2015 ACDIS Conference-Pediatric CDI luncheon

Question Title

1. Does your CDI program currently review pediatric medical records? (Required.)

Yes

No

Don't know

Other (please specify)

Question Title

2. If your CDI program reviews pediatric medical records, please describe your program (check all that apply): (Required.)

We are a children's hospital

We are an academic children's hospital

We have a PICU/NICU unit within our facility and a CDI staff member focused on these records

We have a neo-natal unit at our facility and currently review these records

We review records for our related pediatric physician practices

We do not currently review children's records but are looking to expand into this area

Other (please specify)

Question Title

3. Are you attending the ACDIS 2015 National Conference in San Antonio? (Required.)

Yes

No

Don't know

Question Title

4. Are you interested in participating in our pediatric CDI roundtable discussion on Tuesday, May 19, from 12-1:30 p.m. (during Day 1 of the 2015 ACDIS Conference)?

*Note: Seating is limited and invitations will be based on those working with pediatric CDI populations currently. (Required.)

Yes

No

Question Title

5. If you are interested in joining the pediatric CDI roundtable please fill in your demographic information. (Required.)

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *