Shfa
.ai
Healthcare data intake
Share an overview of your data.
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01
Company identification
Company Name
*
Address
*
Company Website
Legal entity name, if different
*
Is the company legally based in the United States?
*
Select
Yes
No
Other entities or brands under common ownership
02
Contact information
First name
*
Last name
*
Job title
*
Work email
*
Phone
🇺🇸
+1
Decision maker who signs, if different
Did anybody refer you to this form? If so, please write down their full name and email.
03
About the organization
Primary specialty
Ownership
*
Select
Founder or physician owned
Family owned
Private equity or VC backed
Hospital or health system owned
Public company
Nonprofit
Other
Number of locations or sites
LinkedIn company page
What the organization does, in two or three plain sentences
Describe your clients/patients
What a typical client/patient journey looks like, start to finish
04
Staff and history
Office (desk) staff using the systems
Clinical or non-desk staff
Total headcount today
Peak headcount, and the year
Staff by country
Share of email, chat and documents in English (%)
Year founded
Still operating and generating new data?
*
Select
Yes
No
Records from
Records to
Are the earliest records and are they still in the same system?
05
Clinical data sources
Which clinical sources are in scope?
*
DICOM / Imaging
CT, MRI, X-ray, ultrasound studies
EHR Data
Clinical records, encounters, notes
Claims
Payer / billing claims data
Wearables
Continuous device / sensor data
Audio
Dictation, patient-clinician calls
Video
Surgical, procedural, or clinical recordings
Genomics
Sequencing, lab molecular data
Pathology
Whole-slide images, reports
Other clinical sources
EHR Data — Which subspecialties does this include?
*
Cardiology
Primary care
Pulmonology
Gastroenterology
Oncology
Neurology
Orthopedics
Pediatrics
OB/GYN
Emergency medicine
Psychiatry
Dermatology
DICOM / Imaging — Which subspecialties does this include?
*
Cardiology
Pulmonology
Neurology
Orthopedics / MSK
Oncology
Gastroenterology
Breast imaging
Pediatrics
Emergency / trauma
General diagnostic
Claims — Which subspecialties does this include?
*
Cardiology
Gastroenterology
Primary care
Oncology
Orthopedics
Neurology
Pulmonology
Pediatrics
OB/GYN
Emergency medicine
Psychiatry
Wearables — Which devices / platforms does this include?
*
Apple Health
Garmin
Fitbit
Google Fit
Dexcom / CGM
Withings
Whoop
Oura
Audio — Which subspecialties does this include?
*
Primary care visits
Psychiatry
Cardiology
Pulmonology
Emergency medicine
Pediatrics
Neurology
Video — volume
Hours of video
Total size (GB)
Notes
Genomics — Which test types does this include?
*
Signaling / pathway data
Disease-specific panels
Whole genome (WGS)
Whole exome (WES)
Targeted gene panels
Genotyping / SNP arrays
RNA-seq
Pathology — Which specimen types does this include?
*
Dermatology biopsies
Curettage
Surgical resection
Cytology
Fine needle aspiration (FNA)
Bone marrow
06
Systems that hold your data
Email
Gmail
Microsoft 365
Chat
Slack
Teams
Google Chat
Files
Google Drive
OneDrive
SharePoint
Dropbox
Box
Calls and meetings
Zoom
RingCentral
Dialpad
Gong
Fathom
CRM
HubSpot
Salesforce
Industry CRMs
Money
QuickBooks
Xero
Stripe
ADP
Gusto
Work and operations
monday.com
Asana
Trello
ClickUp
Jira
Docs and wiki
Notion
Confluence
Code
GitHub
GitLab
Data warehouse
BioQuery
Snowflake
Other
Add
07
Scale and distribution
Units
*
Unit type
Count
Exact or estimate
Notes
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
Select
Patients — unique individuals
Imaging studies — one examination (e.g. one CT study)
Encounters / visits — one appointment or admission
Reports — authored clinical reports
Records — charts or files (clarify in notes)
Specimens — physical samples or associated results
Videos — one recording (e.g. one surgical procedure)
Other — specify the unit in notes
Select
Exact
Estimate
New data added per month
Total size
Geographic distribution of units
*
Does this data come from a single facility, or is it aggregated from multiple sources like hospitals, clinics, or software vendors? If multiple, please list the sources.
*
08
Ownership, retention and sensitive data
Does the organization own the records in these systems?
Is any data held for clients, licensed from a third party, or restricted by a vendor contract?
Which systems hold patient health information, legally privileged material or regulated financial data? Is any of it already de-identified?
Do any systems delete data automatically?
Have you discussed selling or licensing this data with anyone else? If yes, who and when?
09
Anything else we should know
Notes
