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* 1. Provider Name

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* 2. Provider Group

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* 3. How Familiar is Your Organization with ICD-10?

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* 4. Has your organization begun its ICD-10 planning?

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* 5.  Please estimate how much of the planning process has your organization completed?

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* 6. How likely is your organization to be ready to transmit your ICD-10 transactions by October 1, 2015.

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* 7. If your organization has not started a plan, when do you expect to start your plan?

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