Notice of Intent to Join the Institute for Family Health's ACHIEVING MEANINGFUL USE IN COMMUNITY HEALTH CENTERS: A VIRTUAL LEARNING COLLABORATIVE
Hosted by the Institute for Family Health - Dr. Neil Calman, President & CEO

Please complete and submit the following form by August 15th. We will contact you by August 17th. The information you submit through this form will only be seen by the Institute for Family Health. If you are selected to participate in the collaborative, your organization’s name and information will be shared with HRSA.
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FQHC Name *
Website *
City *
State *
Contact Person Name *
Contact Person Phone *
Contact Person Email *
How long has your FQHC had an EHR? *
What EHR system does your FQHC use? *
How many sites does your FQHC operate? *
Approximately how many providers does your FQHC employ? *
Approximately how many EHR users are there in your organization (include providers as well as support staff)? *
How many patients does your FQHC serve annually? *
(2011 UDS)
Which topics are you interested in? *
Check all that apply.
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