Chicago Health Information Technology Regional Extension Center

CHITREC Practice Profile Form

Please complete the following form to provide CHITREC with an initial profile of your practice.  You may estimate payer mix percentages and annual patient/encounter totals if you do not have that information readily available.  Your responses will not be shared with any third parties.  Thank you.

CHITREC provides services specifically for practices within the 606** zip codes.  If your practice is outside of our service area, please visit www.ilhitrec.org.

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