EMR Interface Request Form
Laboratory Information
Please Select a Lab
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Axis Professional Lab
Clearview Diagnostics
Precision Lab Services
Quality Metric Laboratories
Laboratory Name
*
Laboratory Contact Name
*
Laboratory Contact Phone
*
Lab Contact E-mail
*
You will receive a confirmation email for your request at this email address
Practice Information
Practice Locations (Click on "Save" after you enter the practice information)
*
Physician Account Numbers (Click on "Save" after you enter the physician information)
EMR Company Information
EMR Company
*
Please Select
Other than below
Adapta Med
ADS
Advanced MD
AllegianceMD
Allscripts
Alpha CM
Alpha Med
Altapoint
Amazing Charts
Amis Health
Aprima
Arete
Athena Health
ATP Software
AVS Medical
Behavioral
Bizmatics
Care Cloud
Care360
Cascade Clinical Systems
CCS Anti-Aging
Celerity
Centricity
Cerner
Chart Logic
ChoiceOne
Claim Power
Claim Tower
Clover Health
ComChart
Connexin
Conxit
Criterions
Cure MD
DHIN
Digi
Doc Assist
Doc Comply
DOC-TOR
Doctor Enterprise
Doctors on Call
Dr. Chrono
Dr-Solutions
eClinical Works
EDE
EDTS
EHI
Elchay
Ellkay
Emdeon
eMDs
E-Med Practice
EMedicalNotes
E-Transmedia
Excelsys
Exscribe
EZ Practice
Ezmd
Fugitsu
GE Centricity
Glenwood Systems
Gloemr
Glo-Stream
Greenway
Halfpenny Technologies
Happe MD's
Health Fusion
Healthcare Software
Hello Health
Holt Systems
Iatric
Ignis
IKnoMD
IMS
INSYNC
Integrity Med System
iPatient Care
Jupiter
Kareo
KIPU Systems
Lab Health
LabSoft
Liaison Healthcare
Life Point
Lumeris
Lytec
Matrin MD
Mckesson
MDLand
Mdol
MD-Reports
ME Computer Systems
Med Allies
Medaz
Medent
Medgen
Medical Business Sys
Medical Mastermind
Medinote E
Medios
Medisoft
Medi-Tab
Meditec
MediTouch
Medix Elite
Meridian
Methasoft
Micro MD
Microwize
MTBC
Netsmart
Next Gen
Nextech
Office Ally
Office Practicum
OMNImd
Optimus
Optum Insight
Orchard
Osis
Paragon
Patient Now
PDS
PHI Medical Office Solution
Physioage
Power2Practice
Practice Choice
Practice Fusion
Practice Partners
Praxis
Prognosis
PULSE
QRS
RXNT
Sequel Med
Set Point Health
Sevocity
Silicon Mesa
Smart Management
SOAPware
Spring Charts
STI
Stratus
Sunrise
Tangible
Tenet Healthcare
The TenEleven Group
Tower Systems
Urochart
US Medical Scientific
Verify EMR
Virtual Officeware
Write Pad
WRS Health
XLEMR
Zoom
Please Drag and Drop the Practice Fusion Bound Email in the box below and then select Begin Upload
*
New EMR Company Name
*
REPLY EMAIL EMR
EMR Contact Name
*
EMR Contact E-mail
*
EMR Contact Phone
*
Interface Details
Interface Type
*
Please Select
Uni-Directional
Bi-Directional
Will AOE's be required?
Yes
No
Will insurance mapping be required?
Yes
No
Cost of EMR Interface
Monthly Maintenence
Comments
Requester Name
*
Assigned to
Assigned to Email
Submit
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