Please complete all three pages of this application to be considered for the HealthInsight Certificate for Excellence in Quality Improvement. The tab key may be used to navigate to the next field.
In order to save your application and continue completing it at a later time, you must first click this button:
From there, you can register your account, login and then click "Save for Later" at the bottom of the page. When you return to the form and login, you can then continue completing the application.
Please write the hospital's name as it should appear on the certificate in the event that the hospitals is a recipient.
Note: Please do not send protected health information (PHI) with your report. Please de-identify your reports of any patient identifiers.