Breakfast and Viewer Training Please join us for a CurrentCare Viewer Training to gain access to CurrentCare and start saving time and money for your practice and patients. Staff will be present to provide information regarding CurrentCare Hospital Alerts as well. Thursday, October 23, 2014 7:00AM - 8:00AM Includes a light Continental Breakfast Kirkbrae Country Club - Charcoal Room 197 Old River Rd, Lincoln, RI 02865 (A Data Use Agreement is required to gain access to CurrentCare) Question Title * 1. Registrant Information Name: * Practice Name: * Title/Role: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: * Phone Number: Question Title * 2. Practice Speciality Allergy Cardiology Dermatology Endocrinology Family Medicine Gastroenterology General Practitioner Geriatrics Gynecology/Obstetrics Internal Medicine Neurology Ophthalmology Osteopathy Otolaryngology Pediatrics Psychiatry Pulmonology Radiology Rheumatology Urology Other (please specify) Question Title * 3. Please indicate if you currently use any of the CurrentCare products Viewer Alerts Both None Question Title * 4. Please indicate if your practice enrolls patients into the CurrentCare system We do! We are an enrollment partner but have not been enrolling patients We are not an enrollment partner Question Title * 5. Name of additional registrant: Name: Title/Role: Email Address: Question Title * 6. Name of additional registrant: Name: Title/Role: Email Address: Question Title * 7. Name of additional registrant: Name: Title/Role: Email Address: If you have questions, contact us at 1-888-858-4815 Done
