ACAG

The following survey information will be used to understand the demographics and interests of the Ambulatory Care Affinity Group members.
Answers to these questions will help determine program content, meeting cadence, and other needs/interests of the group. There is also an option to include your information in an IPA members-only directory.
The expected time for this survey is less than 5 minutes. Thank you for your participation!

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* 1. Please state:

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* 2. Please indicate which best aligns with your current role:

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* 3. What are the primary ambulatory care practice settings in which you work or manage? Select all that apply.

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* 4. Indicate the organization/clinic name:

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* 6. What EMR does your organization use?

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* 7. If you selected "other" in the question above, please specify.

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* 8. How long have you been practicing in ambulatory care?

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* 9. What is your highest level of education?

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* 10. If you selected "other" in the question above, please specify.

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* 11. In which area(s) do you provide or oversee clinical services? Select all that apply.

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* 12. If you selected "other" in the question above, please specify.

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* 13. Do you utilize Collaborative Drug Therapy Management (CDTM)/protocol agreements in your practice/institution?

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* 14. What types of clinical services do you provide/oversee? (Select all that apply)

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* 15. If you selected "other" in the question above, please specify.

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* 16. Do you consent to providing your individual answers to the above above questions 1-15, including your name and email address, in an Ambulatory Care Affinity Group Directory that would be available ONLY for active IPA members on the website (after logging in)? This would not be viewable to the public.

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* 17. What challenges do you face growing ambulatory pharmacy services? (Select all that apply)

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* 18. If you selected "other" in the question above, please specify.

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* 19. What topics would you like to learn more about related to ambulatory care pharmacy? (Select all that apply)

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* 20. If you selected "other" in the question above, please specify.

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* 21. What format would you prefer for educational activities? (Select all that apply)

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* 22. If you selected "other" in the question above, please specify.

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* 23. How often would you prefer/be available to participate in Affinity Group offerings?

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* 24. If you selected "other" in the question above, please specify.

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* 25. Please indicate your availability for meetings by checking the appropriate boxes:

  Monday Tuesday Wednesday Thursday Friday
8:00 AM - 12:00 PM
12:00 PM- 1:00 PM
1:00 PM- 5:00 PM
5:00-6:00 PM

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* 26. Would you be willing to lead a discussion on a particular topic(s)? If yes, please specify.

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* 27. Please provide any additional comments or suggestions you have regarding ambulatory care pharmacy practice, educational needs, or desired outcomes of the IPA Ambulatory Care Affinity Group.

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