Electronic Medical Record Expression of Interest

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15-01 as it relates directly to and is necessary for the Electronic Medical Record Expression of Interest Application. If you have any questions about this collection of personal information, you may contact emrprogram@gov.pe.ca. Information may be verified.

Identification
Community-based physicians and nurse practitioners are invited to put forward their expression of interest to learn more about implementing an Electronic Medical Record (EMR). This is not a commitment to begin the implementation process, only to learn more. This form may also be completed on behalf of health-care providers by a clinic lead or office manager.

Please insert the name of the clinic and contact information.

For example C1B 0X1 or 12345
For example 902-555-5555
For example 902-555-5555
For example 902-555-5555

Someone from the EMR Program Team will be in touch to discuss your interest and learn about your practice.

2 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.