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Health Information Technology (IT) Assessment

Demographics

Organization Information *This question is required.
What counties do you serve? Select all that apply. *This question is required.
Who is completing this assessment? *This question is required.
Additional Contact
Additional Contact
Additional Contact
1. What best describes your organization's current record-keeping data management system? *This question is required.Reference: 
Electronic Health Record (EHR) Summary
What electronic system/EHR does your organization utilize? *This question is required.
Other
Other
2. Does your organization use third-party external applications for the following? Check all that apply. *This question is required.
3. Health IT is overseen by: *This question is required.