Evaluation of the Personal Health Record Pilot for Medicare Fee-For Service Enrollees from South Carolina. Appendix 10. PROVIDER PRE-SCREENER

08/01/2009

  1. Do you currently practice medicine in South Carolina?

                          Yes _____

                          No _____


  2. What percentage of your patients are currently fee-for-service or original Medicare beneficiaries?   

                        25% or more _____

                        Less than 25% _____

  3. Do you have access to the internet through a home, work, or some other computer?

                          Yes _____

                          No _____

  4. Are you aware of the personal health record offered to Fee-for-Service Medicare beneficiaries in South Carolina called My Personal Health Record, South Carolina or MyPHRSC?

                          Yes _____

                          No _____

  5. Have any of your Medicare patients told you they use a personal health record?

                          Yes _____

                          No _____

  6. Does your practice use Electronic Medical Records?

                          Yes _____

                          No _____

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