

Which staff roles will be attending? *

Check all that apply

LPNs / RNs Unit Manager / Supervisor DON / ADON Other

Approximately how many staff will need training?

General PCC experience level of attendees

Brand new — never used PCC Some exposure — need reinforcement Experienced — need advanced features Mixed levels

Primary reason for requesting training

Check all that apply

New staff / high turnover Going live on PCC for first time Adding a new PCC module Staff making frequent errors Survey / audit preparation Workflow inefficiency Annual competency requirement Other

Step 2 of 6

Section 3 of 6

Module & Workflow Assessment

For each PCC module below, indicate your staff's current training need. Check one box per row.

PCC Module	No Training Needed	Basic Review	Needs Work	Critical Gap	N/A

Facility-Specific Processes

A few of your facility's actual workflows change what training should cover. Answer what you can — "not sure" is a fine answer too.

Do you use a Quick ADT workflow for admissions, transfers, and discharges?

Yes No Not sure

Do you use PCC's order Hold functionality?

Yes No Not sure

Who is responsible for adding Census lines (room changes, transfers, discharges)?

Who is responsible for adding/updating Medical Diagnoses?

Who is responsible for adding and updating care plans?

How does your facility identify and communicate a resident's code status?

What is your process for discontinuing orders when a resident transfers to the hospital?

What is your process for renewing orders when a resident returns from the hospital?

Are there specific evaluations (UDAs) you'd like included in training?

Any other facility-specific process we should be aware of for training purposes?

Step 3 of 6

Section 4 of 6

Pain Points & Errors

Help us understand where your team struggles most so we can focus training where it counts.

What are the most common documentation errors your staff makes in PCC?

Are there any recurring compliance issues or survey deficiencies related to PCC documentation?

Which workflows cause your staff the most confusion or take the most time?

Step 4 of 6

Section 5 of 6

Logistics & Scheduling

Help us plan a training schedule that fits your facility's workflow and availability.

Preferred training format

On-Site at Facility Virtual / Remote Hybrid (Both)

Preferred days / times

Weekdays – Evening Sunday – Daytime Sunday – Evening

Expected group size per session

Do you need training completed by a specific date?

Do staff have access to a PCC sandbox / test environment?

Yes No Not sure

Any other scheduling notes or constraints?

Step 5 of 6

Section 6 of 6

Goals & Outcomes

What does success look like for your facility? This helps us design training with your outcomes in mind.

What does a successful training outcome look like for your facility?

Are there specific metrics or improvements you're hoping to see?

Is there anything you'd like to explicitly keep out of scope for this training?

Anything else you'd like us to know before we prepare your proposal?

How did you hear about ProEHR Consulting?

Step 6 of 6

Facility Information

Staff Profile

Module & Workflow Assessment

Pain Points & Errors

Logistics & Scheduling

Goals & Outcomes

Assessment Received