Instructions For Schedule Em-C - Wisconsin Department Of Revenue - 2012 Page 2
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3Technology Product List) number, and amount paid
If the total amount of hardware and software
during the 2012 calendar year to maintain electronic
expenses paid in the calendar year by all claimants
medical records. The CHPL product number issued
does not exceed $20,000,000; the credit will be
by The Office of the National Coordinator for Health
equal to 50 percent of the amount the applicant paid
Information Technology. For more information, go to
during the calendar year in which the information
Choose the
technology hardware and software was purchased.
appropriate practice type of either ambulatory or
inpatient. Click either "browse" to search all inpatient
If the total amount of hardware and software
products or "search" to search for the software
expenses paid in the calendar year by all claimants
product by name. Once in the software product list,
exceeds $20,000,000; the total available credits of
click the blue hyperlink of the product purchased
$10,000,000 will be allocated to each certified
and the CHPL product number will be displayed at
applicant in proportion to the amount paid during the
the top of the screen.
Enter this number in the
calendar year.
CHPL Product Number section located in column B
of Schedule EM-C. If additional lines are required,
Example: Health Care Providers A, B, and C are
attach a schedule and enter the total from the
certified to claim the electronic medical records
supplemental schedule on line 8.
credit for the following amounts paid in 2012 for
certified hardware and software:
Fiscal year filers should enter amounts in section B
for the software purchased on or after the first day of
A
$ 8,000,000
their fiscal year that begins in 2012 through
B
$12,000,000
December 31, 2012.
C
$ 4,000,000
Total $24,000,000
Section C: Enter a description of the hardware used
to maintain medical records in electronic form, the
The $10,000,000 of available credits are allocated to
quantity purchased, and the dollar amount paid in
A, B, and C based on their proportionate share of
2012.
the total amount of $24,000,000 paid.
Fiscal year filers should enter amounts in section C
Health Care Provider A is allocated a credit of
for the software purchased on or after the first day of
$3,333,333 computed as follows: ($8,000,000 ÷
their fiscal year that begins in 2012 through
$24,000,000) x $10,000,000.
December 31, 2012.
Health Care Provider B is allocated a credit of
Section D: If you are submitting this form
$5,000,000 computed as follows: ($12,000,000 ÷
electronically, check the signature box. This serves
$24,000,000) x $10,000,000.
as an electronic signature and no additional
signature is required.
Health Care Provider C is allocated a credit of
$1,666,667 computed as follows:
($4,000,000 ÷
If you are submitting the form by mail, check the
$24,000,000) x $10,000,000.
certification box, print your name, the date, and sign
the form. Send the completed form to:
Fiscal Year Filers
Wisconsin Department of Revenue
Electronic Medical Records Credit
The maximum amount of credit that may be
PO Box 8932
awarded in a calendar year is $10,000,000. For
Madison WI 53708-8932
fiscal year filers, the amount to enter in sections B
and C for qualified medical hardware and software
purchased is the amount paid during the claimants
Allocation of Credit
fiscal year which begins in 2012 through December
31, 2012, not the amount paid during the entity's
The maximum amount of credit that may be
fiscal taxable year. The applicant must allocate the
awarded to all claimants in a taxable year is
credit awarded for the calendar year and claim it in
$10,000,000.
its respective taxable fiscal year.
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