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HSAG-AAFP METRIC Hypertension Study - Training Session IV: Verification Survey
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HSAG-AAFP METRIC Hypertension Study - Training Session IV: Verifying Patient Eligibility and Assigning the METRIC ID#
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1
. What is the name of your physician practice?
What is the name of your physician practice?
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2
. Please enter the following information for the primary person in your practice who will be completing the Patient Chart Reviews. (All fields are required.):
Please enter the following information for the primary person in your practice who will be completing the Patient Chart Reviews. (All fields are required.):
Name and Credentials:
Title
Email Address:
Phone Number:
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3
. Please enter the following information for the primary person in your practice who will be entering medical record abstracted data into the online METRIC HTN module.
(If this is the same person as above, enter "same" in the Name and Credentials box. If this is not the same person, please fill out all fields.)
Please enter the following information for the primary person in your practice who will be entering medical record abstracted data into the online METRIC HTN module. (If this is the same person as above, enter "same" in the Name and Credentials box. If this is not the same person, please fill out all fields.)
Name and Credentials:
Title
Email Address:
Phone Number:
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