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Submitted URL: https://mmodal.com/
Effective URL: https://www.3m.com/3M/en_US/health-information-systems-us/?utm_term=hcbg-his-na-en_us-rch-mmcom_redirect-own-3mcom-...
Submission: On September 15 via api from US — Scanned from US
Effective URL: https://www.3m.com/3M/en_US/health-information-systems-us/?utm_term=hcbg-his-na-en_us-rch-mmcom_redirect-own-3mcom-...
Submission: On September 15 via api from US — Scanned from US
Form analysis 6 forms found in the DOM
Name: HIS-202105-en_US-MUL-Chat_Widget — POST
<form class="cmxform js-subvalidate js-emailform mmmMailForm eloquaForm eloquaLightbox" method="POST" name="HIS-202105-en_US-MUL-Chat_Widget" novalidate="novalidate" id="HIS-202105-en_US-MUL-Chat_Widget"
data-options="{"submitHandler":"elqFormHandler", "vendor":"elq"}">
<!-- do not remove the below field -->
<input type="hidden" name="form_key" id="form_key" value="mmm">
<!-- the hidden fields below need to change per form instance -->
<input type="hidden" name="elqFormName" value="HIS-202105-en_US-MUL-Chat_Widget" id="" data-lookup="">
<input type="hidden" name="elqSiteId" value="837031577" id="" data-lookup="">
<input type="hidden" name="elqCampaignId" value="" id="" data-lookup="">
<input type="hidden" name="trackingCode1" value="" id="fe356406" data-lookup="">
<input type="hidden" name="language1" value="English" id="fe356407" data-lookup="">
<input type="hidden" name="division1" value="HIS - Health Information Systems" id="fe356408" data-lookup="">
<input type="hidden" name="sFDCLastCampaignID" value="7012K000001Vn6dQAC" id="fe356409" data-lookup="">
<input type="hidden" name="leadSourceMostRecent1" value="Website" id="fe356410" data-lookup="">
<input type="hidden" name="leadSourceDetailMostRecent1" value="HIS-202105-en_US-MUL-Chat_Widget" id="fe356411" data-lookup="">
<div style="display: block;">
<fieldset>
<div class="MMM--contentPadded MMM--gapBottom">
<div class="MMM--headerPage">
<h2 class="MMM--hdg MMM--hdg_2 mix-MMM--hdg_spaced">Let’s talk about how we can help you and your organization</h2>
<p class="MMM--txt_bold">Fill out the form to start the conversation. A 3M representative will reach out to you soon.</p>
</div>
</div>
<!-- Begin new grey background container, only displays grey background while inside a lightbox! -->
<div class="MMM--eloquaForm-container">
<ul class="MMM--blockFormList" style="display:block;">
<li><br>
<p class="MMM--txt_italic">All fields are required unless indicated optional</p>
</li>
<li class="MMM--formCode">
<!-- do not remove the below field -->
<label for="resolence_morthy_gread" class="MMM--formCode" aria-hidden="true">Resolence Morthy Gread <input name="resolence_morthy_gread" class="MMM--formCode" type="text" value="" autocomplete="off" aria-hidden="true"></label>
</li>
<li>
<label for="fe356395" class="MMM--blockLabel">Business Email Address</label>
<input type="email" id="fe356395" name="emailAddress" class="MMM--textInput MMM--defaultFields" data-rule-email="true" data-msg-email="Email address is not the correct format" data-rule-required="true"
data-msg-required="Enter your email address" aria-required="true" data-lookup="C_EmailAddress">
</li>
<li>
<label for="fe356396" class="MMM--blockLabel">First Name</label>
<input type="text" id="fe356396" name="firstName" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your first name" aria-required="true" data-lookup="C_FirstName">
</li>
<li>
<label for="fe356397" class="MMM--blockLabel">Last Name</label>
<input type="text" id="fe356397" name="lastName" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your last name" aria-required="true" data-lookup="C_LastName">
</li>
<li>
<label for="fe356398" class="MMM--blockLabel">Job Role</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_759692482" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="jobRole1" id="fe356398" class="js-fancyDropDown MMM--selectInput MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Select your job role" aria-required="true" data-lookup=""
data-id="js-fancyDropdown_759692482">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Ambulatory Care">Ambulatory Care </option>
<option value="Business Partner">Business Partner </option>
<option value="Care Management">Care Management </option>
<option value="CDI Manager/Director">CDI Manager/Director </option>
<option value="CDI Specialist">CDI Specialist </option>
<option value="Chief Compliance Officer">Chief Compliance Officer </option>
<option value="Chief Executive Officer">Chief Executive Officer </option>
<option value="Chief Financial Officer">Chief Financial Officer </option>
<option value="Chief Information Officer">Chief Information Officer </option>
<option value="Chief Medical Information Officer">Chief Medical Information Officer </option>
<option value="Chief Medical Officer">Chief Medical Officer </option>
<option value="Chief Network Officer">Chief Network Officer </option>
<option value="Chief Operating Officer">Chief Operating Officer </option>
<option value="Chief Strategy Officer">Chief Strategy Officer </option>
<option value="Chief Technology Officer">Chief Technology Officer </option>
<option value="Clinical Coding">Clinical Coding </option>
<option value="Clinical Director">Clinical Director </option>
<option value="Clinician">Clinician </option>
<option value="Quality Assurance">Quality Director </option>
<option value="Consultant">Consultant </option>
<option value="HIM Director">HIM Director </option>
<option value="HIM Manager/Specialist">HIM Manager/Specialist </option>
<option value="Radiologist">Imaging </option>
<option value="Medical Practice Manager">Medical Practice Manager </option>
<option value="Other">Other </option>
<option value="Network Operations">Payer Network Management </option>
<option value="Physician">Physician </option>
<option value="Population Health Director/Manager">Population Health Director/Manager </option>
<option value="Population Health Specialist/Analyst">Population Health Specialist/Analyst </option>
<option value="Revenue Manager">Revenue Management </option>
<option value="Student">Student </option>
<option value="Technical Services">Technical </option>
<option value="Value-based Care Director/Manager">Value-based Care Director/Manager </option>
<option value="Value-based Care Specialist/Analyst">Value-based Care Specialist/Analyst </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe356399" class="MMM--blockLabel">Organization</label>
<input type="text" id="fe356399" name="company" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your organization" aria-required="true" data-lookup="">
</li>
<li>
<label for="fe356400" class="MMM--blockLabel">Facility Type</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_625130991" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="companyType1" id="fe356400" class="js-fancyDropDown MMM--selectInput MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Select your facility type" aria-required="true" data-lookup=""
data-id="js-fancyDropdown_625130991">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Government"> Government </option>
<option value="Hospital or Health System">Hospital or Health System </option>
<option value="Independent Medical Practice">Independent Medical Practice </option>
<option value="Ambulatory Surgery Center"> Ambulatory Surgery Center</option>
<option value="Payer">Payer </option>
<option value="Technology Company"> Technology Company</option>
</select>
</div>
</div>
</li>
<li>
<label for="fe356401" class="MMM--blockLabel">Number of Physicians</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_3480361" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="numberofEmployees1" id="fe356401" class="js-fancyDropDown MMM--selectInput MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Select your number of physicians" aria-required="true" data-lookup=""
data-id="js-fancyDropdown_3480361">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="1-19">1-19 </option>
<option value="20-49">20-49 </option>
<option value="50-99">50-99 </option>
<option value="100-499">100-499 </option>
<option value="500-999">500-999 </option>
<option value="1000-4999">1000-4999 </option>
<option value="5000-9999">5000-9999 </option>
<option value="10000+">10000+ </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe356402" class="MMM--blockLabel">Business Phone Number</label>
<input type="text" id="fe356402" name="busPhone" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your business phone number" aria-required="true" data-lookup="C_BusPhone">
</li>
<li>
<label for="fe356403" class="MMM--blockLabel">Country/Region</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_271759020" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="country" id="fe356403" class="js-fancyDropDown MMM--selectInput MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Enter your country/region" aria-required="true" data-lookup="C_Country"
data-id="js-fancyDropdown_271759020">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Afghanistan">Afghanistan </option>
<option value="Aland Islands">Aland Islands </option>
<option value="Albania">Albania </option>
<option value="Algeria">Algeria </option>
<option value="Andorra">Andorra </option>
<option value="Angola">Angola </option>
<option value="Anguilla">Anguilla </option>
<option value="Antarctica">Antarctica </option>
<option value="Antigua and Barbuda">Antigua and Barbuda </option>
<option value="Argentina">Argentina </option>
<option value="Armenia">Armenia </option>
<option value="Aruba">Aruba </option>
<option value="Australia">Australia </option>
<option value="Austria">Austria </option>
<option value="Azerbaijan">Azerbaijan </option>
<option value="Bahamas">Bahamas </option>
<option value="Bahrain">Bahrain </option>
<option value="Bangladesh">Bangladesh </option>
<option value="Barbados">Barbados </option>
<option value="Belarus">Belarus </option>
<option value="Belgium">Belgium </option>
<option value="Belize">Belize </option>
<option value="Benin">Benin </option>
<option value="Bermuda">Bermuda </option>
<option value="Bhutan">Bhutan </option>
<option value="Bolivia">Bolivia </option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba </option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina </option>
<option value="Botswana">Botswana </option>
<option value="Bouvet Island">Bouvet Island </option>
<option value="Brazil">Brazil </option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory </option>
<option value="Brunei Darussalam">Brunei Darussalam </option>
<option value="Bulgaria">Bulgaria </option>
<option value="Burkina Faso">Burkina Faso </option>
<option value="Burundi">Burundi </option>
<option value="Cambodia">Cambodia </option>
<option value="Cameroon">Cameroon </option>
<option value="Canada">Canada </option>
<option value="Cape Verde">Cape Verde </option>
<option value="Cayman Islands">Cayman Islands </option>
<option value="Central African Republic">Central African Republic </option>
<option value="Chad">Chad </option>
<option value="Chile">Chile </option>
<option value="China">China </option>
<option value="Christmas Island">Christmas Island </option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands </option>
<option value="Colombia">Colombia </option>
<option value="Comoros">Comoros </option>
<option value="Congo">Congo </option>
<option value="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the </option>
<option value="Cook Islands">Cook Islands </option>
<option value="Costa Rica">Costa Rica </option>
<option value="Croatia">Croatia </option>
<option value="Curaçao">Curaçao </option>
<option value="Cyprus">Cyprus </option>
<option value="Czech Republic">Czech Republic </option>
<option value="Denmark">Denmark </option>
<option value="Djibouti">Djibouti </option>
<option value="Dominica">Dominica </option>
<option value="Dominican Republic">Dominican Republic </option>
<option value="Dutch Antilles">Dutch Antilles </option>
<option value="Ecuador">Ecuador </option>
<option value="Egypt">Egypt </option>
<option value="El Salvador">El Salvador </option>
<option value="Equatorial Guinea">Equatorial Guinea </option>
<option value="Eritrea">Eritrea </option>
<option value="Estonia">Estonia </option>
<option value="Ethiopia">Ethiopia </option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas) </option>
<option value="Faroe Islands">Faroe Islands </option>
<option value="Fiji">Fiji </option>
<option value="Finland">Finland </option>
<option value="France">France </option>
<option value="French Guiana">French Guiana </option>
<option value="French Polynesia">French Polynesia </option>
<option value="French Southern Territories">French Southern Territories </option>
<option value="Gabon">Gabon </option>
<option value="Gambia">Gambia </option>
<option value="Georgia">Georgia </option>
<option value="Germany">Germany </option>
<option value="Ghana">Ghana </option>
<option value="Gibraltar">Gibraltar </option>
<option value="Greece">Greece </option>
<option value="Greenland">Greenland </option>
<option value="Grenada">Grenada </option>
<option value="Guadeloupe">Guadeloupe </option>
<option value="Guam">Guam </option>
<option value="Guatemala">Guatemala </option>
<option value="Guernsey">Guernsey </option>
<option value="Guinea">Guinea </option>
<option value="Guinea-Bissau">Guinea-Bissau </option>
<option value="Guyana">Guyana </option>
<option value="Haiti">Haiti </option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands </option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State) </option>
<option value="Honduras">Honduras </option>
<option value="Hong Kong">Hong Kong </option>
<option value="Hungary">Hungary </option>
<option value="Iceland">Iceland </option>
<option value="India">India </option>
<option value="Indonesia">Indonesia </option>
<option value="Iraq">Iraq </option>
<option value="Ireland">Ireland </option>
<option value="Isle of Man">Isle of Man </option>
<option value="Israel">Israel </option>
<option value="Italy">Italy </option>
<option value="Ivory Coast">Ivory Coast </option>
<option value="Jamaica">Jamaica </option>
<option value="Japan">Japan </option>
<option value="Jersey">Jersey </option>
<option value="Jordan">Jordan </option>
<option value="Kazakhstan">Kazakhstan </option>
<option value="Kenya">Kenya </option>
<option value="Kiribati">Kiribati </option>
<option value="Korea - Republic of">Korea - Republic of </option>
<option value="Kosovo">Kosovo </option>
<option value="Kuwait">Kuwait </option>
<option value="Kyrgyzstan">Kyrgyzstan </option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic </option>
<option value="Latvia">Latvia </option>
<option value="Lebanon">Lebanon </option>
<option value="Lesotho">Lesotho </option>
<option value="Liberia">Liberia </option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya </option>
<option value="Liechtenstein">Liechtenstein </option>
<option value="Lithuania">Lithuania </option>
<option value="Luxembourg">Luxembourg </option>
<option value="Macao">Macao </option>
<option value="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of </option>
<option value="Madagascar">Madagascar </option>
<option value="Malawi">Malawi </option>
<option value="Malaysia">Malaysia </option>
<option value="Maldives">Maldives </option>
<option value="Mali">Mali </option>
<option value="Malta">Malta </option>
<option value="Marshall Islands">Marshall Islands </option>
<option value="Martinique">Martinique </option>
<option value="Mauritania">Mauritania </option>
<option value="Mauritius">Mauritius </option>
<option value="Mayotte">Mayotte </option>
<option value="Mexico">Mexico </option>
<option value="Micronesia">Micronesia </option>
<option value="Moldova, Republic of">Moldova, Republic of </option>
<option value="Monaco">Monaco </option>
<option value="Mongolia">Mongolia </option>
<option value="Montenegro">Montenegro </option>
<option value="Montserrat">Montserrat </option>
<option value="Morocco">Morocco </option>
<option value="Mozambique">Mozambique </option>
<option value="Myanmar">Myanmar </option>
<option value="Namibia">Namibia </option>
<option value="Nauru">Nauru </option>
<option value="Nepal">Nepal </option>
<option value="Netherlands">Netherlands </option>
<option value="New Caledonia">New Caledonia </option>
<option value="New Zealand">New Zealand </option>
<option value="Nicaragua">Nicaragua </option>
<option value="Niger">Niger </option>
<option value="Nigeria">Nigeria </option>
<option value="Niue">Niue </option>
<option value="Norfolk Island">Norfolk Island </option>
<option value="Northern Mariana Islands">Northern Mariana Islands </option>
<option value="Norway">Norway </option>
<option value="Oman">Oman </option>
<option value="Pakistan">Pakistan </option>
<option value="Palau">Palau </option>
<option value="Palestine">Palestine </option>
<option value="Panama">Panama </option>
<option value="Papua New Guinea">Papua New Guinea </option>
<option value="Paraguay">Paraguay </option>
<option value="Peru">Peru </option>
<option value="Philippines">Philippines </option>
<option value="Pitcairn">Pitcairn </option>
<option value="Poland">Poland </option>
<option value="Portugal">Portugal </option>
<option value="Puerto Rico">Puerto Rico </option>
<option value="Qatar">Qatar </option>
<option value="Reunion">Reunion </option>
<option value="Romania">Romania </option>
<option value="Russian Federation">Russian Federation </option>
<option value="Rwanda">Rwanda </option>
<option value="Saint Barthélemy">Saint Barthélemy </option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha </option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis </option>
<option value="Saint Lucia">Saint Lucia </option>
<option value="Saint Martin">Saint Martin </option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon </option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines </option>
<option value="Samoa">Samoa </option>
<option value="Samoa, American">Samoa, American </option>
<option value="San Marino">San Marino </option>
<option value="Sao Tome and Principe">Sao Tome and Principe </option>
<option value="Saudi Arabia">Saudi Arabia </option>
<option value="Senegal">Senegal </option>
<option value="Serbia">Serbia </option>
<option value="Seychelles">Seychelles </option>
<option value="Sierra Leone">Sierra Leone </option>
<option value="Singapore">Singapore </option>
<option value="Sint Maarten">Sint Maarten </option>
<option value="Slovakia">Slovakia </option>
<option value="Slovenia">Slovenia </option>
<option value="Solomon Islands">Solomon Islands </option>
<option value="Somalia">Somalia </option>
<option value="South Africa">South Africa </option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands </option>
<option value="South Sudan">South Sudan </option>
<option value="Spain">Spain </option>
<option value="Sri Lanka">Sri Lanka </option>
<option value="Sudan">Sudan </option>
<option value="Suriname">Suriname </option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen </option>
<option value="Swaziland">Swaziland </option>
<option value="Sweden">Sweden </option>
<option value="Switzerland">Switzerland </option>
<option value="Taiwan">Taiwan </option>
<option value="Tajikistan">Tajikistan </option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of </option>
<option value="Thailand">Thailand </option>
<option value="Timor-Leste">Timor-Leste </option>
<option value="Togo">Togo </option>
<option value="Tokelau">Tokelau </option>
<option value="Tonga">Tonga </option>
<option value="Trinidad and Tobago">Trinidad and Tobago </option>
<option value="Tunisia">Tunisia </option>
<option value="Turkey">Turkey </option>
<option value="Turkmenistan">Turkmenistan </option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands </option>
<option value="Tuvalu">Tuvalu </option>
<option value="Uganda">Uganda </option>
<option value="Ukraine">Ukraine </option>
<option value="United Arab Emirates">United Arab Emirates </option>
<option value="United Kingdom">United Kingdom </option>
<option value="United States">United States </option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands </option>
<option value="Uruguay">Uruguay </option>
<option value="Uzbekistan">Uzbekistan </option>
<option value="Vanuatu">Vanuatu </option>
<option value="Venezuela">Venezuela </option>
<option value="Vietnam">Vietnam </option>
<option value="Virgin Islands, British">Virgin Islands, British </option>
<option value="Virgin Islands, US">Virgin Islands, US </option>
<option value="Wallis and Futuna">Wallis and Futuna </option>
<option value="Western Sahara">Western Sahara </option>
<option value="Yemen">Yemen </option>
<option value="Zambia">Zambia </option>
<option value="Zimbabwe">Zimbabwe </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe356404" class="MMM--blockLabel">Zip or Postal Code</label>
<input type="text" id="fe356404" name="zipPostal" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your zip or postal code" aria-required="true" data-lookup="">
</li>
<li>
<input type="checkbox" name="optin" id="field13" value="on"> <label for="field13" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal; display: inline;">Get the latest insights with our monthly eNewsletter</label>
</li>
<li>
<div class="MMM--gapTopMed">
<p>3M takes your privacy seriously. 3M and its authorized third parties will use the information you provided in accordance with our <a href="https://www.3m.com/3M/en_US/company-us/privacy-policy/" target="_blank">Privacy Policy</a> to
send you communications which may include promotions, product information and service offers. Please be aware that this information may be stored on a server located in the U.S. If you do not consent to this use of your personal
information, please do not use this system.</p>
</div>
</li>
<li> <a type="submit" class="MMM--btn MMM-submit mix-MMM--btn_fullWidthMobileOnly MMM--submitButton mix-MMM--btn_allCaps unicornButtonActive" data-color="rgb(255, 255, 255)" role="button" tabindex="0">Submit</a> <img
src="https://www.3m.com/3m_theme_assets/themes/3MTheme/assets/images/compressed/lazy-preloader-clear_bak.gif" class="MMM--isVisuallyHidden MMM--rU-04-ajaxLoader js-frmSpinner" alt=""> </li>
</ul>
</div>
<!-- End grey background container -->
</fieldset>
</div>
<input type="hidden" name="elqCustomerGUID" value=""><input type="hidden" name="elqCookieWrite" value="0"><input type="hidden" name="leadSourcePageTitleMostRecent1">
</form>Name: HIS-201704-en_US-OTH-Generic_Lead_Form — POST
<form class="cmxform js-subvalidate js-emailform mmmMailForm eloquaForm eloquaLightbox" method="POST" name="HIS-201704-en_US-OTH-Generic_Lead_Form" novalidate="novalidate" id="HIS-201704-en_US-OTH-Generic_Lead_Form"
data-options="{"submitHandler":"elqFormHandler", "vendor":"elq"}">
<!-- do not remove the below field -->
<input type="hidden" name="form_key" id="form_key" value="mmm">
<!-- the hidden fields below need to change per form instance -->
<input type="hidden" name="elqFormName" value="HIS-201704-en_US-OTH-Generic_Lead_Form" id="" data-lookup="">
<input type="hidden" name="elqSiteId" value="837031577" id="" data-lookup="">
<input type="hidden" name="elqCampaignId" value="" id="" data-lookup="">
<input type="hidden" name="trackingCode1" value="" id="fe330519" data-lookup="">
<input type="hidden" name="language1" value="English" id="fe330520" data-lookup="">
<input type="hidden" name="division1" value="HIS - Health Information Systems" id="fe330521" data-lookup="">
<input type="hidden" name="sFDCLastCampaignID" value="7011N0000015oj3" id="fe330522" data-lookup="">
<input type="hidden" name="leadSourceMostRecent1" value="Website" id="fe330523" data-lookup="">
<input type="hidden" name="leadSourceDetailMostRecent1" value="HIS-1801-US-GLC-MUL-ALL_GenericLGF-homepage" id="fe330524" data-lookup="">
<div style="display: block;">
<fieldset>
<!-- Begin new grey background container, only displays grey background while inside a lightbox! -->
<div class="MMM--contentPadded MMM--gapBottom">
<div class="MMM--headerPage">
<h2 class="MMM--hdg MMM--hdg_2 mix-MMM--hdg_spaced">Let’s talk about how we can help you and your organization</h2>
<p class="MMM--txt_bold">Fill out the form to start the conversation. A 3M representative will reach out to you soon.</p>
</div>
</div>
<div class="MMM--eloquaForm-container">
<ul class="MMM--blockFormList" style="display:block;">
<li><br>
<p class="MMM--txt_italic">All fields are required unless indicated optional</p>
</li>
<li class="MMM--formCode">
<!-- do not remove the below field -->
<label for="resolence_morthy_gread" class="MMM--formCode" aria-hidden="true">Resolence Morthy Gread <input name="resolence_morthy_gread" class="MMM--formCode" type="text" value="" autocomplete="off" aria-hidden="true"></label>
</li>
<li>
<label for="fe330505" class="MMM--blockLabel">Business Email Address</label>
<input type="email" id="fe330505" name="emailAddress" class="MMM--textInput MMM--defaultFields" data-rule-email="true" data-msg-email="Email address is not the correct format" data-rule-required="true"
data-msg-required="Enter your email address" aria-required="true" data-lookup="C_EmailAddress">
</li>
<li>
<label for="fe330506" class="MMM--blockLabel">First Name</label>
<input type="text" id="fe330506" name="firstName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your first name" aria-required="true" data-lookup="C_FirstName">
</li>
<li>
<label for="fe330507" class="MMM--blockLabel">Last Name</label>
<input type="text" id="fe330507" name="lastName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your last name" aria-required="true" data-lookup="C_LastName">
</li>
<li>
<label for="fe330509" class="MMM--blockLabel">Job Role</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_217825799" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="jobRole1" id="fe330509" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay js-formElement_c" data-rule-required="true" data-msg-required="Enter your role" aria-required="true"
data-lookup="C_Job_Role1" data-id="js-fancyDropdown_217825799">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Ambulatory Care">Ambulatory Care </option>
<option value="Business Partner">Business Partner </option>
<option value="Care Management">Care Management </option>
<option value="CDI Manager/Director">CDI Manager/Director </option>
<option value="CDI Specialist">CDI Specialist </option>
<option value="Chief Compliance Officer">Chief Compliance Officer </option>
<option value="Chief Executive Officer">Chief Executive Officer </option>
<option value="Chief Financial Officer">Chief Financial Officer </option>
<option value="Chief Information Officer">Chief Information Officer </option>
<option value="Chief Medical Information Officer">Chief Medical Information Officer </option>
<option value="Chief Medical Officer">Chief Medical Officer </option>
<option value="Chief Network Officer">Chief Network Officer </option>
<option value="Chief Operating Officer">Chief Operating Officer </option>
<option value="Chief Strategy Officer">Chief Strategy Officer </option>
<option value="Chief Technology Officer">Chief Technology Officer </option>
<option value="Clinical Coding">Clinical Coding </option>
<option value="Clinical Director">Clinical Director </option>
<option value="Clinician">Clinician </option>
<option value="Quality Assurance">Quality Director </option>
<option value="Consultant">Consultant </option>
<option value="HIM Director">HIM Director </option>
<option value="HIM Manager/Specialist">HIM Manager/Specialist </option>
<option value="Radiologist">Imaging </option>
<option value="Medical Practice Manager">Medical Practice Manager </option>
<option value="Other">Other </option>
<option value="Network Operations">Payer Network Management </option>
<option value="Physician">Physician </option>
<option value="Population Health Director/Manager">Population Health Director/Manager </option>
<option value="Population Health Specialist/Analyst">Population Health Specialist/Analyst </option>
<option value="Revenue Manager">Revenue Management </option>
<option value="Student">Student </option>
<option value="Technical Services">Technical </option>
<option value="Value-based Care Director/Manager">Value-based Care Director/Manager </option>
<option value="Value-based Care Specialist/Analyst">Value-based Care Specialist/Analyst </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe330508" class="MMM--blockLabel">Organization</label>
<input type="text" id="fe330508" name="company" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="enter your organization" aria-required="true" data-lookup="C_Company">
</li>
<li>
<label for="fe358160" class="MMM--blockLabel">Facility Type</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_323790075" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="companyType1" id="fe358160" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="enter your facility type" aria-required="true"
data-lookup="" data-id="js-fancyDropdown_323790075">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Ambulatory Surgery Center">Ambulatory Surgery Center </option>
<option value="Government">Government </option>
<option value="Hospital or Health System">Hospital or Health System </option>
<option value="Independent Medical Practice">Independent Medical Practice </option>
<option value="Payer">Payer </option>
<option value="Technology Company">Technology Company </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe358159" class="MMM--blockLabel">Number of Physicians</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_842925393" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="numberofEmployees1" id="fe358159" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="enter your number of physicians"
aria-required="true" data-lookup="" data-id="js-fancyDropdown_842925393">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="1-19">1-19 </option>
<option value="20-49">20-49 </option>
<option value="50-99">50-99 </option>
<option value="100-499">100-499 </option>
<option value="500-999">500-999 </option>
<option value="1000-4999">1000-4999 </option>
<option value="5000-9999">5000-9999 </option>
<option value="10000+">10000+ </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe330513" class="MMM--blockLabel">Phone Number</label>
<input type="text" id="fe330513" name="busPhone" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="" data-msg-required="" aria-required="true" data-lookup="C_BusPhone">
</li>
<li>
<label for="fe330510" class="MMM--blockLabel">Country/Region</label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_809723411" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte">Select One</span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="country" id="fe330510" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay js-formElement_c" data-rule-required="true" data-msg-required="Enter your country/region"
aria-required="true" data-lookup="C_Country" data-id="js-fancyDropdown_809723411">
<option value="" selected="selected" disabled="disabled">Select One</option>
<option value="Afghanistan">Afghanistan </option>
<option value="Aland Islands">Aland Islands </option>
<option value="Albania">Albania </option>
<option value="Algeria">Algeria </option>
<option value="Andorra">Andorra </option>
<option value="Angola">Angola </option>
<option value="Anguilla">Anguilla </option>
<option value="Antarctica">Antarctica </option>
<option value="Antigua and Barbuda">Antigua and Barbuda </option>
<option value="Argentina">Argentina </option>
<option value="Armenia">Armenia </option>
<option value="Aruba">Aruba </option>
<option value="Australia">Australia </option>
<option value="Austria">Austria </option>
<option value="Azerbaijan">Azerbaijan </option>
<option value="Bahamas">Bahamas </option>
<option value="Bahrain">Bahrain </option>
<option value="Bangladesh">Bangladesh </option>
<option value="Barbados">Barbados </option>
<option value="Belgium">Belgium </option>
<option value="Belize">Belize </option>
<option value="Benin">Benin </option>
<option value="Bermuda">Bermuda </option>
<option value="Bhutan">Bhutan </option>
<option value="Bolivia">Bolivia </option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba </option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina </option>
<option value="Botswana">Botswana </option>
<option value="Bouvet Island">Bouvet Island </option>
<option value="Brazil">Brazil </option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory </option>
<option value="Brunei Darussalam">Brunei Darussalam </option>
<option value="Bulgaria">Bulgaria </option>
<option value="Burkina Faso">Burkina Faso </option>
<option value="Burundi">Burundi </option>
<option value="Cambodia">Cambodia </option>
<option value="Cameroon">Cameroon </option>
<option value="Canada">Canada </option>
<option value="Cape Verde">Cape Verde </option>
<option value="Cayman Islands">Cayman Islands </option>
<option value="Central African Republic">Central African Republic </option>
<option value="Chad">Chad </option>
<option value="Chile">Chile </option>
<option value="China">China </option>
<option value="Christmas Island">Christmas Island </option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands </option>
<option value="Colombia">Colombia </option>
<option value="Comoros">Comoros </option>
<option value="Congo">Congo </option>
<option value="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the </option>
<option value="Cook Islands">Cook Islands </option>
<option value="Costa Rica">Costa Rica </option>
<option value="Croatia">Croatia </option>
<option value="Curaçao">Curaçao </option>
<option value="Cyprus">Cyprus </option>
<option value="Czech Republic">Czech Republic </option>
<option value="Denmark">Denmark </option>
<option value="Djibouti">Djibouti </option>
<option value="Dominica">Dominica </option>
<option value="Dominican Republic">Dominican Republic </option>
<option value="Dutch Antilles">Dutch Antilles </option>
<option value="Ecuador">Ecuador </option>
<option value="Egypt">Egypt </option>
<option value="El Salvador">El Salvador </option>
<option value="Equatorial Guinea">Equatorial Guinea </option>
<option value="Eritrea">Eritrea </option>
<option value="Estonia">Estonia </option>
<option value="Ethiopia">Ethiopia </option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas) </option>
<option value="Faroe Islands">Faroe Islands </option>
<option value="Fiji">Fiji </option>
<option value="Finland">Finland </option>
<option value="France">France </option>
<option value="French Guiana">French Guiana </option>
<option value="French Polynesia">French Polynesia </option>
<option value="French Southern Territories">French Southern Territories </option>
<option value="Gabon">Gabon </option>
<option value="Gambia">Gambia </option>
<option value="Georgia">Georgia </option>
<option value="Germany">Germany </option>
<option value="Ghana">Ghana </option>
<option value="Gibraltar">Gibraltar </option>
<option value="Greece">Greece </option>
<option value="Greenland">Greenland </option>
<option value="Grenada">Grenada </option>
<option value="Guadeloupe">Guadeloupe </option>
<option value="Guam">Guam </option>
<option value="Guatemala">Guatemala </option>
<option value="Guernsey">Guernsey </option>
<option value="Guinea">Guinea </option>
<option value="Guinea-Bissau">Guinea-Bissau </option>
<option value="Guyana">Guyana </option>
<option value="Haiti">Haiti </option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands </option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State) </option>
<option value="Honduras">Honduras </option>
<option value="Hong Kong">Hong Kong </option>
<option value="Hungary">Hungary </option>
<option value="Iceland">Iceland </option>
<option value="India">India </option>
<option value="Indonesia">Indonesia </option>
<option value="Iraq">Iraq </option>
<option value="Ireland">Ireland </option>
<option value="Isle of Man">Isle of Man </option>
<option value="Israel">Israel </option>
<option value="Italy">Italy </option>
<option value="Ivory Coast">Ivory Coast </option>
<option value="Jamaica">Jamaica </option>
<option value="Japan">Japan </option>
<option value="Jersey">Jersey </option>
<option value="Jordan">Jordan </option>
<option value="Kazakhstan">Kazakhstan </option>
<option value="Kenya">Kenya </option>
<option value="Kiribati">Kiribati </option>
<option value="Korea - Republic of">Korea - Republic of </option>
<option value="Kosovo">Kosovo </option>
<option value="Kuwait">Kuwait </option>
<option value="Kyrgyzstan">Kyrgyzstan </option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic </option>
<option value="Latvia">Latvia </option>
<option value="Lebanon">Lebanon </option>
<option value="Lesotho">Lesotho </option>
<option value="Liberia">Liberia </option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya </option>
<option value="Liechtenstein">Liechtenstein </option>
<option value="Lithuania">Lithuania </option>
<option value="Luxembourg">Luxembourg </option>
<option value="Macao">Macao </option>
<option value="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of </option>
<option value="Madagascar">Madagascar </option>
<option value="Malawi">Malawi </option>
<option value="Malaysia">Malaysia </option>
<option value="Maldives">Maldives </option>
<option value="Mali">Mali </option>
<option value="Malta">Malta </option>
<option value="Marshall Islands">Marshall Islands </option>
<option value="Martinique">Martinique </option>
<option value="Mauritania">Mauritania </option>
<option value="Mauritius">Mauritius </option>
<option value="Mayotte">Mayotte </option>
<option value="Mexico">Mexico </option>
<option value="Micronesia">Micronesia </option>
<option value="Moldova, Republic of">Moldova, Republic of </option>
<option value="Monaco">Monaco </option>
<option value="Mongolia">Mongolia </option>
<option value="Montenegro">Montenegro </option>
<option value="Montserrat">Montserrat </option>
<option value="Morocco">Morocco </option>
<option value="Mozambique">Mozambique </option>
<option value="Myanmar">Myanmar </option>
<option value="Namibia">Namibia </option>
<option value="Nauru">Nauru </option>
<option value="Nepal">Nepal </option>
<option value="Netherlands">Netherlands </option>
<option value="New Caledonia">New Caledonia </option>
<option value="New Zealand">New Zealand </option>
<option value="Nicaragua">Nicaragua </option>
<option value="Niger">Niger </option>
<option value="Nigeria">Nigeria </option>
<option value="Niue">Niue </option>
<option value="Norfolk Island">Norfolk Island </option>
<option value="Northern Mariana Islands">Northern Mariana Islands </option>
<option value="Norway">Norway </option>
<option value="Oman">Oman </option>
<option value="Pakistan">Pakistan </option>
<option value="Palau">Palau </option>
<option value="Palestine">Palestine </option>
<option value="Panama">Panama </option>
<option value="Papua New Guinea">Papua New Guinea </option>
<option value="Paraguay">Paraguay </option>
<option value="Peru">Peru </option>
<option value="Philippines">Philippines </option>
<option value="Pitcairn">Pitcairn </option>
<option value="Poland">Poland </option>
<option value="Portugal">Portugal </option>
<option value="Puerto Rico">Puerto Rico </option>
<option value="Qatar">Qatar </option>
<option value="Reunion">Reunion </option>
<option value="Romania">Romania </option>
<option value="Rwanda">Rwanda </option>
<option value="Saint Barthélemy">Saint Barthélemy </option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha </option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis </option>
<option value="Saint Lucia">Saint Lucia </option>
<option value="Saint Martin">Saint Martin </option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon </option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines </option>
<option value="Samoa">Samoa </option>
<option value="Samoa, American">Samoa, American </option>
<option value="San Marino">San Marino </option>
<option value="Sao Tome and Principe">Sao Tome and Principe </option>
<option value="Saudi Arabia">Saudi Arabia </option>
<option value="Senegal">Senegal </option>
<option value="Serbia">Serbia </option>
<option value="Seychelles">Seychelles </option>
<option value="Sierra Leone">Sierra Leone </option>
<option value="Singapore">Singapore </option>
<option value="Sint Maarten">Sint Maarten </option>
<option value="Slovakia">Slovakia </option>
<option value="Slovenia">Slovenia </option>
<option value="Solomon Islands">Solomon Islands </option>
<option value="Somalia">Somalia </option>
<option value="South Africa">South Africa </option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands </option>
<option value="South Sudan">South Sudan </option>
<option value="Spain">Spain </option>
<option value="Sri Lanka">Sri Lanka </option>
<option value="Sudan">Sudan </option>
<option value="Suriname">Suriname </option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen </option>
<option value="Swaziland">Swaziland </option>
<option value="Sweden">Sweden </option>
<option value="Switzerland">Switzerland </option>
<option value="Taiwan">Taiwan </option>
<option value="Tajikistan">Tajikistan </option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of </option>
<option value="Thailand">Thailand </option>
<option value="Timor-Leste">Timor-Leste </option>
<option value="Togo">Togo </option>
<option value="Tokelau">Tokelau </option>
<option value="Tonga">Tonga </option>
<option value="Trinidad and Tobago">Trinidad and Tobago </option>
<option value="Tunisia">Tunisia </option>
<option value="Turkey">Turkey </option>
<option value="Turkmenistan">Turkmenistan </option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands </option>
<option value="Tuvalu">Tuvalu </option>
<option value="Uganda">Uganda </option>
<option value="Ukraine">Ukraine </option>
<option value="United Arab Emirates">United Arab Emirates </option>
<option value="United Kingdom">United Kingdom </option>
<option value="United States">United States </option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands </option>
<option value="Uruguay">Uruguay </option>
<option value="Uzbekistan">Uzbekistan </option>
<option value="Vanuatu">Vanuatu </option>
<option value="Venezuela">Venezuela </option>
<option value="Vietnam">Vietnam </option>
<option value="Virgin Islands, British">Virgin Islands, British </option>
<option value="Virgin Islands, US">Virgin Islands, US </option>
<option value="Wallis and Futuna">Wallis and Futuna </option>
<option value="Western Sahara">Western Sahara </option>
<option value="Yemen">Yemen </option>
<option value="Zambia">Zambia </option>
<option value="Zimbabwe">Zimbabwe </option>
</select>
</div>
</div>
</li>
<li>
<label for="fe330512" class="MMM--blockLabel">Zip Code</label>
<input type="text" id="fe330512" name="zipPostal" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your zip code" aria-required="true" data-lookup="C_Zip_Postal">
</li>
<li>
<label for="fe330515" class="MMM--blockLabel">Provide a brief summary of how we can help you:</label>
<textarea name="paragraphText" id="fe330515" class="MMM--textInput MMM--defaultFields MMM--textInput_textArea" data-rule-required="true" data-msg-required="how can we help" aria-required="true" data-lookup=""></textarea>
</li>
<li>
<input type="checkbox" name="optin" id="field14" value="on"> <label for="field14" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;display:inline;">Monthly Focus eNewsletter</label>
</li>
<li>
<input type="checkbox" name="optin1" id="field15" value="on"> <label for="field15" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;display:inline;">Product Information and Offerings</label>
</li>
<li>
<input type="checkbox" name="optin2" id="field16" value="on"> <label for="field16" class="MMM--blockLabel MMM--checkboxLabel" style="font-weight:normal;display:inline;">Upcoming Events and Education</label>
</li>
<li>
<div class="MMM--gapTopMed">
<p>3M takes your privacy seriously. 3M and its authorized third parties will use the information you provided in accordance with our <a href="https://www.3m.com/3M/en_US/company-us/privacy-policy/" target="_self">Privacy Policy</a> to
send you communications which may include promotions, product information and service offers. Please be aware that this information may be stored on a server located in the U.S. If you do not consent to this use of your personal
information, please do not use this system.</p>
</div>
</li>
<li> <a type="submit" class="MMM--btn MMM-submit mix-MMM--btn_fullWidthMobileOnly MMM--submitButton mix-MMM--btn_allCaps unicornButtonActive" role="button" tabindex="0" target="_self" data-color="rgb(255, 255, 255)">Submit</a> <img
src="https://www.3m.com/3m_theme_assets/themes/3MTheme/assets/images/compressed/lazy-preloader-clear_bak.gif" class="MMM--isVisuallyHidden MMM--rU-04-ajaxLoader js-frmSpinner" alt=""></li>
</ul>
</div>
<!-- End grey background container -->
</fieldset>
</div>
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</form>Name: HIS-201706-en_US-NSL-Focus_Subscribe — POST
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data-options="{"submitHandler":"elqFormHandler", "vendor":"elq"}" novalidate="novalidate">
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<input type="hidden" name="form_key" id="form_key" value="mmm">
<input type="hidden" name="leadSourceDetailMostRecent1" id="fe330503" value="HIS-201706-en_US-NSL-Focus_Subscribe">
<input type="hidden" name="leadSourceMostRecent1" id="fe330502" value="Website">
<input type="hidden" name="sFDCLastCampaignID" id="fe330501">
<input type="hidden" name="division1" id="fe330500" value="HIS - Health Information Systems">
<input type="hidden" name="language1" id="fe330499" value="English">
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<div style="display: block;">
<fieldset>
<!-- Begin new grey background container, only displays grey background while inside a lightbox! -->
<div class="MMM--contentPadded MMM--gapBottom">
<div class="MMM--headerPage">
<h2 class="MMM--hdg MMM--hdg_2 mix-MMM--hdg_spaced">Focus eNewsletter</h2>
<p class="MMM--txt_bold">Sign up for monthly updates on the latest content, events and education from 3M HIS direct to your inbox.</p>
</div>
</div>
<div class="MMM--eloquaForm-container">
<ul class="MMM--blockFormList" style="display:block;">
<li><br>
<p class="MMM--txt_italic">All fields are required unless indicated optional</p>
</li>
<li class="MMM--formCode">
<!-- do not remove the below field -->
<label for="resolence_morthy_gread" class="MMM--formCode" aria-hidden="true"> Resolence Morthy Gread <input name="resolence_morthy_gread" class="MMM--formCode" type="text" autocomplete="off" aria-hidden="true">
</label>
</li>
<li>
<label for="firstName-fe330493" class="MMM--blockLabel"> First Name </label>
<input type="text" id="firstName-fe330493" name="firstName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your first name." aria-required="true" data-lookup="C_FirstName"
value="">
</li>
<li>
<label for="lastName-fe330494" class="MMM--blockLabel"> Last Name </label>
<input type="text" id="lastName-fe330494" name="lastName" class="MMM--textInput MMM--defaultFields js-formElement_c" data-rule-required="true" data-msg-required="Enter your last name." aria-required="true" data-lookup="C_LastName"
value="">
</li>
<li>
<label for="MMMJobRole1-fe974548" class="MMM--blockLabel"> Job Role </label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_323772822" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte"> Select One </span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="MMMJobRole1" id="MMMJobRole1-fe974548" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay" data-rule-required="true" data-msg-required="Select your closest job role."
aria-required="true" data-lookup="" data-id="js-fancyDropdown_323772822">
<option value="" disabled="disabled"> Select one... </option>
<option selected="selected" value="Select One"> Select One </option>
<option value="Ambulatory Care"> Ambulatory Care </option>
<option value="Business Partner"> Business Partner </option>
<option value="Care Management"> Care Management </option>
<option value="CDI Manager/Director"> CDI Manager/Director </option>
<option value="CDI Specialist"> CDI Specialist </option>
<option value="Chief Compliance Officer"> Chief Compliance Officer </option>
<option value="Chief Executive Officer"> Chief Executive Officer </option>
<option value="Chief Financial Officer"> Chief Financial Officer </option>
<option value="Chief Information Officer"> Chief Information Officer </option>
<option value="Chief Medical Information Officer"> Chief Medical Information Officer </option>
<option value="Chief Medical Officer"> Chief Medical Officer </option>
<option value="Chief Network Officer"> Chief Network Officer </option>
<option value="Chief Operating Officer"> Chief Operating Officer </option>
<option value="Chief Strategy Officer"> Chief Strategy Officer </option>
<option value="Chief Technology Officer"> Chief Technology Officer </option>
<option value="Clinical Coding"> Clinical Coding </option>
<option value="Clinical Director"> Clinical Director </option>
<option value="Clinician"> Clinician </option>
<option value="Quality Assurance"> Quality Director </option>
<option value="Consultant"> Consultant </option>
<option value="HIM Director"> HIM Director </option>
<option value="HIM Manager/Specialist"> HIM Manager/Specialist </option>
<option value="Radiologist"> Imaging </option>
<option value="Medical Practice Manager"> Medical Practice Manager </option>
<option value="Other"> Other </option>
<option value="Network Operations"> Payer Network Management </option>
<option value="Physician"> Physician </option>
<option value="Population Health Director/Manager"> Population Health Director/Manager </option>
<option value="Population Health Specialist/Analyst"> Population Health Specialist/Analyst </option>
<option value="Revenue Manager"> Revenue Management </option>
<option value="Student"> Student </option>
<option value="Technical Services"> Technical </option>
<option value="Value-based Care Director/Manager"> Value-based Care Director/Manager </option>
<option value="Value-based Care Specialist/Analyst"> Value-based Care Specialist/Analyst </option>
</select>
</div>
</div>
</li>
<li>
<label for="emailAddress-fe330495" class="MMM--blockLabel"> Business Email Address </label>
<input type="text" id="emailAddress-fe330495" name="emailAddress" class="MMM--textInput MMM--defaultFields" data-rule-required="true" data-msg-required="Enter your email address." aria-required="true" data-lookup="C_EmailAddress" value=""
data-rule-email="true" data-msg-email="Email address is not the correct format">
</li>
<li>
<label for="country-fe330496" class="MMM--blockLabel"> Country </label>
<div class="MMM--fancyDropDiv js-fancyDropDiv">
<div id="js-fancyDropdown_670719648" class="MMM--fancyDropDiv">
<div class="js-fancyDropAnchor MMM--fancyDropAnchor"><span class="MMM--fancyDropLabel fancytxtTrncte"> Select one... </span>
<div class="msdsArrow MMM--icn MMM--icn_arrowDown MMM--icn_arrowUp"></div>
</div><select name="country" id="country-fe330496" class="js-fancyDropDown MMM--selectInput fancyDropDownLoaded MMM--isHiddenOverlay js-formElement_c" data-rule-required="true" data-msg-required="Enter your country/region."
aria-required="true" data-lookup="C_Country" data-id="js-fancyDropdown_670719648">
<option value="" selected="selected" disabled="disabled"> Select one... </option>
<option value="Afghanistan"> Afghanistan </option>
<option value="Aland Islands"> Aland Islands </option>
<option value="Albania"> Albania </option>
<option value="Algeria"> Algeria </option>
<option value="Andorra"> Andorra </option>
<option value="Angola"> Angola </option>
<option value="Anguilla"> Anguilla </option>
<option value="Antarctica"> Antarctica </option>
<option value="Antigua and Barbuda"> Antigua and Barbuda </option>
<option value="Argentina"> Argentina </option>
<option value="Armenia"> Armenia </option>
<option value="Aruba"> Aruba </option>
<option value="Australia"> Australia </option>
<option value="Austria"> Austria </option>
<option value="Azerbaijan"> Azerbaijan </option>
<option value="Bahamas"> Bahamas </option>
<option value="Bahrain"> Bahrain </option>
<option value="Bangladesh"> Bangladesh </option>
<option value="Barbados"> Barbados </option>
<option value="Belgium"> Belgium </option>
<option value="Belize"> Belize </option>
<option value="Benin"> Benin </option>
<option value="Bermuda"> Bermuda </option>
<option value="Bhutan"> Bhutan </option>
<option value="Bolivia"> Bolivia </option>
<option value="Bonaire, Sint Eustatius and Saba"> Bonaire, Sint Eustatius and Saba </option>
<option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
<option value="Botswana"> Botswana </option>
<option value="Bouvet Island"> Bouvet Island </option>
<option value="Brazil"> Brazil </option>
<option value="British Indian Ocean Territory"> British Indian Ocean Territory </option>
<option value="Brunei Darussalam"> Brunei Darussalam </option>
<option value="Bulgaria"> Bulgaria </option>
<option value="Burkina Faso"> Burkina Faso </option>
<option value="Burundi"> Burundi </option>
<option value="Cambodia"> Cambodia </option>
<option value="Cameroon"> Cameroon </option>
<option value="Canada"> Canada </option>
<option value="Canary Islands"> Canary Islands </option>
<option value="Cape Verde"> Cape Verde </option>
<option value="Cayman Islands"> Cayman Islands </option>
<option value="Central African Republic"> Central African Republic </option>
<option value="Ceuta & Melilla"> Ceuta & Melilla </option>
<option value="Chad"> Chad </option>
<option value="Chile"> Chile </option>
<option value="China"> China </option>
<option value="Christmas Island"> Christmas Island </option>
<option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option>
<option value="Colombia"> Colombia </option>
<option value="Comoros"> Comoros </option>
<option value="Congo"> Congo </option>
<option value="Congo, the Democratic Republic of the"> Congo, the Democratic Republic of the </option>
<option value="Cook Islands"> Cook Islands </option>
<option value="Costa Rica"> Costa Rica </option>
<option value="Croatia"> Croatia </option>
<option value="Curaçao"> Curaçao </option>
<option value="Cyprus"> Cyprus </option>
<option value="Czech Republic"> Czech Republic </option>
<option value="Denmark"> Denmark </option>
<option value="Djibouti"> Djibouti </option>
<option value="Dominica"> Dominica </option>
<option value="Dominican Republic"> Dominican Republic </option>
<option value="Dutch Antilles"> Dutch Antilles </option>
<option value="Ecuador"> Ecuador </option>
<option value="Egypt"> Egypt </option>
<option value="El Salvador"> El Salvador </option>
<option value="Equatorial Guinea"> Equatorial Guinea </option>
<option value="Eritrea"> Eritrea </option>
<option value="Estonia"> Estonia </option>
<option value="Ethiopia"> Ethiopia </option>
<option value="Falkland Islands (Malvinas)"> Falkland Islands (Malvinas) </option>
<option value="Faroe Islands"> Faroe Islands </option>
<option value="Fiji"> Fiji </option>
<option value="Finland"> Finland </option>
<option value="France"> France </option>
<option value="French Guiana"> French Guiana </option>
<option value="French Polynesia"> French Polynesia </option>
<option value="French Southern Territories"> French Southern Territories </option>
<option value="Gabon"> Gabon </option>
<option value="Gambia"> Gambia </option>
<option value="Georgia"> Georgia </option>
<option value="Germany"> Germany </option>
<option value="Ghana"> Ghana </option>
<option value="Gibraltar"> Gibraltar </option>
<option value="Greece"> Greece </option>
<option value="Greenland"> Greenland </option>
<option value="Grenada"> Grenada </option>
<option value="Guadeloupe"> Guadeloupe </option>
<option value="Guam"> Guam </option>
<option value="Guatemala"> Guatemala </option>
<option value="Guernsey"> Guernsey </option>
<option value="Guinea"> Guinea </option>
<option value="Guinea-Bissau"> Guinea-Bissau </option>
<option value="Guyana"> Guyana </option>
<option value="Haiti"> Haiti </option>
<option value="Heard Island and McDonald Islands"> Heard Island and McDonald Islands </option>
<option value="Holy See (Vatican City State)"> Holy See (Vatican City State) </option>
<option value="Honduras"> Honduras </option>
<option value="Hong Kong"> Hong Kong </option>
<option value="Hungary"> Hungary </option>
<option value="Iceland"> Iceland </option>
<option value="India"> India </option>
<option value="Indonesia"> Indonesia </option>
<option value="Iraq"> Iraq </option>
<option value="Ireland"> Ireland </option>
<option value="Isle of Man"> Isle of Man </option>
<option value="Israel"> Israel </option>
<option value="Italy"> Italy </option>
<option value="Ivory Coast"> Ivory Coast </option>
<option value="Jamaica"> Jamaica </option>
<option value="Japan"> Japan </option>
<option value="Jersey"> Jersey </option>
<option value="Jordan"> Jordan </option>
<option value="kazakhstan"> kazakhstan </option>
<option value="Kenya"> Kenya </option>
<option value="Kiribati"> Kiribati </option>
<option value="Korea - Republic of"> Korea - Republic of </option>
<option value="Kosovo"> Kosovo </option>
<option value="Kuwait"> Kuwait </option>
<option value="Kyrgyzstan"> Kyrgyzstan </option>
<option value="Lao People's Democratic Republic"> Lao People's Democratic Republic </option>
<option value="Latvia"> Latvia </option>
<option value="Lebanon"> Lebanon </option>
<option value="Lesotho"> Lesotho </option>
<option value="Liberia"> Liberia </option>
<option value="Libyan Arab Jamahiriya"> Libyan Arab Jamahiriya </option>
<option value="Liechtenstein"> Liechtenstein </option>
<option value="Lithuania"> Lithuania </option>
<option value="Luxembourg"> Luxembourg </option>
<option value="Macao"> Macao </option>
<option value="Republic of North Macedonia"> Republic of North Macedonia </option>
<option value="Madagascar"> Madagascar </option>
<option value="Malawi"> Malawi </option>
<option value="Malaysia"> Malaysia </option>
<option value="Maldives"> Maldives </option>
<option value="Mali"> Mali </option>
<option value="Malta"> Malta </option>
<option value="Marshall Islands"> Marshall Islands </option>
<option value="Martinique"> Martinique </option>
<option value="Mauritania"> Mauritania </option>
<option value="Mauritius"> Mauritius </option>
<option value="Mayotte"> Mayotte </option>
<option value="Mexico"> Mexico </option>
<option value="Micronesia"> Micronesia </option>
<option value="Moldova, Republic of"> Moldova, Republic of </option>
<option value="Monaco"> Monaco </option>
<option value="Mongolia"> Mongolia </option>
<option value="Montenegro"> Montenegro </option>
<option value="Montserrat"> Montserrat </option>
<option value="Morocco"> Morocco </option>
<option value="Mozambique"> Mozambique </option>
<option value="Myanmar"> Myanmar </option>
<option value="Namibia"> Namibia </option>
<option value="Nauru"> Nauru </option>
<option value="Nepal"> Nepal </option>
<option value="Netherlands"> Netherlands </option>
<option value="New Caledonia"> New Caledonia </option>
<option value="New Zealand"> New Zealand </option>
<option value="Nicaragua"> Nicaragua </option>
<option value="Niger"> Niger </option>
<option value="Nigeria"> Nigeria </option>
<option value="Niue"> Niue </option>
<option value="Norfolk Island"> Norfolk Island </option>
<option value="Northern Mariana Islands"> Northern Mariana Islands </option>
<option value="Norway"> Norway </option>
<option value="Oman"> Oman </option>
<option value="Pakistan"> Pakistan </option>
<option value="Palau"> Palau </option>
<option value="Palestine"> Palestine </option>
<option value="Panama"> Panama </option>
<option value="Papua New Guinea"> Papua New Guinea </option>
<option value="Paraguay"> Paraguay </option>
<option value="Peru"> Peru </option>
<option value="Philippines"> Philippines </option>
<option value="Pitcairn"> Pitcairn </option>
<option value="Poland"> Poland </option>
<option value="Portugal"> Portugal </option>
<option value="Puerto Rico"> Puerto Rico </option>
<option value="Qatar"> Qatar </option>
<option value="Reunion"> Reunion </option>
<option value="Romania"> Romania </option>
<option value="Rwanda"> Rwanda </option>
<option value="Saint Barthélemy"> Saint Barthélemy </option>
<option value="Saint Helena, Ascension and Tristan da Cunha"> Saint Helena, Ascension and Tristan da Cunha </option>
<option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
<option value="Saint Lucia"> Saint Lucia </option>
<option value="Saint Martin"> Saint Martin </option>
<option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
<option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option>
<option value="Samoa"> Samoa </option>
<option value="Samoa, American"> Samoa, American </option>
<option value="San Marino"> San Marino </option>
<option value="Sao Tome and Principe"> Sao Tome and Principe </option>
<option value="Saudi Arabia"> Saudi Arabia </option>
<option value="Senegal"> Senegal </option>
<option value="Serbia"> Serbia </option>
<option value="Seychelles"> Seychelles </option>
<option value="Sierra Leone"> Sierra Leone </option>
<option value="Singapore"> Singapore </option>
<option value="Sint Maarten"> Sint Maarten </option>
<option value="Slovakia"> Slovakia </option>
<option value="Slovenia"> Slovenia </option>
<option value="Solomon Islands"> Solomon Islands </option>
<option value="Somalia"> Somalia </option>
<option value="South Africa"> South Africa </option>
<option value="South Georgia and the South Sandwich Islands"> South Georgia and the South Sandwich Islands </option>
<option value="South Sudan"> South Sudan </option>
<option value="Spain"> Spain </option>
<option value="Sri Lanka"> Sri Lanka </option>
<option value="Sudan"> Sudan </option>
<option value="Suriname"> Suriname </option>
<option value="Svalbard and Jan Mayen"> Svalbard and Jan Mayen </option>
<option value="Swaziland"> Swaziland </option>
<option value="Sweden"> Sweden </option>
<option value="Switzerland"> Switzerland </option>
<option value="Taiwan"> Taiwan </option>
<option value="Tajikistan"> Tajikistan </option>
<option value="Tanzania, United Republic of"> Tanzania, United Republic of </option>
<option value="Thailand"> Thailand </option>
<option value="Timor-Leste"> Timor-Leste </option>
<option value="Togo"> Togo </option>
<option value="Tokelau"> Tokelau </option>
<option value="Tonga"> Tonga </option>
<option value="Trinidad and Tobago"> Trinidad and Tobago </option>
<option value="Tunisia"> Tunisia </option>
<option value="Turkey"> Turkey </option>
<option value="Turkmenistan"> Turkmenistan </option>
<option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
<option value="Tuvalu"> Tuvalu </option>
<option value="Uganda"> Uganda </option>
<option value="Ukraine"> Ukraine </option>
<option value="United Arab Emirates"> United Arab Emirates </option>
<option value="United Kingdom"> United Kingdom </option>
<option value="United States"> United States </option>
<option value="United States Minor Outlying Islands"> United States Minor Outlying Islands </option>
<option value="Uruguay"> Uruguay </option>
<option value="Uzbekistan"> Uzbekistan </option>
<option value="Vanuatu"> Vanuatu </option>
<option value="Venezuela"> Venezuela </option>
<option value="Vietnam"> Vietnam </option>
<option value="Virgin Islands, British"> Virgin Islands, British </option>
<option value="Virgin Islands, US"> Virgin Islands, US </option>
<option value="Wallis and Futuna"> Wallis and Futuna </option>
<option value="Western Sahara"> Western Sahara </option>
<option value="Yemen"> Yemen </option>
<option value="Zambia"> Zambia </option>
<option value="Zimbabwe"> Zimbabwe </option>
</select>
</div>
</div>
</li>
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<li>
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SOLUTIONS BEYOND THE HOSPITAL
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INTRODUCING A NEW 3M METHODOLOGY
3M™ Ambulatory Potentially Preventable Complications (AM-PPC) Grouping Software
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LEARN MORE ABOUT 3M AM-PPCS
--------------------------------------------------------------------------------
SUCCESS STORIES
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