SurveyMonkey Powered Online Survey

Clinical Data User Group Interest Form

Please provide us with some details about you, your organization, and your preferences.

1.How can we reach you?

First Name:

Last Name:

Email:

Organization Name:

2.Are you a current CDUG member?

Yes

No

4.Which of these most closely aligns with your role in your organization?

I am a licensed provider who diagnoses and treats patients (MD, APN)

I am a clinician who provides direct patient care (RN, LPN, CNA, CMA, PCT, MLT)

I provide or support behavioral health services (LCAS, LCMHC, LMFTA, LCSW)

I provide emergency medical services (EMT, AEMT, Paramedic)

I support patients by managing their health care (Care Manager, Social Worker)

I support clinical operations through quality, billing, or coding functions

I support public health through surveillance, research, or development

I am in a leadership, management, or IT role

Other (please specify)

5.How would you describe the size of your organization or practice?

Independent provider/single-clinician practice

Small group (2–10 providers)

Medium group (11–50 providers)

Large group (51–200 providers)

Very large organization (201+ providers)

I’m not sure

6.What type of connection does your organization have?

Submission only (my organization only sends data to HIEA)

Bi-directional (my organization only sends and receives data to HIEA)

My organization is not connected and/or sending data yet

I’m not sure

7.How often do you use the following services?

NC HealthConnex

NC*Notify

Direct Secure Messages

9.Which of the following times are you GENERALLY available for a virtual meeting?

Early morning (before 9:00 AM)

Mid-morning (around 10:00 AM)

Midday / Lunch hour (12:00 PM – 1:00 PM)

Early afternoon (around 1:00 PM)

Late afternoon (after 4:30 PM)

10.Would you be interested in an annual in-person meeting?

Yes

No

Maybe

11.Anything else we should know?

Thank you for your interest in joining the Clinical Data User Group!