Enrollment

Meeting the Criteria for WIREC Services

Our agreement with the Office of the National Coordinator for Health Information Technology allows us to provide services to primary care providers (MD, DO, PA-C, ARNP, CNMW) in the states of Washington and Idaho. Primary care includes:

• Family Practice/General Practice
• Pediatrics
• Internal Medicine
• OB/GYN
• Geriatrics

If you are a specialty practice and would like to receive more information about services, please send an email to wirec@qualishealth.org.

If your organization meets the above criteria and would like to apply for WIREC technical assistance, please complete the provider enrollment materials:

1. Memorandum of Understanding
   Please read and then enter information in the shaded areas of the document and have an authorized practice representative sign before submitting the document to WIREC.
2. Memorandum of Understanding Attachments A, B and C
   Please note there are three tabs on this document
3. Practice Assessment

Please note that the Office of the National Coordinator requires us to collect the demographic data outlined in our enrollment materials. Your organization name may be published as being a participant in the WIREC project, but all other data collected will be kept confidential.

After completing your enrollment materials, please keep one copy for your records and send another to Qualis Health, attention Kristin Johnson. You may return your MOU as an email to kristinj@qualishealth.org, via fax (206) 366-3370 or mail to P.O. Box 33400, Seattle, WA 98133-0400.

After we receive your completed paperwork, one of our consultants will contact you within two weeks.

Here’s an additional document that may be helpful to introduce the WIREC project to members of your practice.