Request a Quality Measure to be exported by QRDA Registry Export Interface

Please fill out the following form to request our measure development team review implementation of a quality measure for export to a data registry.

MEDENT Account #*

Contact Name*

Preferred phone # for call back*

- -


E-Mail Address*


Name of the Registry or Company your practice is currently submitting Quality data to:*
(Note: Your practice must be currently submitting Quality Data via a QRDA I Export Interface in order request a measure for review.)


Requested Measure Number:*
(Quality #, CMS # and/or QCDR id #)


Requested Measure Name:*


What is your current workflow for documenting the various parts of this measure?
(document codes, templates, etc.)


Any other information you would like to provide?


Please attach official specifications if you have them (8MB max)
(.png,.jpg,.jpeg,.pdf,.xls,.xlsx,.doc,.docx,.tiff,.tif)



Note: Completed forms will be reviewed and researched by the measure development team. Submission of this form does not guarantee a measure can or will be developed.