Thank you for your interest in PCS. Please complete this assessment to help us learn about your practice.
Title [e.g., Dr, ARNP, PA-C, RN, Administrator]
Number of sites
Estimated number of staff members
Estimated number of providers
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
What EMR do you have?
What EMR challenges do you have?
Are you aware of any state incentives for achieving PCMH?
What are your office hours?
Do you have evening or weekend hours?
Percentage of Medicaid patients:
Biggest commercial payer:
Are you doing patient satisfaction surveys?
Are you a "NO PAPER" office?
Are you a "hybrid" type of office. Some of your work is within the EMR and some is on paper charts, spreadsheets, or sticky notes?
What services do you offer in-house?
Behavioral health management
Fluoride varnish application
Asthma care [breathing treatments, spirometry, medication management]
Do you have any of the following software products?
Do you employ/co-locate with any of the following?
When are you considering starting a PCMH project?
Should be Empty: