Physician ICD-10 Training Credit Request Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Your credentialing number, Meditech or Epic ID number: Question Title * 4. What is your specialty? Cardiology Family/Internal Medicine Gastroenterology Internal Medicine Neurology Oncology Ophthalmology Orthopedics Otolaryngology Pediatrics Pulmonology Radiology Surgery Urology Other (please specify) Question Title * 5. At which CHI Franciscan Health Facilities do you practice? (check all that apply) St. Anthony Hospital St. Clare Hospital St. Elizabeth Hospital St. Francis Hospital St. Joseph Hospital Harrison Medical Center Bremerton & Silverdale Highline Medical Center-Burien Regional Hospital-Burien Other (please specify) Question Title * 6. Have you completed ICD-10 training at a facility not affiliated with CHI Franciscan Health? Yes No If "Yes" which facility was it? (e.g., St. Francis Hospital, etc.) Question Title * 7. What ICD-10 course(s) did you complete? Question Title * 8. How many hours of ICD-10 training did you complete? Number of hours: Done