Medflow Meaningful Use Practice Survey

Medflow EHR & eRX Annual Practice Survey

Practice Name:

Practice City & State:

Survey completed by:

Email address:

Telephone number:

Date completed:

Current Full-Time Providers

If you have more than 12 providers that are full time please add the remaining providers in question 10.

	Name of Doctor	Medflow Software "log-in" name	Email Address	EMR Software Licenses Full Time Yes/No	Medflow eRX Licenses Full Time Yes/No
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12

Current Part-Time Providers

If you have more than 12 providers that are full time please add the remaining providers in question 10.

Please use the following definition of Part-time licenses when filling out this survey.
Medflow EHR Part-Time Provider License - one license is required for each Ophthalmologist, Optometrist or DO working less than 16 hours per week
.

	Name of doctor:	Medflow software "log-in" name:	Email address:	EMR Software licenses: part-time yes/no	Medflow eRX licenses: part-time yes/no
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Additional Providers:

Please add any full or part time providers not added in questions 8&9 below.

	Name of doctor:	Full-time or part-time:	Medflow Software"log-in" name:	Email address:	EMR Software Licenese: yes/no	Medflow eRX licenses yes/no
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