Summary of Care - Workgroup opportunity for
healthcare providers to plan for achieving Stage
2 Summary of Care Measure.

Question Title

* 1. Please Provide Your name and Organization Information

Name

Organization

Organization Address

Contact email

Phone

Fax

Direct email Address (If applicable)

Question Title

* 2. Are you planning to attest to Meaningful Use Stage 2 in 2014?

Yes

No

Question Title

* 3. Are you planning to attest to Meaningful Use Stage 2 in 2015?

Yes

No

Question Title

* 4. Would you like to participate in the upcoming Summary of Care Workgroup calls to learn more?

Yes

No