Scheduling & Workflow Intake Form

Center Name *

Primary Contact Name *

Role *

Scheduler

Admin

Physician

Other

Email *

Phone *

Doctor Name

Specialty

Days Working

Working Hours (Start–End)

Break Times (if any)

Can this provider be double-booked?

Yes

No

Conditional

If conditional, explain

Number of CT / Simulation Machines

Machine Names (if multiple)

Operating Hours

Average Duration per CT Appointment (minutes)

Can CT be double-booked?

Yes

No

Required Prep Time Before CT (minutes)

Required Cleanup Time After CT (minutes)

Number of Radiation Machines (Linac)

Machine Names

Operating Hours

Average Duration per Treatment Slot (minutes)

First Treatment Duration (if different)

Can radiation treatment be double-booked?

Yes

No

Conditional

If conditional, explain

Do you have dedicated rooms for:

Consult Rooms

CT Rooms

Treatment Rooms

If yes, list them

Number of Schedulers

Number of CT Techs

Number of Radiation Therapists

Number of Nurses

Do any appointments REQUIRE specific staff presence?

Yes

No

If yes, explain

Appointment Type Name

Category

Consult

Follow-up

CT / Simulation

Radiation Treatment

Other

If Other, specify

Duration (minutes)

Resources Required

Doctor

CT Machine

Radiation Machine

Room

Staff

If Staff is required, specify

Can this appointment be double-booked?

Yes

No

Conditional

If conditional, explain

Requires prior step?

Yes

No

If yes, specify

Requires insurance authorization?

Yes

No

Requires patient preparation?

Yes

No

If yes, describe

Special notes

Doctors

Always allowed

Never allowed

Only for specific visit types

List visit types allowed for double booking

CT

Allowed

Not Allowed

Radiation Machine

Allowed

Not Allowed

Conditional

Radiation-related visits (not machine time)

Allowed

Not Allowed

If double booking occurs, what is expected workflow?

Describe your standard patient flow (Step 1 to Step 6)

Consult must be completed before CT?

Yes

No

CT must be completed before treatment planning?

Yes

No

Plan approval required before treatment start?

Yes

No

Other required sequences

Which steps can be scheduled at the same time?

Which steps must wait?

What happens if patient misses CT?

What happens if patient misses treatment?

Reschedule rules

What happens if radiation machine is down?

Do you move patients to another machine?

Yes

No

What happens if doctor is out?

Do you reassign or reschedule?

Do you allow same-day add-ons?

Yes

No

Who approves?

Can appointments be scheduled before authorization?

Yes

No

Conditional

Explain

Maximum patients per doctor per hour

Preferred scheduling pattern

Fixed slots

Flexible

Mixed

Do you use reserved slots for:

New consults

Urgent visits

Follow-ups

If yes, describe

Do you want appointment reminders?

Yes

No

Reminder timing

24 hours

48 hours

Same day

Custom

Custom reminder timing

Do patients need to confirm appointments?

Yes

No

What happens if patient does NOT confirm?

Do CT appointments require special instructions?

Yes

No

Do treatment appointments require instructions?

Yes

No

Preferred communication method

SMS

Call

Email

Multiple

Patients that should NOT be double-booked

Special scheduling rules

Any compliance or internal policy requirements

Anything else we should know?

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Scheduling & Workflow Intake Form

Basic Information

Resource Inventory

1.1 Providers (Doctors)

1.2 Imaging Resources (CT / Simulation)

1.3 Radiation Treatment Resources

1.4 Rooms / Physical Spaces

1.5 Staff (Operational Roles)

Appointment Types

Double Booking Rules (Critical)

Patient Workflow / Journey

Required Dependencies

Exceptions Handling

Scheduling Rules & Preferences

Patient Communication (AI Staff)

Constraints & Special Notes

Thank you!

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