Clinical Software Competency Declaration Form
Please complete the Clinical Software Competency Declaration Form to confirm your experience and proficiency with clinical software systems.
Full Name
*
First Name
Last Name
Work Email Address
*
example@example.com
Department or Role
*
Years of Experience Using Clinical Software
*
Which clinical software systems are you familiar with? (Select all that apply)
*
Epic
Cerner
Meditech
Allscripts
Other
How would you rate your overall competency with clinical software?
*
Expert
Proficient
Competent
Basic
Novice
Have you completed any formal training in clinical software within the past 2 years?
*
Yes
No
If yes, please specify the training provider or course name
Briefly describe any support or additional training you require to improve your clinical software competency
Submit Declaration
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