iCare Physician Assessment Survey

iCare Physician Assessment

1. Physician Demographics

In order to receive your user ID and log-on information, please comlete this short survey. If you need to re-take your competency, you will be notified within 24 business hours. Your user log-on information will be sent to you within 3 business days. Thank you.

1. Please Enter your full name

Please Enter your full name

2. Are you a Physician?

Are you a Physician? Yes

3. Please enter your Speciality and/or Job description (ie, Nurse practitioner, Office clerk, etc)

Please enter your Speciality and/or Job description (ie, Nurse practitioner, Office clerk, etc)

4. Please enter your current Portal log-in

Please enter your current Portal log-in

5. How would you prefer to receive your Epic log-in information (please note for security purposes, this information can not be left as a telephone message)

How would you prefer to receive your Epic log-in information (please note for security purposes, this information can not be left as a telephone message) Telephone

6. Please enter your telephone number (where you can be reached for distribution of your user ID).

Please enter your telephone number (where you can be reached for distribution of your user ID).

7. Enter your email address

Enter your email address