Please complete the below information and someone from the ILHITREC team will contact you with more information on the Clinician-Focused Quality Improvement Initiative. 

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* 1. Name

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* 2. Title

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* 3. Phone number

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* 4. Email address

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* 5. Organization Name

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* 6. Check all items that describe your organization

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* 7. Do your have a 2015 CEHRT?

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* 8. If so, which EHR and Version?

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* 9. How many clinicians (physicians, physician assistants, and nurse practitioners) are in your organization?

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