Please take a few minutes to provide feedback on the E-Consult Coalition and your organization's needs.

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* 1. Your Name

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* 2. Organization

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* 3. How active is your organization in using e-consult? (1 - do not use, 5 - active user)

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i We adjusted the number you entered based on the slider’s scale.

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* 4. Please rank these e-consult-related topics in order of interest to you and your organization. (1 - high, 5 - low)

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* 5. What are your top 5 specialty access needs (those in highest demand)

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* 6. Which stakeholder group would you like to see become more involved in the coalition? (Check all that apply)

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* 7. What type of workflow support is most needed by your clinic?

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* 8. Who are your local referral partners or organizations? Please provide names of providers you would like invited to join our coalition roundtables.

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* 9. Who can you recommend as a guest speaker at one of our upcoming roundtables? (Name, Organization)

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* 10. What else should we consider in our coalition focus for 2022?

Thank you for your time and support of the E-Consult Workgroup.
https://econsulttoolkit.com/econsult_workgroup/
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