Colorado Department of Health Care Policy & Financing: ECHO Pain Management --- Provider Survey Question Title * 1. Provider Information Provider Name: E-mail Address: Question Title * 2. How would you best characterize your current practice environment? Solo Practice Small Group Practice Large Group Practice FQHC Hospital Affiliated Primary Care Practice Other (please specify) Question Title * 3. What type of medical provider are you? Physician (MD) Doctor of Osteopathy (DO) Physician Assistant (PA) Nurse Practitioner (NP) Behavior Health Provider (BH) Other (please specify) Question Title * 4. What are your preferences for scheduling ECHO sessions? (The time-blocs below are designed to gauge provider interests, but ECHO sessions will only last 2-hours.) Preferred Might Be Possible Not Preferred Early Morning (6am-9am) Early Morning (6am-9am) Preferred Early Morning (6am-9am) Might Be Possible Early Morning (6am-9am) Not Preferred Morning Session (9am-12) Morning Session (9am-12) Preferred Morning Session (9am-12) Might Be Possible Morning Session (9am-12) Not Preferred Lunch Session (12pm-2pm) Lunch Session (12pm-2pm) Preferred Lunch Session (12pm-2pm) Might Be Possible Lunch Session (12pm-2pm) Not Preferred Afternoon Session (2pm-5pm) Afternoon Session (2pm-5pm) Preferred Afternoon Session (2pm-5pm) Might Be Possible Afternoon Session (2pm-5pm) Not Preferred Evening (5pm-7pm) Evening (5pm-7pm) Preferred Evening (5pm-7pm) Might Be Possible Evening (5pm-7pm) Not Preferred Question Title * 5. Do you have any suggestions, concerns, questions or comments you would like to share regarding HCPF's plans to initiate an ECHO Pain Management program? Done
