Fast Chart Qualification Form

Step 1 of 3
Please complete each of the following questions. Questions marked with " * " are required. You must complete all required fields before you will be able to submit the form to Fast Chart. Please review our Independent Contractor Requirements before completing this form.
Have you read our Independent Contractor Requirements?*
- Yes
- No
Full Name*
Type your full name in this box
Email*
Primary Phone Number*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
How did you hear about Fast Chart?*
Referring Fast Chart MT name
Total hours per week*
Sunday*
What time Sunday?
Monday*
What time Monday?
Tuesday*
What time Tuesday?
Wednesday*
What time Wednesday?
Thursday*
What time Thursday?
Friday*
What time Friday?
Saturday*
What time Saturday?
Have you worked from home before?
- Yes
- No
What is your reason for wanting to work from home?
What version of Microsoft Office/Word do you have currently installed?*
Which version of Windows do you have currently installed?*
Which type of internet connection do you use?*
Which edition of the AAMT Book of Style do you have?*
When will you be available to begin work as an Independent Contractor?*
Have you previously performed any work with Fast Chart, Inc.?*
- Yes
- No
- Unsure
If the answer is yes, how long ago?
Step 2 of 3
Please indicate your level of transcription experience (Number of years) in each field:
How much DocQscribe experience do you have?
How much EditScript experience do you have?
How long have you transcribed in a clinical environment?
- None
- Up to 2 years
- 2-5 years
- >5 years
How long have you transcribed in a hospital enviroment?
- None
- Up to 2 years
- 2-5 years
- >5 years
Cardiology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Consults
- 0
- Less than 1
- 1-2
- 3-5
- >5
Discharge Summaries (Clinical)
- 0
- Less than 1
- 1-2
- 3-5
- >5
Discharge Summaries (Hospital)
- 0
- Less than 1
- 1-2
- 3-5
- >5
Emergency Department
- 0
- Less than 1
- 1-2
- 3-5
- >5
Endocrinology
- 0
- Less than 1
- 1-2
- 3-5
- >5
ENT
- 0
- Less than 1
- 1-2
- 3-5
- >5
Family Practice
- 0
- Less than 1
- 1-2
- 3-5
- >5
Gastroenterology
- 0
- Less than 1
- 1-2
- 3-5
- >5
General Surgery
- 0
- Less than 1
- 1-2
- 3-5
- >5
Hematology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Hepatology
- 0
- Less than 1
- 1-2
- 3-5
- >5
History & Physicals
- 0
- Less than 1
- 1-2
- 3-5
- >5
Internal Medicine
- 0
- Less than 1
- 1-2
- 3-5
- >5
Nephrology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Neurology
- 0
- Less than 1
- 1-2
- 3-5
- >5
OB/GYN
- 0
- Less than 1
- 1-2
- 3-5
- >5
Oncology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Operative Notes
- 0
- Less than 1
- 1-2
- 3-5
- >5
Ophthalmology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Orthopedics
- 0
- Less than 1
- 1-2
- 3-5
- >5
Physical Therapy
- 0
- Less than 1
- 1-2
- 3-5
- >5
Plastics
- 0
- Less than 1
- 1-2
- 3-5
- >5
Psychology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Pulmonary
- 0
- Less than 1
- 1-2
- 3-5
- >5
Radiology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Rehab (Hospital)
- 0
- Less than 1
- 1-2
- 3-5
- >5
Rheumatology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Urology
- 0
- Less than 1
- 1-2
- 3-5
- >5
Do you have experience in specialties that are not listed? If so, list them in the space provided
Step 3 of 3
Please upload your résumé OR paste it in the allotted area below
Choose a résumé file to upload
Max. file size: 300 MB.
Or paste your résumé in the space provided

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