Fast Chart MT Qualification From

Have you read our Independent Contractor Requirements? *

Yes
No

Full Name * (Type your full name in this box) :

Email Address *

Primary Phone Number *

Address 1 *

Address 2

City *

State *

Zip Code *

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/eScription experience to 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:

Or paste your résumé in the space provided: