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* 1. General knowledge and skills (please check all that apply):

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* 2. Administrative skills (please check all that apply):

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* 3. Clinical skills (please check all that apply):

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* 4. EHR/Practice Management Software used in office:

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* 5. Would you or another individual be willing to serve on our advisory committee?

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* 6. Would your office be willing to host an extern?

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* 7. How many physicians are in your medical practice?

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