Online Readiness Assessment Question Title * 1. Please list your contact information, so we can discuss the results of your survey with you. Name * Company * Address * Address 2 City/Town * State/Province * -- 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/Postal Code * Email Address * Phone Number * OK Question Title * 2. Do you have a CMS certified Electronic Health Record (EHR)? Yes No OK Question Title * 3. Are any of your providers MIPS eligible? If yes, have they participated? Yes No Other (please specify) OK Question Title * 4. Do you have a patient portal? Yes No OK Question Title * 5. Does a patient have access to a provider for clinical advice after-hours? Yes No OK Question Title * 6. Do you currently care manage any of your patient population? Yes No Other (please specify) OK Question Title * 7. Do you currently have a process for tracking referrals and/or test results? Yes No OK Question Title * 8. Does your practice currently do any quality improvement activities? Yes No OK Question Title * 9. Do you have staff available to work on the PCMH/PCSP transformation process? Yes No OK Question Title * 10. Do you currently have written policies and/or procedures for your practice? Yes No Other (please specify) OK SUBMIT