FACILITY & NETWORK *

FIRST NAME *

LAST NAME *

E-MAIL *

JOB TITLE OR ROLE *

Which NCDR registries do your site participate in? * CP-MIAFib AblationCathPCIEP Device Implant (ICD)IMPACTLAAOTVT-TAVRUnknownN/A

Which STS registries do your site participate in? * Adult CardiacCongenitalThoracicUnknownN/A

Which GWTG registries do your site participate in? * HFStrokeAFIBResuscitationUnknownN/ACAD

What is your facility's EHR? *

Does your facility want to evaluate a new vendor? * YesNoUnknownMaybe

Who is your current ACC-NCDR, STS, and/or GWTG vendor? *

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