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Submission Form

Submission Form

This feature is under development and is to be modeled after our existing HIPAA Services by our Members matrix. All Data Service members are invited to participate by submitting their information via this form. Once a few submissions have been collected, we will reconfigure the chart to best suit the needs of our Data customers.

If you have suggestions for information that may be beneficial to include in this grid, please contact us at via e-mail or (781) 419-7800. We welcome your input!


Please fill out completely.

Contact Information

Name

Title

Company

Address


City

State

Zip

Phone

Email

Type of submission (please choose one):

NEW entry with your company's information (Please fill out entire form)
CHANGE to currently listed information (Entries may be limited to changing fields only)


Please check all the groups below that are relevant to your organization:

Target Clients:
Employers
Hospitals
MD's
Payors
Vendors

Types of Service:
Consulting
Legal
Software
Technology
Archival
Other - describe below

Geographic Market (choose one):
Massachusetts
Northeast
USA
Worldwide

Please describe 'Other' Type of Services (if applicable):



If you have a Data Services section on your company's web site, we will be happy to link to it. Please provide the relevant URL:


Brief description of services provided by your company:

Additional Comments:

Thank you for your input and for being a valued member of the Massachusetts Health Data Consortium!


For additional Data Member Services information, please contact us at via e-mail or (781) 419-7800. We welcome your further questions & look forward to your participation in our work and our events!