Louisiana Health Care Review
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION


LHCR PHYSICIAN MEMBER SIGN-UP FORM
To sign up with LHCR as a member physician, please complete this form.

Name:
Business Name:
Address 1:
Address 2:
City:
State:
Zip:
Telephone:
Fax:
E-Mail:
Specialty:
Board Certification:

I agree to the Articles of Incorporation and Bylaws to this organization available at 8591 United Plaza Blvd., Suite 270, Baton Rouge, LA 70809, Phone (225) 926-6353. I am aware that there are no membership fees.
LHCR is the Quality Improvement Organization for the state of Louisiana. Work is performed under Contract Number 500-99-LA02 between LHCR and the Centers for Medicare & Medicaid Services (CMS).

 
 

 

 

 


For more Quality Improvement
resources, visit www.medqic.org

[Home]  [Privacy Policy]
This Web site is produced by Louisiana Health Care Review, Inc., the Quality Improvement Organization (QIO) for Louisiana, under contract 500-99-LA02 with the Centers for Medicare & Medicaid Services (CMS). The contents presented do not necessarily reflect CMS policy.

If you experience any problems with this site, please notify us by e-mail. Thank you.
Louisiana Health Care Review, Inc. © 2002-2007
8591 United Plaza Boulevard, Suite 270
Baton Rouge, Louisiana 70809
Telephone: 225-926-6353 / Fax: 225-923-0957