Clinical Documentation & Coding for Hospitalists
Group Subscriber Form

If your group is interested in enrolling in this program please complete complete the below information for the lead contact at the group. Also, upload an excel spreadsheet with the full listing of those participants who will be enrolled in the program. We will need their full name, hospital/organization, title, address, email, phone and member type. 

First Name* Last Name*
Title Member Type (Physician, Nurse Practitioner etc.)
Group Participants' Information (Name, Title, Organization, Address, Email, Phone and Member Type -Physician, Nurse Practitioner etc.)*