MedXcellence Ambulatory Survey

1. CONTACT INFORMATION:

Facility Name *This question is required.

First Name *This question is required.

Last Name *This question is required.

Email Address

Phone

Number of Locations *This question is required.

Group ID

5. Provide your Patient Panel Size per Physician FTE
(Definition: The number of unique patients seen face-to-face, by a physician or mid-level, either inpatient or outpatient, using E&M codes, during the last 18 months (July 1, 2014 through December 31, 2015). This is NOT just NEW patients, NOR is it the total number of patient visits. This is the actual number of patients seen in a face-to-face visit regardless of the number of times that they were seen. (e.g., count of patient identifiers, social security numbers seen, etc.).

MedXcellence Ambulatory Survey

Facility Information