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Colorado Area Doctor Practices
Data Entry Page

RMCFA hopes to provide on our website

  • well categorized information, both textual and plotted on a map 
  • about well credentialed Doctors and Specialists
  • who serve patients with
    • Fibromyalgia (FM) and/or
    • Chronic Fatigue Syndrome (CFS).
  • We welcome submission of such data using the form below.
  • The form is designed for an individual medical service provider.
    • If you are a multiple-provider business, please repeat the same "Business Name" for any subsquent providers, and simply enter "ibid" to indiate the same data should be repeated as already provided for your first entered provider.

Data Entry Notes: 

  1. Single line fields are set by default to 40 characters, but testing shows the form allows more data.  Be reasonably restrictive, and we probably will receive all you enter without any data loss.
  2. Multi-line fields accommodate more lines than shown at one time, perhaps with limits not yet known to us.
  3. Required Fields are required, as is submission of the data form.  We cannot handle incomplete data sent by other methods.  Please use information using data on this Pop-up "Contact Us" page to ask us about any technical problem prohibiting submission of the form.

Editorial Note:  RMCFA reserves the right to edit submitted data.  Our list is intended to provide balanced and useful information to patients seeking a doctor, and is not as a forum for businesses to promote themselves.  Please restrain yourself from marketing, and you will save us from editing out your marketing material.

 

The first two fields are for administrative use only.

Please use the "name" and "e-mail address" fields to provide contact information for the person providing the data (whether that person is completing the form, or a volunteer is taking data over the phone from that person).  These contact data will be used later to confirm the data as edited/reformated for our web site.   (Also, unless you initiate other contact with RMCFA, your e-mail address will not be used for any other purpose.  We don't intend to list e-mail addresses on our web site.)

 

Previously "Required" fields are no longer enforced.  Instead, "(PP)" at the end of an item is a soft reminder to "Please Provide" the item.

* Required fields
Name *
E-mail Address *
e-mail address is ONLY for RMCFA to communicate with provider, and will NOT be put on any RMCFA web page; name is for name of doctor's representative providing information.
provider's Last Name (PP)
provider's First Name (plus any middle name or initial, if desired) (PP)
Degrees/Certifications (PP)
Primary Specialty (PP)
any additional Specialties or Sub-Specialties?
Professional Affiliations, if any
provider Diagnoses FM illness Yes
No
provider Treats FM patients (PP) Yes
No
provider Diagnoses CFS illness Yes
No
provider Treats CFS patients (PP) Yes
No
approx # of years provider has treated FM and/or CFS (PP)
FM and/or CFS pts: rough estimate of # served over the years, and/or % of current practice (PP)
Is provider accepting New Patients? (PP) All are Welcome
Restrictions Apply - call for information.
Closed for a time - call to see if status has changed.
Is provider able/willing to serve as a Primary Care Physician? (PP) Yes
Possibly
No
Is provider able/willing to serve as an Ongoing Consulting Specialist? (PP) Yes
Possibly
No
Is provider able/willing to handle Disability Paperwork if needed? (PP) Yes
Only a very limited amount
No
Treatment Approach (drop down list) (PP)
If "other" for item just above, briefly name Treatment Approach
Any special Techniques Employed, Approaches Used, or Services Offered?
any other Comments about the Provider which patients should know?
-------(Section Divider)-------
Business Name (and US State if not registered in Colorado) (PP)
Business Address(es) (PP)
Phone (PP)
Fax
Website
type(s) of Products Sold (if any)
---(Payment Methods Section)---
Accept Medicare Insurance (w/ or w/o assignment)
Accept some other forms of Insurance
Available through (or restricted to) one or more HMOs
Self-Pay with possibility of insurance reimbursing pt
Self Pay Only
Does Business have any special pt requirements (gender, age, etc.)?
any other Comments about the Business which patients should know (e.g., HMO if any)?
-------(Section Divider)-------
who Actually Entered the above data in this form? (PP) Representative of Provider
RMCFA Volunteer while on phone with provider's representative
any Additional Data from person who entered data? (If RMCFA Volunteer, please include your initials.)

I have read and agree to the Privacy Policy *

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Thank you for submitting your medical practice information to RMCFA, and for your continuing service to CFS and Fibromyalgia patients.