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Data Aggregator Interest Form

Please submit this form to let us know of your interest. We'll provide you with more information within 48 hours letting you know who to contact for questions and assistance.

Organization Name*:
Organization Address*:
Organization Contact*:
Phone*:
Email*:

The following will help us match you to a performance assessment organization. Please be as specific as possible:

What products/services does your organization offer?
What is your product/service's geographic footprint and respective volume of participating physicians?
Is your product CCHIT or Meaningful Use certified? Yes: No:
Has your product been approved for PQRI submission to CMS? Yes: No:

Do you currently capture data for all the clinical measures assessed in the BTE Care Programs you wish to implement? If not, which ones are missing?

Is medical record data captured and stored centrally or is it housed on site at each physician practice?

Do you have xml capabilities?

Yes: No:
What is your estimated timeline for submitting your first test file?