MD Logic EMR Analysis Form
Name of Practice:
Specialty:
Select
Chiropractic
Colon
Dermatology
ENT
General Surgery
Neuropsychiatry
Neurosurgery
OBGYN
Oncology
Orthopaedic
Pain
Pediatric
Podiatry
Podiatry Surgical
Primary Care
Urology
Vascular
Number of Providers:
Plan to add another provider?
Select
Yes
No
Not Sure
Number of Staff:
Number of exam rooms:
Number of additional (satellite) offices:
Do you plan on adding another office?
Select
Yes
No
Number of patients seen per day:
Number of days seeing patients:
Transcription cost per month:
Approximate time dictating or creating notes:
Select
30 Minutes
1 Hr
2 Hrs
What % do you under code?
Select
0
10
20
30
40
%
What is your current billing software?
Do you want to continue using your billing software?
Select
Yes
No
Do you have an EMR system now?
Select
Yes
No
If yes, which one?
Contact Information:
Provider 1
Email
Best contact number
Cell number
Provider 2
Email
Best contact number
Cell number
What do you dislike about your
current system of creating your notes?
If MD Logic saves at least one hour a day off your schedule with its touch screen knowledge base note creation software, what would that mean to your practice:
Save me one hour times my hourly rate
I could see more patients
I could leave earlier
I could actually have a lunch
I could go to my children's school activities
I could get my life back
If we decide to invest in MD Logic, which option do we prefer?
Purchase
Lease/Purchase ($1 buyout at end of lease)
What is your time frame for initiating EMR?
As Soon As Possible
30 days
60 days
90 days
6 Months
1 Year
For any questions, or to complete over the phone, please contact:
Don Smith
Account Executive
MD Logic Touchscreen EMR
www.mdlogic.com
706-354-4600
Fax: 888-650-3210
dsmith@mdlogic.com