First Name

Last Name

Practice/Organization

Email

In what form are your medical records? Paper EMR Combination of EMR & paper

How will the Evolent team connect to your EMR remotely? EMR is hosted in the cloud and can be accessed via the web (web-based) EMR is hosted on a local-only network (remote) EMR is accessed via an installed application Not applicable. Our medical records are on paper.

For clinical quality measures, can you provide a 2024 data file? Yes No Not applicable. Our medical records are on paper.

What format is the file? CSV XLS XML JSON GZ N/A

Are you the point of contact to create temporary logins to EMR? Yes No N/A

Point of Contact First Name

Point of Contact Last Name

Point of Contact Email

Point of Contact Phone

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