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Clinical Innovations > Practice Performance Registry > Contact Us 

Contact Us About the Practice Performance Registry

Please complete the form below if you are interested in participating in the Practice Performance Registry for Meaningful Use 2 attestation.

Please note that submitting the information below will prompt an agreement packet and a FAQ document to be sent to the email provided. If you wish to sign up for DARTNet’s Practice Performance Registry you must complete and sign the agreement package. Please make sure that you fill out ALL highlighted sections.

Any information you provide will be held in the strictest confidence and will only be used to begin the conversation. If you later choose not to participate, we will not keep your information for any use.

Name: 

 

Organization Name: 

 

Organization Address: 

 

Organization Primary Contact: 

 

E-Mail: 

 

Telephone: 

 

Electronic Health Record (EHR): 

 

Eligible Providers: 

 

Are You Hosted by Your EHR, a 3rd Party Vendor or Locally: 

 

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