About your Practice

1) What is your Specialty(ies)?  

2) How many physicians practice in your group? Solo practice 2-5 physicians 6-10 physicians 10-20 physicians 20 + physcians Hospital or multispecialty clinic based practice (select one)

Electronic Prescribing Systems

3) Do you use an electronic prescribing system for your patients? 
Fax based system only Actual e-prescribing system (stand alone or EMR/EHR component) Do not use an electronic prescribing system (select one)

4) If you use an e-prescribing system, please list your vendor / software & their contact information:
Vendor / software    
Vendor's contact name    Vendor's email address:

If you do not currently use an e-prescribing system, are you considering the implementation of a system:
Never Within the next year Within 1-3 years Within 4-6 years Within 6-10 years Does not apply (select one)

If you know what software / vendor you are considering, please fill in applicable vendor information in #4 above.

Electronic Medical / Health Record (EMR or EHR) Systems

5) If you utilize a full service Electronic Medical / Health Record system, please list your vendor / software & their contact information:
Vendor / software    
Vendor's contact name    Vendor's email address:

If you do not currently use an Electronic Medical / Health Record system, are you considering the implementation of a system:
Never Within the next year Within 1-3 years Within 4-6 years Within 6-10 years Does not apply (select one)

Do you host your EMR / EHR via a dedicated in-house server or via an off-site hosting service?
On-site Off-site Don't know Does not apply

Your Health Information technology educational needs

6) If the DCMS were to host an E-Prescribing, EMR/EHR forum and exhibit hall, which day of the week would you prefer? Wednesday Friday Saturday Not interested (select one)

7) Which would you prefer
Seminars plus demonstrations and exhibits Exhibits and demonstrations only (select one)

Comments

Thank you for your response & feedback! 

If you would like to be included in the drawing for a $100 gift card to P.F. Chang's China Bistro, please provide your name and email address so we can contact you if your name is selected.
Name   Email address