Request Ambulance & EMS Medical Coding If you are a human and are seeing this field, please leave it blank. Name Title Hospital/Organization Affiliation (i.e. Hospital System) Email * Telephone Coding Service Requested (Check All That Apply) Inpatient Acute CareRehabilitationAuditingDiagnostics & ClinicsEmergency RoomObservationEvaluation and ManagementEncounter FormsAuditing Physician Evaluation and ManagementEncounter FormsBilling Other Cancer RegistryCore Measures Abstraction Encoder Type 3MQuadra MedIngenixOther Abstracting Software MEDITECHAffinitySoftMedCPSTOther EHR McKessonEpicCernerPCIOther Expected Start Date Length of Services Needed Additional Comments What does 3+8= *