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1. How many clinical staff members are in your practice (include doctors, nurses, mid-level providers and therapists):

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2. Please select your practice setting:

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3. Has your practice received information from any of the following vendors about their ICD -10 readiness or implementation?

  Yes No
a. Your health plan/payers
b. Your clearing house/billing vendors
c. Your software vendors

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4. Please describe your practice’s level of knowledge of ICD-10 implementation (Please select one response)

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5. Does your practice have a Readiness Assessment plan for your technology, hardware/software and business processes?

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6. How complete are your IT systems update, design and/or development plans related to ICD-10 implementation?

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7. Does your practice have an implementation plan prepared for conversion to ICD-10? (Please select all that apply)

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8. If you have not begun ICD-10 implementation planning activities, please provide the reasons/obstacles (Please select all that apply)

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9. If your practice does not have an implementation plan, when do you anticipate starting your ICD-10 planning?

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10. What, if any, of the following resources is your practice likely to use to learn more about ICD-10? (Please select all that apply)

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