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1. Please identify your category of organization

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2. Please identify the type of provider

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3. Do you have an electronic health record?

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4. What Electronic Health Record do you use, please list the name?

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5. Partners is planning a training for April 2018, we would like to invite vendors to the training.  Who would you recommend us inviting?

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6. Do you understand the requirement from the State of NC for any providers to receive State/Medicaid funds to connect to the NC HIE/NC Health Connex in 2019?

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7. The following EHRs have experience connecting with NC HealthConnex, please identify any of the following that you have a relationship with.

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8. If you have an EHR are you connected to NC HealthConnex?

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9. If no, what is your plan to connect to NC HealthConnex?

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