User account

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password *

Confirm password *

Provide a password for the new account in both fields.

If you are part of a collaborative, please provide your collaborative code below. (optional)

If you are part of a participating health system or collaborative that plans to analyze its aggregate data internally, please enter your assigned health system- or collaborative-specific code when setting up your account. If you do not know your health system- or collaborative-specific code, please contact your health system or collaborative leader before submitting your information. If you are a health system or collaborative leader who would like to obtain a code, please contact: selfassess@ismp.org. If you are not part of a health system or collaborative that will be aggregating its results, please leave this prompt blank.

Please select the one category that best describes the facility completing this assessment. *

Hospital that performs inpatient and/or outpatient medical and/or surgical procedures

Freestanding ambulatory surgery center (ASC) not physically connected to a hospital, irrespective of ownership and licensure, including freestanding ASCs dedicated to specialty procedures (e.g., gastrointestinal/endoscopy procedures, interventional radiology, ophthalmic procedures, pain management procedures, fertility procedures)

Other facility that performs outpatient medical and/or surgical procedures

The assessment tool, which was developed by the Institute for Safe Medication Practices (ISMP), was funded and sponsored by the US Food and Drug Administration (FDA) under contract # 75F40119C10120. All materials associated with this research effort represent the position of ISMP and not necessarily that of FDA.

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