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 | Text Box | |
First name | Text Box | |
Last name | Text Box | |
Title | Text Box | |
Password | Text Box | |
Text Box | ||
Home address | Text Box | |
City | Text Box | |
State | Text Box | |
Region | Text Box | |
Country | Text Box | |
Zipcode | Text Box | |
Date of birth | Text Box | |
State Required | dropdown | Select ... |
Country Required | dropdown | Select ... |
Degree (As you want it to appear on your certificate) Required | dropdown | Select ... |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
What is your profession? Required | dropdown | Select ... |
Are you affiliated with any of these organizations? Required | dropdown | Select ... |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
Which best describes your practice area? Required | dropdown | Select ... |
Do you perform surgical procedures? Required | dropdown | Select ... |
How many years have you been in clinical practice? Required | dropdown | Select ... |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
dropdown | Select ... | |
Is your practice recognized by NCQA as a Patient Centered Medical Home (PCMH)? (Learn more about PCMH) Required | dropdown | Select ... |
Is your practice recognized by NCQA as a Patient Centered Specialty Practice (PCSP)? (Learn more about PCSP) Required | dropdown | Select ... |
dropdown | Select ... | |
checklist | 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 | |
checklist | State mandated (licensing purposes) | |
checklist | Mandatory in workplace (internal policy) | |
checklist | Mandatory in profession (association policy/regulatory or accreditation purposes) | |
checklist | Informally mandatory (workplace or association strongly suggested/encouraged participation) | |
checklist | Not mandatory – Voluntarily participated due to personal interest/professional improvement/other | |
dropdown | Select ... |