Forms and agreements
Find links to VCUR 2008 EMR Funding Extension Program forms and participation offers.
Offer to participating physicians
Eligible physicians must sign an offer to participate in the VCUR 2008 EMR Funding Extension Program. This offer replaces the Physician Participation Agreement that was signed when the physician was enrolled in the Physician Office System Program.
Physicians who do not complete the offer will not be eligible to receive funding. They remain eligible for the program but cannot receive reimbursement for eligible expenses until the offer is completed.
Funding will be applied retroactively to eligible expenses to a maximum of six months, as per the 2014–2019 Program Guidelines.
Eligibility requirements
If the AMA is unable to determine the eligibility of a physician for the program, this form may be requested. Upon request, please submit the following form by fax or email.
VCUR 2008 EMR Funding Extension Program Reimbursement Form
To be reimbursed for eligible costs, clinics complete and submit a reimbursement form on behalf of physicians:
- Download the VCUR 2008 EMR Funding Extension Program Reimbursement Form >> (If more room is required, attach the “Additional Physician Information” sheet.)
Change Request Form
Physicians who wish to change their address, payment instructions or vendor information must notify the VCUR 2008 EMR Funding Extension Program:
Parental, Disability or Sabbatical Leave Form
Physicians who wish to remain funded while they are on a parental, disability or sabbatical leave must submit the form below:
