Oregon Health Authority — Public Health Meaningful Use

Step 1. Facility Information

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Use this form to enter contact information for the facility that will be submitting Meaningful Use data to the Oregon Public Health Division.

Facility name and address, and meaningful use contact information are required fields.

  Facility Name:
Facility Address:
Street:  
City:   State:   Zip:  
Meaningful Use Contact:
Name:   
Title:  
Email:   
Phone (+ Ext.):   
Facility Information:
Number of EPs:  
Number of Sites:  
Estimated Total Patient Volume:  
Facility Affiliations:
HIE Affiliation:
Health Org. Affiliation:

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