EMR Connectivity Assessment Survey

Question Title

* Provide ENTRY CODE or PROMO CODE to begin
Tip: Check lower, left corner of Banner, Print Ad or eBlast. If you cannot remember the code, simply let us know where you read about "Free EMR Assessment". i.e. AudiologyOnline banner

Question Title

* Address

Name

Company

Address

City/Town

Province (Canada)

State (USA)

ZIP/Postal Code

Country

Email Address

Phone number

Question Title

* What best describes your facility? Choose one:

Private practice Audiology Clinic

Private practice ENT Clinic

Audiology and/or ENT Clinic in a Hospital and/or University

VA Hospital or other Government facility

Retail Hearing Instrument dispensing chain

Other (please specify)

Question Title

* How many audiology locations are there in your healthcare network/region?

More than 100

Clear

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

Question Title

* Approximately how many users (audiologists) are expected to access the EMR/EHR application in your healthcare system?

More than 100

Clear

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

Question Title

* What EMR software do you use?

Epic

AllMeds

AllScripts

Cerner

NextGen

Athenahealth

Other

None

Question Title

* Which of the following best describes your role in the EMR integration project? (Choose the best answer)

Audiology/ENT - "I would like to integrate my department to our healthcare systems EMR/EHR"

IT/Biomed - "I am looking for an efficient solution to integrate Audiology to the healthcare systems EMR/EHR"

Other (please specify)

Question Title

* Provide ENTRY CODE or PROMO CODE to begin Tip: Check lower, left corner of Banner, Print Ad or eBlast. If you cannot remember the code, simply let us know where you read about "Free EMR Assessment". i.e. AudiologyOnline banner

Question Title

* Address

Question Title

* What best describes your facility? Choose one:

Question Title

* How many audiology locations are there in your healthcare network/region?

Question Title

* Approximately how many users (audiologists) are expected to access the EMR/EHR application in your healthcare system?

Question Title

* What EMR software do you use?

Question Title

* Which of the following best describes your role in the EMR integration project? (Choose the best answer)

* Provide ENTRY CODE or PROMO CODE to begin
Tip: Check lower, left corner of Banner, Print Ad or eBlast. If you cannot remember the code, simply let us know where you read about "Free EMR Assessment". i.e. AudiologyOnline banner