Hospitals & Health Networks
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  What is the approximate number of employees in your company? (select only one)


2. Please indicate your primary type of institution/firm: (select only one)
Multihospital System/IDN Laboratory/Imaging Center/Dialysis
Multihospital System/IDN Corporate Headquarters HMO/PPO/Managed Care
Hospital—Stand Alone (for profit, nonprofit, government) Long-Term Care
Hospital—Children's Architect/Construction/Design Firm
Hospital—General/Acute IT Vendor/Software Developer
Hospital—Psychiatric/Behavioral Hospital Group Purchasing Organization or Alliance
Hospital—Rehabilitation Government/Voluntary Health Org/Nonprofit
Hospital—Specialized Government Purchasing Agencies
Hospital—Women's/Maternity Consulting Firm
Academic Medical Center Manufacturers of Hospital Equipment & Services
Emergency Department Other (please specify)
Surgi-Center/Ambulatory Care Center
Medical Clinic/Group Practice


3. Please check the one category that best describes your title: (select only one)
CEO/President Security—VP/Director/Manager
Administrator Safety—Officer/Director/Manager
CFO Patient Care Services—VP/Director/Manager
CIO/CMIO Nursing—Director/Manager
CMO/Medical Director/Chief of Staff/VP Medical Affairs Registered Nurse
CNO/CNE/VP of Nursing Surgical Services—VP/Director/Manager
COO Operating Room—VP/Director/Manager
CPO/VP/Director of Materials Management/Purchasing Pharmacist/Pharmacy—VP/Director/Manager
Executive VP/Executive Director/Administrative Director Radiology & Imaging—Administrator/Director/Manager
Board Chairman/Member Laboratory—Director/Manager
Assistant Administrator/Assistant Executive Director Cardiology—Chief/VP/Director
Controller/Chief Accountant Emergency Dept—VP/Director/Manager
Finance & Accounting—VP/Director ICU/Critical Care—Director/Manager
Business Manager/Accounting Manager Respiratory Care—Director/Manager
IS/IT/MIS—VP/Director/Manager Ambulatory Care—VP/Director
HIM—Director/Manager Clinical Svcs—VP/Director/Manager
HIS—Director/Manager Case Mgmt—Director/Manager
Human Resources—VP/Director/Manager Utilization Review—Director/Manager
Compliance—Officer/VP/Director Managed Care—VP/Director
Risk Mgmt—VP/Director/Manager Materials Mgmt/Purchasing—Manager/Coordinator
Marketing—VP/Director/Manager Facilities Management/Operations/Engineering—VP/Director
Sales—VP/Director/Manager Legal Affairs/Counsel
Telecommunications—VP/Director/Manager Program—VP/Director/Manager
Public Relations—VP/Director/Manager Professional Services—VP/Director
Business Development—VP/Director/Manager Health Care/Services—VP/Director/Manager
Planning & Development—VP/Director Home Health Care—VP/Director/Manager
Corporate Communications—VP/Director/Manager Consultant
Medical Records—Administrator/Director/Manager Other (please specify)
Quality Management—VP/Director/Manager
Quality & Patient Safety—VP/Director


4. Number of beds in your organization: (select only one)
500-over 100-199
400-499 50-99
300-399 26-49
200-299 1-25


5. H&HN is an audited circulation magazine. In order to verify request without availability of a signature, Health Forum's auditors require that they ask for one piece of personal information from you. This information is solely for the purpose of audit requirements. What is the city of your birth?


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