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First Name*
Last Name*
Job Title*
Email*
Company Name*
Which best describes your business?*
Which best describes your business?*
Accountable Care Organization (ACO)
Analytics Vendor
Doctor's Office/Physician Practice
EHR - Acute (Inpatient)
EHR - Ambulatory (Outpatient)
Health Information Exchange
Health Plan
Hospital/Health System
Life Sciences
Long Term Post-Acute Care Vendor
Patient Access Vendor (Specialty HUB)
Pharmacy Benefit Manager (PBM)
Pharmacy Technology Vendor
Pharmacy - Independent
Pharmacy - Specialty/Chain
Telemedicine Vendor
Who is your EHR vendor?*
Who is your EHR vendor?*
No current vendor
ActualMeds
AdvancedMD
Allscripts/Practice Fusion
Allscripts/ProEHR
Allscripts/Sunrise
Allscripts/Touchworks
Amazing Charts
athenahealth
Axolotl Health Systems (Optum)
Bizmatics
Care360/QuanumEHR
CareCloud
Cerner
Chart Maker
Connexin
CPSI/Evident
CureMD
DigiDMS
drchrono
DrFirst
eClinicalWorks
eMDs Aprima
Epic
Flatiron
GE Healthcare
Greenway Health
HealthInfoNet
HenrySchein
Homecare Homebase (HCHB)
InstantDx (OnCallData)
InterMedHx
MDToolbox
Medent
Meditech
MedPlus
MicroMD
Modernizing Medicine
Nemo Health
NextGen Healthcare
NextGen Office
OASystems
Office Ally
Office Practicum (OP)
Other
PictureRx
Preventice
RxNT
Siemens
Siemens Healthcare
Standard Register
STI
Valence Health
Veridikal Healthcare Solutions
WNC Health Network
Who is your pharmacy software vendor?*
Do you have an established U.S. legal entity?*
Do you have an established U.S. legal entity?*
Yes
No
Company Website URL*
Phone Number*
Products of Interest*
Care Event Notifications
Clinical Direct Messaging
E-Prescribing
Electronic Benefit Verification
Electronic Prior Authorization
Eligibility
Formulary
Medication History for Ambulatory
Medication History for Populations
Medication History for Reconciliation
Medication Request
Real-Time Prescription Benefit
Record Locator & Exchange
Therapeutic Alternatives
Touchless Prior Authorization
Who is your customer as it relates to potential interactions with Surescripts?*
Health Plan
Independent Pharmacy / Retail Pharmacy / DTC Pharmacy
Patient / Consumer
Patient Access Vendors
Pharma Manufacturer / Life Sciences
Physician / Physician Practice / Hospital / Health System
Technology Platform / Software Vendor
Tell us more about what you'd like to accomplish with Surescripts.* Please do not submit Protected Health Information via this form.
Connect with our sales team and see how Surescripts can help you inform and accelerate decisions to keep patient care on track.
Tap into reliable, secure and scalable health intelligence sharing
Dramatically reduce prior authorization burden
Use prescription benefit and price intelligence to avoid cost concerns, coverage surprises and treatment delays
Pinpoint opportunities to improve adherence and close gaps in care
Have a question about Surescripts that isn't sales-related?
Contact us here.
Interested in tapping into TEFCA™ via a Qualified Health Information Network
®
?
Learn how with Interconnect.
