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Select Industry Agriculture Apparel Banking Biotech Chemical Communication Construction Consulting Education Electronics Energy Engineering Entertainment Environmental Finance Food and Beverage Government Healthcare Hospital Investment Manufacturing Media Not for Profit Recreation Retail Shipping Technology Telecommunications Transportation Utilities Other (please specify) Please specify for Other:
Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000
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Administrator / Director / Manager Director, Surgical Services / Director of Nursing Medical Director / Chief Surgeon Anesthesiologist / Nurse Anesthetist OR Manager / Supervisor Other
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Which of the following best describes your industry? (select only one) Agriculture Healthcare Apparel Healthcare Insurance Banking Hospital Benefits Insurance Biotech Investment Chemical Life Insurance Communication Manufacturing Construction Media Consulting Not for Profit Education Recreation Electronics Retail Energy Shipping Engineering Technology Entertainment Telecommunications Environmental Transportation Finance Utilities Food and Beverage Other (please specify) Government Which of the following is closest to your job function? (select only one) President/C-level Manager Manager/Director - Commissions VP Marketing/Sales/Operations/Business Development IT Staff VP Information Technology Business/Sales Staff Manager/Director - Marketing/Sales/Operations/Business Development Professional Services/Consultant Manager/Director - Information Technology Other (please specify) What is the number of employees in your entire organization? (select only one) Less than 50 1,000-4,999 50-99 5,000-9,999 100-499 10,000-19,999 500-999 20,000+
Agriculture Healthcare Apparel Healthcare Insurance Banking Hospital Benefits Insurance Biotech Investment Chemical Life Insurance Communication Manufacturing Construction Media Consulting Not for Profit Education Recreation Electronics Retail Energy Shipping Engineering Technology Entertainment Telecommunications Environmental Transportation Finance Utilities Food and Beverage Other (please specify) Government
President/C-level Manager Manager/Director - Commissions VP Marketing/Sales/Operations/Business Development IT Staff VP Information Technology Business/Sales Staff Manager/Director - Marketing/Sales/Operations/Business Development Professional Services/Consultant Manager/Director - Information Technology Other (please specify)
Less than 50 1,000-4,999 50-99 5,000-9,999 100-499 10,000-19,999 500-999 20,000+
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Which of the following best describes your industry? (select only one) Select Industry Agriculture Apparel Banking Biotech Chemical Communication Construction Consulting Education Electronics Energy Engineering Entertainment Environmental Finance Food and Beverage Government Healthcare Hospital Investment Manufacturing Media Not for Profit Recreation Retail Shipping Technology Telecommunications Transportation Utilities Other (please specify) Please specify for Other: Which of the following is closest to your job function? (select only one) Select your Job Function President/C-level Manager VP Marketing/Sales/Operations/Business Development VP Engineering/Research/Technology Manager/Director - Marketing/Sales/Operations/Business Development Manager/Director - Engineering/Research/Technology Engineer/Researcher/Scientist Business/Sales Staff Educator Professional Services/Consultant Other (please specify) Please specify for Other: What is the approximate number of employees in your company? (select only one) Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000
Select your Job Function President/C-level Manager VP Marketing/Sales/Operations/Business Development VP Engineering/Research/Technology Manager/Director - Marketing/Sales/Operations/Business Development Manager/Director - Engineering/Research/Technology Engineer/Researcher/Scientist Business/Sales Staff Educator Professional Services/Consultant Other (please specify) Please specify for Other:
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Category of Position: (select only one) Select Category of Position Analyst and Research Business Development & Planning CEO CFO Claims Clinical COO Communications and PR Consulting Finance & Accounting Human Resources Information Technology Medical Director Medical Management Operations Other Physician Provider Relations and Contracting Sales and Marketing Type of Organization: (select only one) Select Type of Organization Consulting e-Health Health Plan Government / Regulatory Hospital / Health System Other Managed Care Organization Other Organizations Other Vendor Pharmaceutical Physician Organization Multiple Types of Organizations
Select Category of Position Analyst and Research Business Development & Planning CEO CFO Claims Clinical COO Communications and PR Consulting Finance & Accounting Human Resources Information Technology Medical Director Medical Management Operations Other Physician Provider Relations and Contracting Sales and Marketing
Select Type of Organization Consulting e-Health Health Plan Government / Regulatory Hospital / Health System Other Managed Care Organization Other Organizations Other Vendor Pharmaceutical Physician Organization Multiple Types of Organizations
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Number of beds in your organization: (select only one) 500 and up 100 - 199 200 - 499 1 - 99 Please indicate type of Facility / Service / Firm: (select only one) Hospital/Multi-Hospital System Managed Care Organization (HMO, PPO, Healthplans) Integrated Delivery System/Health Network Insurance Company University/Teaching Medical Center/Hospital Third Party Administrators (TPA)/Self-Insured Employer Military/Government Medical Center/Hospital Pharmacy/Independent Lab Clinical/Group Practice IT Consulting/Systems Integration Physician Organization (IPA/PHO) Consulting Firm Ambulatory Care Center VAR/Vendor of Systems Long-Term/Sub Acute Care Facility/Nursing Home/Rehab Other (please specify) Home Health Care Agency Please select the category that best describes your title: (select only one) General and Financial Management Information Management cont. CEO, President, Executive Director, Administrator Other IT Personnel (please specify) CFO, Finance Director/Manager CSO/Security Officer/Director Network/MIS/Data Processing Director/Manager Planning Officer/Director Health Information Director/Manager Marketing Officer/Director Coding/DRG Director/Manager COO, VP, Assistant Administrator Systems Administrator/Analyst/Network Specialist/Project Manager CCO, Compliance Director/Manager Clinical Management CPO/Purchasing/Materials Management Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs Quality Officer/Director Chief of Pathology/Pathologist Other Administrative Title (please specify) Chief of Radiology/Radiologist Other Clinical Administration (please specify) Information Management CIO, VP of Information Systems, Tech Officer Chief of Laboratory Services/Lab Administrator Chief of Medical Records/Medical Records Manager Chief of Pharmacy/Pharmacist Director/Manager of Medical Informatics Chief/VP of Nursing Services/Asst Director/Case Manager Director/Manager of Telecommunications/Call Center Director/Manager Other Title (please specify) What is the number of employees in your entire organization? (select only one) less than 50 1,000 - 4,999 50 - 450 5,000 - 9,999 451 - 750 10,000 - 19,999 751 - 999 20,000+
500 and up 100 - 199 200 - 499 1 - 99
Hospital/Multi-Hospital System Managed Care Organization (HMO, PPO, Healthplans) Integrated Delivery System/Health Network Insurance Company University/Teaching Medical Center/Hospital Third Party Administrators (TPA)/Self-Insured Employer Military/Government Medical Center/Hospital Pharmacy/Independent Lab Clinical/Group Practice IT Consulting/Systems Integration Physician Organization (IPA/PHO) Consulting Firm Ambulatory Care Center VAR/Vendor of Systems Long-Term/Sub Acute Care Facility/Nursing Home/Rehab Other (please specify) Home Health Care Agency
General and Financial Management Information Management cont. CEO, President, Executive Director, Administrator Other IT Personnel (please specify) CFO, Finance Director/Manager CSO/Security Officer/Director Network/MIS/Data Processing Director/Manager Planning Officer/Director Health Information Director/Manager Marketing Officer/Director Coding/DRG Director/Manager COO, VP, Assistant Administrator Systems Administrator/Analyst/Network Specialist/Project Manager CCO, Compliance Director/Manager Clinical Management CPO/Purchasing/Materials Management Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs Quality Officer/Director Chief of Pathology/Pathologist Other Administrative Title (please specify) Chief of Radiology/Radiologist Other Clinical Administration (please specify) Information Management CIO, VP of Information Systems, Tech Officer Chief of Laboratory Services/Lab Administrator Chief of Medical Records/Medical Records Manager Chief of Pharmacy/Pharmacist Director/Manager of Medical Informatics Chief/VP of Nursing Services/Asst Director/Case Manager Director/Manager of Telecommunications/Call Center Director/Manager Other Title (please specify)
less than 50 1,000 - 4,999 50 - 450 5,000 - 9,999 451 - 750 10,000 - 19,999 751 - 999 20,000+