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| * Do you have a valid Attendee QR code available? |
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| Is the scanned data acceptable? |
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| * Email Address * | | | | * Zip Code * | | |
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| Badge ID# | | | | * First Name* | | | | * Last Name* | | | | * Company Name* | | | | * Zip Code* | | | | * Email Address* | | |
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| Which product areas interest you?(Select all that apply out of the 8 options) |
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 Product Section: DoseEdge Pharmacy Workflow Manager |
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| InstitutionType?(Select all that apply) |
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Bed size: Pediatric Specialty Bed size: Teaching Institution |
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| How is your pharmacy configured to support sterile compounding? (Select all that apply) |
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Comments: Majority done in-house with some outsourced |
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| What are your concerns specific to IV compounding? (Select all that apply) |
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| How concerned are you about complying with state board regulations specific to IV sterile compounding? |
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| Would you like to learn more about the DoseEdge System? |
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Product section: Nutrition |
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| Are you currently ordering Baxter Nutrition Products? |
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| What is your product(s) of interest? (Select all that apply) |
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| Are you interested in compounding in-house? |
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| Are you interested in receiving a demo of EXACTAMIX? |
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| Do you currently use calculation software when compounding TPN orders? |
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| Are you a current user of CLINIMIX/CLINIMIX E? |
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| How - many TPN’s do you do per day or how frequently are you doing product? | | |
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| How - many TPN’s do you do per day or how frequently are you doing product? | | |
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| Would you like to have a Baxter Representative come speak to you about the Baxter Nutrition Portfolio? |
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Product section:Â ICNetClinical Surveillance Software |
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| Do you currently have an antimicrobial stewardship program in place? |
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| Do you use clinical surveillance software? |
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| Are you happy with your current platform? |
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| Are you interested in learning how a clinical surveillance software tool can help you manage medication usage and infection prevention measures? |
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Product section: NexPath Solutions |
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| Are you considering decreasing your reliance on outsourced sterile compounded IVs? |
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| * Do you currently have an antimicrobial stewardship program in place? |
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| Are you seeing the desired impact within your clinical operations? |
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| Are you considering the development of a program? |
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| Are you informed on the next steps for how to implement an effective program? |
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Product section: Drug Delivery |
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| Which of our drug delivery products are you currently using? (Please select all that apply) |
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| Which of our drug delivery products are you interested in learning more about? (Please select all that apply) |
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| * Are you currently a member of PharmacyAdvisor.com? |
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| Have you participated in any webinars in the last year? |
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| Would you like me to help you get registered? |
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Product section: Access Systems |
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| Product interest categories (Select all that apply)? |
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Product section: Infusion Systems |
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| What large volume pump are you currently using in your institution? (Select all that apply) |
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| Are you using a system that allows for integration between the EMR and the pump? |
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| Do you use Dose Error Reduction Software? |
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| How soon are you considering the purchase of new pumps? |
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Product section: CCoE |
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| * Do you currently use Baxter Drug Delivery or Nutrition products? |
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| * Are you a Baxter contracted hospital (i.e. for base IV solutions)? |
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| Do you have any unmet needs with your drug delivery or nutrition systems? |
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| Do you know how your Pharmacy is doing in terms of maximizing the terms of the contract? |
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| Which Products do you currently use? (Select all that apply) |
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| Do you have any unmet needs or goals for these? |
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| Would you be interested in exploring Opportunities with a pharmacist consultant? |
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| Would you be interested in exploring potential opportunities to maximize the contract with Baxter? |
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| Are you familiar with Baxter’s product Line? (Please select all that apply) |
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Communication Preferences |
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| Would you like a Sales Representative to contact you? |
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| Communication preference options:
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| * Contact No# (Numbers Only) | | |
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| Would you like to receive future emails from Baxter? |
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