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Contact us with your questions, your experiences with barriers or successes in this area and /or your interest in joining any of our groups.

Phone:
(800) 483-0932

Fax:
(877) 335-2490

Email:
rec@healthinsight.org

HOME Regional Extension Center Application to Participate

Application to Participate

Are you interested in assistance with implementing an Electronic Health Records (EHR) system and reaching the meaningful use criteria to receive federal incentive payments? If so, you may be eligible for assistance from HealthInsight, including workflow assessment, process improvement and re-design, EHR vendor selection, system implementation, and assistance in meeting all meaningful use requirements.

Click here to view the REC Application to Participate in PDF format.
 
1.     Does your practice use an Electronic Health Record (EHR) system? Yes  No
      If Yes, list product and version:
      If No, when do you plan to implement?  (approximate date)
 
2.     What is your practice specialty?
      Family Medicine    Pediatrics    OB/GYN    Internal Medicine    
    Other  
 
3.     How many sites does your practice have?  
  • Site 1 - Name or ID   Site NPI #
    Address   City/State/ZIP
    Phone   Fax
  • Site 2 - Name or ID   Site NPI #
    Address   City/State/ZIP
    Phone   Fax
  • Site 3 - Name or ID   Site NPI #
    Address   City/State/ZIP
    Phone   Fax
 
4.     Do your providers' average allowable Medicare charges exceed $24,000?
    Yes  No  Don't know
 
5.     Do you have approx. 30% Medicaid patient volume (based on # of visits)?
    Yes  No  Don't know
 
6.     How did you hear about HealthInsight and the REC services?
 
7.     What is your preferred method of contact?    Phone  Fax  E-mail
 
Practice Name:   Practice NPI:  
Practice Representative Name:  
Address:  
City:   Zip:  
Phone Fax E-mail
Practice Hours Web Address


Provider Full Name Provider NPI Prov. Type Specialty Primary Site
    MD, DO, NP, PA or other (specify) FP, IM, OB, Peds or other (specify) ID or #
if applicable
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