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PopHealth Request
Jamie Gittelman
2024-02-27T13:24:28-05:00
PopHealth Analytics
Reports and Enhancements
User Request Form
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Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Organization
*
Industry Type
*
Job Title
*
Contact Number
Request Date
*
Report Name (if applicable)
Description of Request
*
Please provide a detailed description of the report request, including the specific features or enhancements you would like to see implemented.
Purpose/Use Case
*
Explain the intended purpose or use case for the requested report. How will it benefit your organization or workflow?
Data Requirements
*
Outline any specific data elements or criteria that should be included in the report.
Deadline (if applicable)
Indicate if there is a specific deadline for the completion of this request.
Additional Comments/Attachments
Include any additional comments, suggestions, or attachments that may be relevant to the request.
Submit
By
submitting
this form, I acknowledge that the information provided is
accurate
, and I understand that the implementation of this report request is subject to review and approval by the PopHealth Project team, DHCF, CRISP DC, and hMetrix.
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