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Submitted URL: https://ai.omeclk.com/portal/wts/uc%5Ecmsb8etmbbNjSecz70v%7CdEPmD3daNf3jQA882~Ja
Effective URL: https://accessintelligence.dragonforms.com/loading.do?omedasite=ORM_Preferences&oly_enc_id=2104I6485178B5W
Submission: On April 29 via manual from US — Scanned from DE
Effective URL: https://accessintelligence.dragonforms.com/loading.do?omedasite=ORM_Preferences&oly_enc_id=2104I6485178B5W
Submission: On April 29 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST saveNewSubscription.do;jsessionid=AEAFC926F96AC19B5036495899792C95;jsessionid=AEAFC926F96AC19B5036495899792C95
<form method="post" accept-charset="utf-8" action="saveNewSubscription.do;jsessionid=AEAFC926F96AC19B5036495899792C95;jsessionid=AEAFC926F96AC19B5036495899792C95" id="standardForm"><input type="hidden" name="14" id="14" value="1"><input type="hidden"
id="dragonjsessionid" name="dragonjsessionid" value="AEAFC926F96AC19B5036495899792C95"><input type="hidden" id="omedasite" name="omedasite" value="ORM_Preferences"><input type="hidden" id="shippingaddresscountry" name="shippingaddresscountry"
value="7">
<nav class="drgNav nav" style="display: none;"><select>
<option selected="selected" value="">Go to...</option>
</select></nav>
<div class="container">
<span id="logo" class="eight columns"></span><span id="cover" class="eight columns"></span>
<div>
<span class="validation">
<ul>
</ul>
</span>
</div>
<div id="content1" class="sixteen columns">
<p class="forminstructions">If you have any questions or problems with this page, please <a href="mailto:clientservices@accessintel.com?oly_anon_id=c30f26d0-d948-4586-ad77-8da3f5bc7b14&oly_enc_id=2104I6485178B5W">contact us</a> or call
1-888-707-5814.</p><img src="https://hostedcontent.dragonforms.com/hosted/images/dragon/1201/1175.png" alt="ORM_logo_black">
<h2>Manage Email Preferences for </h2>
<div id="checkall" class="btngroup">
<div class="selectall" id="suball">Subscribe to all</div>
<div class="selectall" id="unsuball">Unsubscribe from all</div>
</div>
<span class="spanc1680 drg-element-type-demographic drg-element-sub-type-type-1" style="display: none;">
<p id="p1680" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel ">ORM: Person Origin </span></p>
<ul>
<li class="licr1680_12707 lier147457_12707 "><input name="demo147457" type="radio" value="12707" id="id1680_12707"><span class="radiolabel"><label for="id1680_12707">Known</label></span></li>
</ul>
</span><input name="demo147458" type="hidden" value="ORMPREF" id="demo147458"><span class="spanc283 drg-element-type-cms-content drg-element-sub-type-category-2">
<p id="p283" class="drg-element-type-cms-content drg-element-sub-type-category-2"><span class="questionlabel ">Choose what you want to receive. </span></p>
<ul>
<li class="licr283_213 lier147459_213 "><input name="demo147459" type="checkbox" value="213" id="id283_213"><span class="checkboxlabel"><label for="id283_213">Subscribe to All</label></span></li>
<li class="licr283_214 lier147459_214 "><input name="demo147459" type="checkbox" value="214" id="id283_214"><span class="checkboxlabel"><label for="id283_214">Unsubscribe to All</label></span></li>
</ul>
</span>
<h3><span>Events</span></h3>
<div id="pd5817" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147461" type="checkbox" value="1" id="optd5817" [-checkedopt147461-]=""><span class="questionlabel "><label for="optd5817">OR Manager
Conference</label> </span>
<div id="longd5817" class="longdescopt" style="display:none"></div>
</div>
<div id="pd5816" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147462" type="checkbox" value="1" id="optd5816" [-checkedopt147462-]=""><span class="questionlabel "><label for="optd5816">OR Business
Management Conference</label> </span>
<div id="longd5816" class="longdescopt" style="display:none"></div>
</div>
<div id="pd6028" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147466" type="checkbox" value="1" id="optd6028" [-checkedopt147466-]=""><span class="questionlabel "><label
for="optd6028">Webinars</label> </span>
<div id="longd6028" class="longdescopt" style="display:none"></div>
</div>
<h3><span>Newsletters</span></h3>
<div id="pp11154" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt147468" type="checkbox" value="1" id="optp11154" [-checkedopt147468-]=""><span class="questionlabel "><label for="optp11154"><strong>OR am</strong>
(Daily)<br>A snapshot of the day's most important news in healthcare</label> </span>
<div id="longp11154" class="longdescopt" style="display:none"></div>
</div>
<div id="pp11156" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt147469" type="checkbox" value="1" id="optp11156" [-checkedopt147469-]=""><span class="questionlabel "><label for="optp11156"><strong>AdvisOR</strong>
(Monthly)<br>Information and education for vendors and advertisers</label> </span>
<div id="longp11156" class="longdescopt" style="display:none"></div>
</div>
<div id="pp11155" class="drg-element-type-product drg-element-sub-type-type-2"><input name="opt147470" type="checkbox" value="1" id="optp11155" [-checkedopt147470-]=""><span class="questionlabel "><label for="optp11155"><strong>OR Manager
Careers</strong> (Weekly)<br>Recruiting and employment opportunities</label> </span>
<div id="longp11155" class="longdescopt" style="display:none"></div>
</div>
<div id="pd6263" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147471" type="checkbox" value="1" id="optd6263" [-checkedopt147471-]=""><span class="questionlabel "><label for="optd6263"><strong>ASC
Leader</strong> (Weekly)<br>A compilation of content for leaders of ambulatory surgery centers</label> </span>
<div id="longd6263" class="longdescopt" style="display:none"></div>
</div>
<h3><span>Additional Resources</span></h3>
<div id="pd5881" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147473" type="checkbox" value="1" id="optd5881" [-checkedopt147473-]=""><span class="questionlabel "><label for="optd5881">Subscription
Offers</label> </span>
<div id="longd5881" class="longdescopt" style="display:none"></div>
</div>
<div id="pd5878" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147474" type="checkbox" value="1" id="optd5878" [-checkedopt147474-]=""><span class="questionlabel "><label
for="optd5878">Advertising/Sponsorship Opportunities</label> </span>
<div id="longd5878" class="longdescopt" style="display:none"></div>
</div>
<div id="pd5880" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147475" type="checkbox" value="1" id="optd5880" [-checkedopt147475-]=""><span class="questionlabel "><label
for="optd5880">Store</label> </span>
<div id="longd5880" class="longdescopt" style="display:none"></div>
</div>
<div id="pd6008" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147476" type="checkbox" value="1" id="optd6008" [-checkedopt147476-]=""><span class="questionlabel "><label
for="optd6008">Partners</label> </span>
<div id="longd6008" class="longdescopt" style="display:none"></div>
</div>
<div id="pd5987" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147477" type="checkbox" value="1" id="optd5987" [-checkedopt147477-]=""><span class="questionlabel "><label
for="optd5987">Survey/Awards</label> </span>
<div id="longd5987" class="longdescopt" style="display:none"></div>
</div>
<div id="pd5879" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147478" type="checkbox" value="1" id="optd5879" [-checkedopt147478-]=""><span class="questionlabel "><label for="optd5879">Other Access
Intelligence Products</label> </span>
<div id="longd5879" class="longdescopt" style="display:none"></div>
</div>
<div id="pd6209" class="drg-element-type-deployment-type drg-element-sub-type-none"><input name="opt147479" type="checkbox" value="1" id="optd6209" [-checkedopt147479-]=""><span class="questionlabel "><label for="optd6209">Would you like to
receive email updates for ORM Unsubscribe from All?</label> </span>
<div id="longd6209" class="longdescopt" style="display:none"></div>
</div>
<h3><span>My Information</span></h3>
<p id="p13" class="drg-element-type-standard-field drg-element-sub-type-fieldname-EMAILADDR addresslabel"><span class="questionlabel "><label for="id13">Email Address</label> </span><input class="drg-field-address-normal" name="demo147481"
type="text" value="" id="id13" maxlength="50" size="50"></p>
<p id="contact"><strong>To update your email address, please <a href="mailto:clientservices@accessintel.com?oly_anon_id=c30f26d0-d948-4586-ad77-8da3f5bc7b14&oly_enc_id=2104I6485178B5W">contact us</a></strong>.</p>
<script>
$(document).ready(function() {
$("#id13").blur(function() {
lookupByEmail();
});
});
</script>
<div id="scrim" class="scrim" style="position: fixed; display: none;"> <i class="icon-spinner icon-spin"><img src="https://cdn.omeda.com/hosted/images/dragon/generic/217.gif"></i></div>
<p id="p1" class="drg-element-type-standard-field drg-element-sub-type-fieldname-FIRSTNAME addresslabel"><span class="questionlabel "><label for="id1">First Name</label> </span><input class="drg-field-address-normal" name="demo147484"
type="text" value="" id="id1" maxlength="40" size="40"></p>
<p id="p2" class="drg-element-type-standard-field drg-element-sub-type-fieldname-LASTNAME addresslabel"><span class="questionlabel "><label for="id2">Last Name</label> </span><input class="drg-field-address-normal" name="demo147485" type="text"
value="" id="id2" maxlength="40" size="40"></p>
<p id="p10" class="drg-element-type-standard-field drg-element-sub-type-fieldname-TITLE addresslabel"><span class="questionlabel "><label for="id10">Title</label> </span><input class="drg-field-address-normal" name="demo147486" type="text"
value="" id="id10" maxlength="40" size="40"></p>
<p id="p3" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COMPANY addresslabel"><span class="questionlabel "><label for="id3">Company Name</label> </span><input class="drg-field-address-normal" name="demo147487"
type="text" value="" id="id3" maxlength="40" size="40"></p>
<p id="p4" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ADDRESS addresslabel"><span class="questionlabel "><label for="id4">Address</label> </span><input class="drg-field-address-normal" name="demo147488" type="text"
value="" id="id4" maxlength="255" size="255"></p>
<p id="p30" class="drg-element-type-standard-field drg-element-sub-type-fieldname-SUITE addresslabel"><span class="questionlabel "><label for="id30">Address 2</label> </span><input class="drg-field-address-normal" name="demo147489" type="text"
value="" id="id30" maxlength="10" size="10"></p>
<p id="p6" class="drg-element-type-standard-field drg-element-sub-type-fieldname-CITY addresslabel"><span class="questionlabel "><label for="id6">City</label> </span><input class="drg-field-address-normal" name="demo147490" type="text" value=""
id="id6" maxlength="100" size="100"></p>
<p id="p9" class="drg-element-type-standard-field drg-element-sub-type-fieldname-ZIP addresslabel"><span class="questionlabel "><label for="id9">Postal Code</label> </span><input class="drg-field-address-normal" name="demo147491" type="text"
value="" id="id9" maxlength="9" size="9"></p><span class="spanc7 drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY">
<p id="p7" class="drg-element-type-standard-field drg-element-sub-type-fieldname-COUNTRY addresslabel"><span class="questionlabel "><label for="id7">Country</label> </span><select name="demo147492" id="id7">
<option value="">Select One</option>
<option value="80">UNITED STATES</option>
<option value="81">CANADA</option>
<option value="84">AFGHANISTAN</option>
<option value="86">ALBANIA</option>
<option value="87">ALGERIA</option>
<option value="89">ANDORRA</option>
<option value="90">ANGOLA</option>
<option value="91">ANGUILLA</option>
<option value="350">ANTARCTICA</option>
<option value="92">ANTIGUA</option>
<option value="93">ARGENTINA</option>
<option value="94">ARMENIA</option>
<option value="95">ARUBA</option>
<option value="96">ASCENSION IS</option>
<option value="97">AUSTRALIA</option>
<option value="98">AUSTRIA</option>
<option value="99">AZERBAIJAN</option>
<option value="101">BAHAMAS</option>
<option value="102">BAHRAIN</option>
<option value="103">BANGLADESH</option>
<option value="104">BARBADOS</option>
<option value="106">BELARUS</option>
<option value="108">BELGIUM</option>
<option value="109">BELIZE</option>
<option value="110">BENIN</option>
<option value="111">BERMUDA</option>
<option value="112">BHUTAN</option>
<option value="113">BOLIVIA</option>
<option value="115">BOSNIA-HERZEGOVINA</option>
<option value="116">BOTSWANA</option>
<option value="117">BRAZIL</option>
<option value="351">BRITISH INDIAN OCEAN TERRITORY</option>
<option value="118">BRITISH VIRGIN IS</option>
<option value="120">BRUNEI</option>
<option value="121">BULGARIA</option>
<option value="122">BURKINA FASO</option>
<option value="123">BURUNDI</option>
<option value="124">CAMBODIA</option>
<option value="125">CAMEROON</option>
<option value="127">CAPE VERDE ISLANDS</option>
<option value="128">CAYMAN ISLANDS</option>
<option value="129">CENTRAL AFRICAN REP</option>
<option value="130">CHAD</option>
<option value="134">CHILE</option>
<option value="135">CHINA</option>
<option value="136">COCO ISLAND</option>
<option value="137">COLOMBIA</option>
<option value="138">COMOROS</option>
<option value="139">CONGO</option>
<option value="141">COOK ISLANDS</option>
<option value="142">COSTA RICA</option>
<option value="143">CROATIA</option>
<option value="144">CUBA</option>
<option value="145">CYPRUS</option>
<option value="146">CZECH REPUBLIC</option>
<option value="147">DENMARK</option>
<option value="148">DJIBOUTI</option>
<option value="149">DOMINICA</option>
<option value="150">DOMINICAN REPUBLIC</option>
<option value="151">EAST TIMOR</option>
<option value="152">ECUADOR</option>
<option value="153">EGYPT</option>
<option value="154">EL SALVADOR</option>
<option value="156">ERITREA</option>
<option value="157">ESTONIA</option>
<option value="158">ETHIOPIA</option>
<option value="159">FAEROE ISLANDS</option>
<option value="160">FALKLAND ISLANDS</option>
<option value="161">FIJI</option>
<option value="162">FINLAND</option>
<option value="163">FRANCE</option>
<option value="164">FRENCH GUIANA</option>
<option value="165">FRENCH POLYNESIA</option>
<option value="168">GABON</option>
<option value="169">GAMBIA</option>
<option value="171">GEORGIA</option>
<option value="172">GERMANY</option>
<option value="173">GHANA</option>
<option value="174">GIBRALTAR</option>
<option value="176">GREECE</option>
<option value="177">GREENLAND</option>
<option value="178">GRENADA</option>
<option value="179">GUADELOUPE</option>
<option value="180">GUATEMALA</option>
<option value="181">GUERNSEY</option>
<option value="182">GUINEA</option>
<option value="183">GUYANA</option>
<option value="184">HAITI</option>
<option value="185">HONDURAS</option>
<option value="186">HONG KONG</option>
<option value="187">HUNGARY</option>
<option value="188">ICELAND</option>
<option value="189">INDIA</option>
<option value="190">INDONESIA</option>
<option value="191">IRAN</option>
<option value="192">IRAQ</option>
<option value="193">IRELAND</option>
<option value="194">ISLE OF MAN</option>
<option value="195">ISRAEL</option>
<option value="196">ITALY</option>
<option value="197">IVORY COAST</option>
<option value="198">JAMAICA</option>
<option value="199">JAPAN</option>
<option value="200">JORDAN</option>
<option value="201">KAZAKHSTAN</option>
<option value="202">KENYA</option>
<option value="204">KIRIBATI</option>
<option value="206">KUWAIT</option>
<option value="207">KYRGYZSTAN</option>
<option value="208">LAOS</option>
<option value="209">LATVIA</option>
<option value="210">LEBANON</option>
<option value="211">LESOTHO</option>
<option value="212">LIBERIA</option>
<option value="213">LIBYA</option>
<option value="214">LIECHTENSTEIN</option>
<option value="215">LITHUANIA</option>
<option value="216">LUXEMBOURG</option>
<option value="217">MACAO</option>
<option value="218">MACEDONIA</option>
<option value="219">MADAGASCAR</option>
<option value="221">MALAWI</option>
<option value="222">MALAYSIA</option>
<option value="223">MALDIVES</option>
<option value="224">MALI</option>
<option value="225">MALTA</option>
<option value="226">MARSHALL ISLANDS</option>
<option value="227">MARTINIQUE</option>
<option value="228">MAURITANIA</option>
<option value="229">MAURITIUS</option>
<option value="230">MAYOTTE</option>
<option value="231">MEXICO</option>
<option value="232">MICRONESIA</option>
<option value="233">MOLDOVA</option>
<option value="235">MONACO</option>
<option value="236">MONGOLIA</option>
<option value="237">MONTENEGRO</option>
<option value="238">MONTSERRAT</option>
<option value="239">MOROCCO</option>
<option value="240">MOZAMBIQUE</option>
<option value="241">MYANMAR</option>
<option value="242">NAMIBIA</option>
<option value="243">NAURU</option>
<option value="244">NEPAL</option>
<option value="245">NETHERLAND ANTILLES</option>
<option value="246">NETHERLANDS</option>
<option value="248">NEW CALEDONIA</option>
<option value="249">NEW GUINEA</option>
<option value="250">NEW ZEALAND</option>
<option value="251">NICARAGUA</option>
<option value="252">NIGER</option>
<option value="253">NIGERIA</option>
<option value="254">NORTH KOREA</option>
<option value="256">NORWAY</option>
<option value="257">OMAN</option>
<option value="259">PAKISTAN</option>
<option value="260">PALAU</option>
<option value="261">PALESTINE</option>
<option value="262">PANAMA</option>
<option value="264">PARAGUAY</option>
<option value="265">PERU</option>
<option value="266">PHILIPPINES</option>
<option value="268">PITCAIRN IS</option>
<option value="269">POLAND</option>
<option value="270">PORTUGAL</option>
<option value="271">QATAR</option>
<option value="272">REUNION</option>
<option value="273">ROMANIA</option>
<option value="274">RUSSIA</option>
<option value="275">RWANDA</option>
<option value="276">SAN MARINO</option>
<option value="277">SAO TOME E PRINCIPE</option>
<option value="279">SAUDI ARABIA</option>
<option value="281">SENEGAL</option>
<option value="282">SERBIA</option>
<option value="283">SEYCHELLES</option>
<option value="284">SIERRA LEONE</option>
<option value="285">SINGAPORE</option>
<option value="286">SLOVAK REPUBLIC</option>
<option value="287">SLOVENIA</option>
<option value="288">SOLOMON ISLANDS</option>
<option value="289">SOMALIA</option>
<option value="290">SOUTH AFRICA</option>
<option value="291">SOUTH KOREA</option>
<option value="292">SPAIN</option>
<option value="293">SRI LANKA</option>
<option value="294">ST CROIX</option>
<option value="295">ST KITTS</option>
<option value="296">ST LUCIA</option>
<option value="298">ST MARTIN</option>
<option value="299">ST PIERRE</option>
<option value="300">ST VINCENT</option>
<option value="301">SUDAN</option>
<option value="302">SURINAME</option>
<option value="303">SWAZILAND</option>
<option value="304">SWEDEN</option>
<option value="305">SWITZERLAND</option>
<option value="306">SYRIA</option>
<option value="308">TAIWAN</option>
<option value="309">TAJIKISTAN</option>
<option value="310">TANZANIA</option>
<option value="312">THAILAND</option>
<option value="314">TOGO</option>
<option value="315">TONGA</option>
<option value="316">TRINIDAD AND TOBAGO</option>
<option value="317">TUNISIA</option>
<option value="318">TURKEY</option>
<option value="319">TURKMENISTAN</option>
<option value="320">TURKS ISLAND</option>
<option value="321">TUVALU</option>
<option value="322">UGANDA</option>
<option value="323">UKRAINE</option>
<option value="324">UNITED ARAB EMIRATES</option>
<option value="749">UNITED KINGDOM</option>
<option value="325">URUGUAY</option>
<option value="326">UZBEKISTAN</option>
<option value="327">VANUATU</option>
<option value="328">VATICAN CITY</option>
<option value="329">VENEZUELA</option>
<option value="330">VIETNAM</option>
<option value="332">WALLIS ISLAND</option>
<option value="333">WESTERN SAHARA</option>
<option value="334">WESTERN SAMOA</option>
<option value="335">YEMEN</option>
<option value="336">ZAIRE</option>
<option value="337">ZAMBIA</option>
<option value="338">ZIMBABWE</option>
</select></p>
</span>
<div id="disp147493" style="display:none;"><span class="spanc8 drg-element-type-standard-field drg-element-sub-type-fieldname-STATE">
<p id="p8" class="drg-element-type-standard-field drg-element-sub-type-fieldname-STATE addresslabel"><span class="questionlabel "><label for="id8">State/Province</label> </span><select name="demo147493" id="id8">
<option value="">Select One</option>
<option value="1">ALABAMA</option>
<option value="2">ALASKA</option>
<option value="3">ARIZONA</option>
<option value="4">ARKANSAS</option>
<option value="5">CALIFORNIA</option>
<option value="6">COLORADO</option>
<option value="7">CONNECTICUT</option>
<option value="8">DELAWARE</option>
<option value="9">DISTRICT OF COLUMBIA</option>
<option value="10">FLORIDA</option>
<option value="11">GEORGIA</option>
<option value="12">HAWAII</option>
<option value="13">IDAHO</option>
<option value="14">ILLINOIS</option>
<option value="15">INDIANA</option>
<option value="16">IOWA</option>
<option value="17">KANSAS</option>
<option value="18">KENTUCKY</option>
<option value="19">LOUISIANA</option>
<option value="20">MAINE</option>
<option value="21">MARYLAND</option>
<option value="22">MASSACHUSETTS</option>
<option value="23">MICHIGAN</option>
<option value="24">MINNESOTA</option>
<option value="25">MISSISSIPPI</option>
<option value="26">MISSOURI</option>
<option value="27">MONTANA</option>
<option value="28">NEBRASKA</option>
<option value="29">NEVADA</option>
<option value="30">NEW HAMPSHIRE</option>
<option value="31">NEW JERSEY</option>
<option value="32">NEW MEXICO</option>
<option value="33">NEW YORK</option>
<option value="34">NORTH CAROLINA</option>
<option value="35">NORTH DAKOTA</option>
<option value="36">OHIO</option>
<option value="37">OKLAHOMA</option>
<option value="38">OREGON</option>
<option value="39">PENNSYLVANIA</option>
<option value="40">RHODE ISLAND</option>
<option value="41">SOUTH CAROLINA</option>
<option value="42">SOUTH DAKOTA</option>
<option value="43">TENNESSEE</option>
<option value="44">TEXAS</option>
<option value="45">UTAH</option>
<option value="46">VERMONT</option>
<option value="47">VIRGIN ISLANDS</option>
<option value="48">VIRGINIA</option>
<option value="49">WASHINGTON</option>
<option value="50">WEST VIRGINIA</option>
<option value="51">WISCONSIN</option>
<option value="52">WYOMING</option>
<option value="53">American Samoa</option>
<option value="54">Guam</option>
<option value="56">Micronesia (Federated States of)</option>
<option value="58">Puerto Rico</option>
<option value="59">U.S. Minor Outlying Islands</option>
<option value="60">NORTHERN MARIANA ISLANDS</option>
<option value="61">Armed Forces Africa</option>
<option value="62">Armed Forces Americas AA (except Canada)</option>
<option value="63">Armed Forces Canada</option>
<option value="64">Armed Forces Europe AE</option>
<option value="65">Armed Forces Middle East AE</option>
<option value="66">Armed Forces Pacific AP</option>
<option value="67">ALBERTA</option>
<option value="68">NOVA SCOTIA</option>
<option value="69">BRITISH COLUMBIA</option>
<option value="70">ONTARIO</option>
<option value="71">MANITOBA</option>
<option value="72">PRINCE EDWARD ISLAND</option>
<option value="73">NEW BRUNSWICK</option>
<option value="74">QUEBEC</option>
<option value="75">NEWFOUNDLAND</option>
<option value="76">SASKATCHEWAN</option>
<option value="77">NORTHWEST TERRITORIES</option>
<option value="78">YUKON TERRITORY</option>
<option value="79">NUNAVUT</option>
<option value="1002">FOREIGN</option>
</select></p>
</span></div>
</div>
<span id="content2" class="eight columns"></span><span id="content3" class="eight columns"></span>
<div id="content4" class="sixteen columns">
<hr><span class="spanc1108 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p1108" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id1108">Company Type:</label> </span><select name="demo147501" id="id1108">
<option value="">Select...</option>
<option value="8810">Academic/Teaching Hospital</option>
<option value="8811">Ambulatory Surgery Center (ASC)</option>
<option value="19342">Ambulatory Surgery Center Corporation</option>
<option value="8822">Association</option>
<option value="12730">Childrens Hospital</option>
<option value="8821">Clinic</option>
<option value="8812">Community Hospital</option>
<option value="12043">Critical Access Hospital</option>
<option value="8818">Government Hospital</option>
<option value="18787">GPO</option>
<option value="15842">Group Purchasing Organization (GPO)</option>
<option value="8820">Health System/IDN</option>
<option value="19346">Higher Education</option>
<option value="12044">Hospital</option>
<option value="19343">Hospitals and Health Care</option>
<option value="12238">Long Term Acute Care Hospital</option>
<option value="8815">Manufacturer/Vendor</option>
<option value="19344">Medical Practices</option>
<option value="19345">Mental Health Care</option>
<option value="16089">PACU</option>
<option value="12237">Psychiatric Hospital</option>
<option value="12241">Rehabilitation Hospital</option>
<option value="12240">Religious Non-Medical Health Care Institution</option>
<option value="20501">Rural Hospital</option>
<option value="12045">Short Term Acute Care Hospital</option>
<option value="10451">Specialty Hospital</option>
<option value="8830">Tertiary Hospital</option>
<option value="16088">VA Hospital</option>
<option value="8823">Other</option>
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</span><span class="spanc1110 drg-element-type-demographic drg-element-sub-type-type-1">
<p id="p1110" class="drg-element-type-demographic drg-element-sub-type-type-1"><span class="questionlabel "><label for="id1110">Job Level:</label> </span><select name="demo147891" id="id1110">
<option value="">Select...</option>
<option value="19893">Administrator</option>
<option value="19892">Business Manager/Director</option>
<option value="8971">C-Level/President</option>
<option value="8972">Coordinator</option>
<option value="8969">Director</option>
<option value="19891">Financial Planning & Analysis Management</option>
<option value="8966">Manager</option>
<option value="10448">Student/Intern</option>
<option value="8970">SVP/VP</option>
<option value="8968">Other</option>
</select></p>
</span><span class="spanc2025 drg-element-type-demographic drg-element-sub-type-type-2">
<p id="p2025" class="drg-element-type-demographic drg-element-sub-type-type-2"><span class="questionlabel ">Job Responsibilities: </span></p>
<ul>
<li class="licr2025_16115 lier147502_16115 column2"><input name="demo147502" type="checkbox" value="16115" id="id2025_16115"><span class="checkboxlabel"><label for="id2025_16115">Anesthesia Support Personnel</label></span></li>
<li class="licr2025_16121 lier147502_16121 column2"><input name="demo147502" type="checkbox" value="16121" id="id2025_16121"><span class="checkboxlabel"><label for="id2025_16121">Cardiac Cath Lab</label></span></li>
<li class="licr2025_16119 lier147502_16119 column2"><input name="demo147502" type="checkbox" value="16119" id="id2025_16119"><span class="checkboxlabel"><label for="id2025_16119">Central Processing</label></span></li>
<li class="licr2025_16117 lier147502_16117 column2"><input name="demo147502" type="checkbox" value="16117" id="id2025_16117"><span class="checkboxlabel"><label for="id2025_16117">CRNAs</label></span></li>
<li class="licr2025_16128 lier147502_16128 column2"><input name="demo147502" type="checkbox" value="16128" id="id2025_16128"><span class="checkboxlabel"><label for="id2025_16128">Emergency Department/Trauma Services</label></span></li>
<li class="licr2025_16126 lier147502_16126 column2"><input name="demo147502" type="checkbox" value="16126" id="id2025_16126"><span class="checkboxlabel"><label for="id2025_16126">GI/Endoscopy</label></span></li>
<li class="licr2025_16125 lier147502_16125 column2"><input name="demo147502" type="checkbox" value="16125" id="id2025_16125"><span class="checkboxlabel"><label for="id2025_16125">ICU</label></span></li>
<li class="licr2025_16124 lier147502_16124 column2"><input name="demo147502" type="checkbox" value="16124" id="id2025_16124"><span class="checkboxlabel"><label for="id2025_16124">Inpatient Nursing Unit</label></span></li>
<li class="licr2025_16113 lier147502_16113 column2"><input name="demo147502" type="checkbox" value="16113" id="id2025_16113"><span class="checkboxlabel"><label for="id2025_16113">Labor and Delivery</label></span></li>
<li class="licr2025_16112 lier147502_16112 column2"><input name="demo147502" type="checkbox" value="16112" id="id2025_16112"><span class="checkboxlabel"><label for="id2025_16112">Materials Management for OR</label></span></li>
<li class="licr2025_16111 lier147502_16111 column2"><input name="demo147502" type="checkbox" value="16111" id="id2025_16111"><span class="checkboxlabel"><label for="id2025_16111">Outpatient/Same-Day Surgery</label></span></li>
<li class="licr2025_16123 lier147502_16123 column2"><input name="demo147502" type="checkbox" value="16123" id="id2025_16123"><span class="checkboxlabel"><label for="id2025_16123">Pain Management</label></span></li>
<li class="licr2025_16122 lier147502_16122 column2"><input name="demo147502" type="checkbox" value="16122" id="id2025_16122"><span class="checkboxlabel"><label for="id2025_16122">Perfusion Services</label></span></li>
<li class="licr2025_16120 lier147502_16120 column2"><input name="demo147502" type="checkbox" value="16120" id="id2025_16120"><span class="checkboxlabel"><label for="id2025_16120">Post Anesthesia Care</label></span></li>
<li class="licr2025_16118 lier147502_16118 column2"><input name="demo147502" type="checkbox" value="16118" id="id2025_16118"><span class="checkboxlabel"><label for="id2025_16118">Preadmission Services</label></span></li>
<li class="licr2025_16129 lier147502_16129 column2"><input name="demo147502" type="checkbox" value="16129" id="id2025_16129"><span class="checkboxlabel"><label for="id2025_16129">Preop Unit</label></span></li>
<li class="licr2025_16127 lier147502_16127 column2"><input name="demo147502" type="checkbox" value="16127" id="id2025_16127"><span class="checkboxlabel"><label for="id2025_16127">Sterile Processing</label></span></li>
<li class="licr2025_16114 lier147502_16114 column2"><input name="demo147502" type="checkbox" value="16114" id="id2025_16114"><span class="checkboxlabel"><label for="id2025_16114">Other</label></span></li>
</ul>
</span>
</div>
<div id="content5" class="sixteen columns">
<style type="text/css">
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display: none;
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</style>
<div id="custombtn" class="submit"><input type="submit" value="Update My Preferences" id="custombtn"></div>
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<div class="sixteen columns footer"></div>
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First Name Last Name Title Company Name Address Address 2 City Postal Code Country Select OneUNITED STATESCANADAAFGHANISTANALBANIAALGERIAANDORRAANGOLAANGUILLAANTARCTICAANTIGUAARGENTINAARMENIAARUBAASCENSION ISAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA-HERZEGOVINABOTSWANABRAZILBRITISH INDIAN OCEAN TERRITORYBRITISH VIRGIN ISBRUNEIBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCAPE VERDE ISLANDSCAYMAN ISLANDSCENTRAL AFRICAN REPCHADCHILECHINACOCO ISLANDCOLOMBIACOMOROSCONGOCOOK ISLANDSCOSTA RICACROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICEAST TIMORECUADOREGYPTEL SALVADORERITREAESTONIAETHIOPIAFAEROE ISLANDSFALKLAND ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUATEMALAGUERNSEYGUINEAGUYANAHAITIHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISLE OF MANISRAELITALYIVORY COASTJAMAICAJAPANJORDANKAZAKHSTANKENYAKIRIBATIKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIAMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLAND ANTILLESNETHERLANDSNEW CALEDONIANEW GUINEANEW ZEALANDNICARAGUANIGERNIGERIANORTH KOREANORWAYOMANPAKISTANPALAUPALESTINEPANAMAPARAGUAYPERUPHILIPPINESPITCAIRN ISPOLANDPORTUGALQATARREUNIONROMANIARUSSIARWANDASAN MARINOSAO TOME E PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH KOREASPAINSRI LANKAST CROIXST KITTSST LUCIAST MARTINST PIERREST VINCENTSUDANSURINAMESWAZILANDSWEDENSWITZERLANDSYRIATAIWANTAJIKISTANTANZANIATHAILANDTOGOTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS ISLANDTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMWALLIS ISLANDWESTERN SAHARAWESTERN SAMOAYEMENZAIREZAMBIAZIMBABWE State/Province Select OneALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIARHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMINGAmerican SamoaGuamMicronesia (Federated States of)Puerto RicoU.S. Minor Outlying IslandsNORTHERN MARIANA ISLANDSArmed Forces AfricaArmed Forces Americas AA (except Canada)Armed Forces CanadaArmed Forces Europe AEArmed Forces Middle East AEArmed Forces Pacific APALBERTANOVA SCOTIABRITISH COLUMBIAONTARIOMANITOBAPRINCE EDWARD ISLANDNEW BRUNSWICKQUEBECNEWFOUNDLANDSASKATCHEWANNORTHWEST TERRITORIESYUKON TERRITORYNUNAVUTFOREIGN -------------------------------------------------------------------------------- Company Type: Select...Academic/Teaching HospitalAmbulatory Surgery Center (ASC)Ambulatory Surgery Center CorporationAssociationChildrens HospitalClinicCommunity HospitalCritical Access HospitalGovernment HospitalGPOGroup Purchasing Organization (GPO)Health System/IDNHigher EducationHospitalHospitals and Health CareLong Term Acute Care HospitalManufacturer/VendorMedical PracticesMental Health CarePACUPsychiatric HospitalRehabilitation HospitalReligious Non-Medical Health Care InstitutionRural HospitalShort Term Acute Care HospitalSpecialty HospitalTertiary HospitalVA HospitalOther Job Level: Select...AdministratorBusiness Manager/DirectorC-Level/PresidentCoordinatorDirectorFinancial Planning & Analysis ManagementManagerStudent/InternSVP/VPOther Job Responsibilities: * Anesthesia Support Personnel * Cardiac Cath Lab * Central Processing * CRNAs * Emergency Department/Trauma Services * GI/Endoscopy * ICU * Inpatient Nursing Unit * Labor and Delivery * Materials Management for OR * Outpatient/Same-Day Surgery * Pain Management * Perfusion Services * Post Anesthesia Care * Preadmission Services * Preop Unit * Sterile Processing * Other <%-- the gray background --%> Yes No