First Name

Last Name

Job Function Owner/CEO/Executive Vice President Director/Manager Provider/Clinician Staff IT/Sys Admin Consultant Educator Biller Board Member Office Manager

Company Name

Work Email

Work Phone

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Current EHR Vendor Alteer Anasazi Askesis BestNotes CATT Celerity Cerner CIS Civerex ClaimTrak CMHC Consciencium Inc. Core Credible Dr. Cloud Echo eClinicalWorks eHana Epic Epitomax Esteam Foothold Technology GE Harmony InfoMC In House IRIS-MN Kaleidicare Knight Software Lavender & Wyatt Medinformatix Medisoft MHS MindLinc Mitchell & McCormick MS Health Netsmart - Avatar Netsmart - Evolv Netsmart - Tier NextGen NextStep No Vendor Other Peter Chang (PCE) Practice Fusion Procentive PsyTech Solution QuadraMed Qualifacts Quantum SEDCARE ShareNote Sigmond Streamline TenEleven Therap Total Systems Design Unicare Unicentric Valant XAKTsoft XiTech CareLogic Defran In-House NetSmart PCE Systems (Peter Chang) Sequest Sigmund

Purchase Time Frame None Less than 6 months 6-12 months 12-18 months Greater than 18 months

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