GI Operations Benchmarking Registration Form

Questions? Please contact Michelle Akers, ASGE Senior Manager of Practice Management and Reimbursement at operationsbenchmarking@asge.org

Unit Name

Address

Address 2

Country

City

State

Zip

Unit Staff Member (responsible for reading and agreeing to the conditions of the "Disclaimer”)

Name

Position Title

Phone Number

Email Address

Authorized User #1

Name

Position Title

Phone Number

Email Address

Authorized User #2

Name

Position Title

Phone Number

Email Address

ASGE GI Operations Benchmarking Disclaimer

The American Society for Gastrointestinal Endoscopy (ASGE) welcome you as a participant to ASGE GI Operations Benchmarking. By submitting the unit registration form, you are acknowledging you have read and agree to be bound by ASGE’s Terms of Use, ASGE’s Privacy Policy, and terms of service specific to ASGE GI Operations Benchmarking as found below.

ASGE GI Operations Benchmarking is provided to you for your use as a free benefit. When you register your authorized data respondents for benchmarking, you are acknowledging that you are voluntarily entering your unit’s data for inclusion into the aggregate database, which is accessible by other GI Operations Benchmarking participants. We reserve the right to exclude data that appears to be erroneous or markedly inconsistent. ASGE will not display on its website nor share with anyone else except internal staff (if deemed necessary) through any other means (email, electronic document, printed material or otherwise) your registration information (unit demographics) either alone or in conjunction with your unit’s data. Additionally, identifiers specific to your unit will be stripped from the final data set, and the number of data sets displayed in the reporting tools (either the complete aggregate set or any filtered set as defined by the user) must be equal to or greater than 5 complete data sets. ASGE is adhering to the requirements set forth by the Department of Justice and Federal Trade Commission regarding benchmarking practices, and ASGE cannot be held liable if by chance your unit is identified by another participant.

Should either of the registered authorized data respondents leave the employment of the unit, they are to immediately cease use of the benchmarking password and username. You acknowledge that it would be a violation of civil and criminal law should your registered authorized data respondents access your private, proprietary data after they have ended their employment with the unit. You further understand that providing access to the benchmarking database to any other party other than the authorized data respondents registered for your unit is also a violation of the law and subject to applicable punishment. The benchmarking data is provided for your use only and should not be forwarded, posted, emailed, reproduced or published in any on-line, print, or electronic media.