I refer the following candidate for membership in CHIME:Name:* First Last Title:* Organization:* Phone:Email* Is this candidate the highest-ranking clinical IS executive at his or her organization?* Yes No Is this candidate's organization a direct healthcare provider (ie, hospital, group practice) or payer (HMO, health insurance) and not a vendor or an association?* Yes No Would you like to refer another candidate?* Yes No Name:* First Last Title:* Organization:* Phone:Email:* Is this candidate the highest-ranking clinical IS executive at his or her organization?* Yes No Is this candidate's organization a direct healthcare provider (ie, hospital, group practice) or payer (HMO, health insurance) and not a vendor or an association?* Yes No Would you like to refer another candidate? Yes No Name:* First Last Organization:* Phone:Email:* Is this candidate the highest-ranking clinical IS executive at his or her organization?* Yes No Is this candidate's organization a direct healthcare provider (ie, hospital, group practice) or payer (HMO, health insurance) and not a vendor or an association?* Yes No Recommender's InformationRecommender's Name:* First Last
