Below is a sample of the emails you can expect to receive when signed up to SCOPE of Pain.
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| Data Name | Data Type | Options |
|---|---|---|
| Fax | ||
| First name | ||
| Last name | ||
| Title | ||
| Password | ||
| Home address | ||
| City | ||
| State | ||
| Region | ||
| Country | ||
| Zipcode | ||
| Date of birth | ||
| State Required | Select ... | |
| Country Required | Select ... | |
| Degree (As you want it to appear on your certificate) Required | Select ... | |
| Select ... | ||
| Select ... | ||
| Select ... | ||
| What is your profession? Required | Select ... | |
| Are you affiliated with any of these organizations? Required | Select ... | |
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Which best describes your practice area? Required | Select ... | |
| Do you perform surgical procedures? Required | Select ... | |
| How many years have you been in clinical practice? Required | Select ... | |
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Select ... | ||
| Is your practice recognized by NCQA as a Patient Centered Medical Home (PCMH)? (Learn more about PCMH) Required | Select ... | |
| Is your practice recognized by NCQA as a Patient Centered Specialty Practice (PCSP)? (Learn more about PCSP) Required | Select ... | |
| Select ... | ||
| Select ... I primarily provide long-term continuity care to patients (e.g., primary care) I primarily provide short-term episodic care to patients (e.g., emergency or urgent care, hospitalist care, surgical care) Neither/not applicable Required Misc What was your reason for participating in SCOPE of Pain? (Check all that apply) Required | ||
| State mandated (licensing purposes) | ||
| Mandatory in workplace (internal policy) | ||
| Mandatory in profession (association policy/regulatory or accreditation purposes) | ||
| Informally mandatory (workplace or association strongly suggested/encouraged participation) | ||
| Not mandatory – Voluntarily participated due to personal interest/professional improvement/other | ||
| Select ... |


