Record Storage and Retention Program-Retroactive Reimbursement-EMR Storage (Aug 1, 2023 launch)

RECORDS STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form- EMR Storage FY-2023-2024
Retroactive Reimbursement Form for

EMR Storage

The purpose of the Records Storage and Retention Program is to provide members with financial support to offset the costs of midwifery records storage and retention.

ELIGIBILITY:

All registered MABC members residing in B.C. with records created in B.C. will be eligible to apply for this funding.

Please review the details in the form to ensure you are completing the correct document (refer back to the Members website as needed).

If you closed your practice after April 1, 2022, incurred the costs for EMR storage, and have your receipt, you can apply for retroactive funding
Contact Information
Full Name*

First NameLast Name
Member's Personal Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of Practice for which records associated*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Type of EMR*

AccuroOslerOSCARTelus HealthWolf EMRMed Access EMROther EMR type
Date of Practice Closure*

YearMonthDay
Date Cost Incurred*

YearMonthDay

RECORDS STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form- EMR Storage FY-2023-2024
Total reimbursement amount requested for transfer, digitalization, and storage of midwifery records*
Name of the Company Hosting EMR. blanks*
Please upload your receipts #1

Cancelof
Please upload your receipts # 2

Cancelof

RECORD STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form-EMR Storage FY 2023-2024
I confirm that:*

The information I have provided on this form is true and accurate
Signature*

Clear
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