I attest that I have watched all of the required ORCHID PowerChart Training Videos and passed the online Certification Examination.
Your Name:
Your Email:
Your Level of Training: Student Intern Resident Fellow Attending Advanced Practice Provider (NP/PA) Clinical Research Monitor
Your Department: Department Internal Medicine Emergency Medicine Family Medicine Neurology Pediatrics Psychiatry Obstetrics/Gynecology Surgery Anesthesia Radiology Pathology ERI
Your Subspeciality: (if applicable, e.g. Cardiology)
Your Medical License Number: (leave blank if no license)