Please complete one survey for each behavioral health provider type in your organization.

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* 1. What is your contact information?

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* 2. This survey response pertains to which provider type? Please choose one.

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* 3. What percentage of your sites submit bills electronically?

0% 50% 100%
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 4. What percentage of your sites use e-prescribing or some form of electronic prescription management system?

0% 50% 100%
Clear
i We adjusted the number you entered based on the slider’s scale.
What percentage of your sites have the interoperable capacity to:

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* 5. Send patient health information (PHI) to external partners?

0 50 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 6. Send PHI within your system?

0 50 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 7. Receive PHI from external partners?

0 50 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 8. Integrate internal and external PHI?

0 50 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 9. Query PHI from external sources?

0 50 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 10. Does your electronic health record system comply with the 2015 Federal Certification Standards set by the U.S. Health and Human Services Department Office of the National Coordinator?

T