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Personal Information
First Name
Last Name
Email Address
We'll use this for account notifications
Phone Number
Organization Information
Organization Name
Organization Type
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Healthcare Provider
Hospital System
Software Vendor
Research Institution
Other
NPI Number (if applicable)
Application Details
Application Name
This will be displayed to users during authorization
Application Description
Callback URL
For OAuth authentication flow
Intended Use Cases
EHR Integration
Mobile Application
Analytics Platform
Research
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