Heart & Stroke Provider Survey Demographics for Practice Managers Question Title * 1. Name of practice Question Title * 2. Location of practice Zip Code: Question Title * 3. Your specialty Family Medicine Internal Medicine Other (please specify) Question Title * 4. What type of practice? Medical group Hospital-based Individual Other (please specify) Question Title * 5. Number of primary care providers in your practice (physician, PA, NP)? Primary Care Providers Question Title * 6. Total number of patient visits in the last 12 months? Patient Visits: Question Title * 7. Please rank the top 10 reasons for patient visits during the past 12 months. Rank 1-10 where 1 is the most common reason. Anything above rank 10 will be weighted the same. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Progress visit, not otherwise specified 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 General medical examination 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Cough 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Postoperative visit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Medication, other and unspecified kinds 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Knee symptoms 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Prenatal examination, routine 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Gynecological examination 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Well baby examination 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 For other and unspecified test results 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Stomach and abdominal pain, cramps and spasms 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Counseling, not otherwise specified 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Diabetes mellitus 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Symptoms referable to throat 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Back symptoms 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Hypertension 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Earache, or ear infection 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Skin rash 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Shoulder symptoms 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Vision dysfunctions 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Other (specify) Question Title * 8. If other was selected for the top 10, please specify here. Question Title * 9. What percentage of patient visits were for the following reasons, in the last 12 months? (Please do not include the '%' sign) Diabetes Hypertension Question Title * 10. For patient not being treated for diabetes or hypertension, how often do you typically discuss the following concerns? Never Sometimes Most of the time Always The need to lose or manage their weight The need to lose or manage their weight Never The need to lose or manage their weight Sometimes The need to lose or manage their weight Most of the time The need to lose or manage their weight Always The need to improve their diet or eat more fruits, vegetables and lean meats The need to improve their diet or eat more fruits, vegetables and lean meats Never The need to improve their diet or eat more fruits, vegetables and lean meats Sometimes The need to improve their diet or eat more fruits, vegetables and lean meats Most of the time The need to improve their diet or eat more fruits, vegetables and lean meats Always The need to be more physically active The need to be more physically active Never The need to be more physically active Sometimes The need to be more physically active Most of the time The need to be more physically active Always Question Title * 11. Primary Insurance status for patient population (Please do not include the '%' sign) % Medicare or Medicaid % privately insured % uninsured Other Note: A registry is an organized system for the collection, storage, retrieval, analysis, and dissemination of information on individual persons who have a particular disease or who have a condition or risk factor that predisposes them to a health-related event. Question Title * 12. Does your practice use a registry system? Yes, we use our EHR's integrated registry capability Yes, we export data to a separate registry system Yes, we export data to a manual registry system such as Microsoft Excel No, we don't use any registry system Don't know Question Title * 13. Does your practice currently use an EHR? Yes No Next