Certified EMR Implementation Incentive Application

Please check to confirm eligibility.(Required)

I am a regular Ordinary member of the NBMS.

I use my implemented EMR to manage patient electronic medical records (i.e. patient charting).

I am a community-based physician predominantly working from my own practice location in New Brunswick (not in a hospital, nursing home or other institution).

I do not maintain my patient records within an information technology system provided by a publicly managed organization, such as a hospital, community health center, nursing home, or virtual health clinic.

I am personally responsible for the monthly EMR software costs.

I am remunerated by NB Medicare.

Have you received any funding from another source in relation to your EMR implementation costs?(Required)

Yes

If yes, please provide details, including the funding source and amount received.(Required)

Applicant Information

Please note this form does not automatically collect personal information. Your name, email address, and other details will only be recorded if you choose to provide them.

Name(Required)

First Last

Phone(Required)

Email(Required)

NBMS Member Number

Remit incentive payment to:(Required)

Physician

Professional Corporation

Address(Required)

Street Address Address Line 2 City Province Postal Code

EMR Software Provider(Required)

EMR Product Name(Required)

EMR OrgID (Assigned by NB Medicare)(Required)

EMR Provider Contact Information (Contact Name, Phone Number and Email Address)(Required)

EMR Go Live Date (Must be after April 1, 2025).(Required)

Must be after April 1, 2025.

Proof of Implementation/Copy of Contract (Must include the applicant’s name on the contract to be acceptable).(Required)

Drop files here or

Max. file size: 24 MB.

Certified EMR Implementation Incentive Application

Eligibility Criteria

Applicant Information