Please provide the following contact information: NAME TITLE ORGANIZATION WORK PHONE FAX EMAIL WEB ADDRESS Select the following service for which you need staff: CAREcoding.com (remote coding service) Coding Compliance/Data Quality Review Data Collection and Abstraction Cancer Research/Operational Review Coding Education HIM Operational Review Cancer Registry Outsourcing Coding Outsourcing Interim Management Cancer Registry Temporary Services Onsite Temporary Coding Long Term Care (Chicago Metro only) Clinical Research Data Collection Your Staff@Home Master Patient Index Projects Number of estimated staff needed: Duration of Project (days/weeks):     Target Start Date (mm/dd/yy): Project Completion Date (mm/dd/yy): Please add additional comments about your project:

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