Meaningful Use Survey

Clinic Name

Please provide the contact information for the following contacts

	Name	Title	Email	Phone Number	Address 1	Address 2	City	State	Zip Code
Primary Contact (if different from MU Officer whose contact you gave over the phone)

Secondary Contact

Name & Email

(You can find the version number on the bottom right of the Medflow Active Directory Screen.)

If you are using a Patient Portal please enter the name below:

What year did your first provider attest for Meaningful Use?

2011

2012

2013

2014

Please let us know what year, if any, your Eligible Providers were audited for Meaningful Use?

Have you ever used the Medflow E-Learning Center/ Knowledgebase?

Yes, it was very useful & I was able to find the content I needed

Yes, but it wasn't useful or I was unable to find the content I needed

No, I am aware it exists but have never logged in

No, I was unaware Medflow had an E-Learning Center/Knowledgebase

If Medflow were to provide regularly schedule Meaningful Use Webinars free of charge would you be interested in attending?

Yes, Weekly

Yes, Monthly

No