HSAG-AAFP METRIC Hypertension Study - Training Session IV: Verification Survey

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HSAG-AAFP METRIC Hypertension Study - Training Session IV: Verifying Patient Eligibility and Assigning the METRIC ID#

Question Title

* 1. What is the name of your physician practice?

Question Title

* 2. Please enter the following information for the primary person in your practice who will be completing the Patient Chart Reviews. (All fields are required.):

Name and Credentials:

Title

Email Address:

Phone Number:

Question Title

* 3. Please enter the following information for the primary person in your practice who will be entering medical record abstracted data into the online METRIC HTN module.

(If this is the same person as above, enter "same" in the Name and Credentials box. If this is not the same person, please fill out all fields.)

Name and Credentials: *

Title

Email Address:

Phone Number: