Project Abstract This eMERGE IV (E4) supplement proposes extend the outcomes timeline for the prior implementation of 10 “genomic risk assessment” (GIRA) scores in a network-wide set of participants. These GIRAs include polygenic risk score (PRS) information, as well as risk information, such as personal and family health history, environmental and social health determinants, and physical and lab measures. Substantial challenges must be addressed before genomic medicine is a part of standard medical care. The specific aims of our proposal are designed to use an implementation science approach to advance the integration of genomic data into clinical practice, including evaluation of patient perspectives and economic outcomes, and broadening the impact of eMERGE through collaborations. The University of Washington Medicine dedication to preventative health in a learning health system and broad expertise across genomics, statistical, ethical, informatic, implementation, outcomes and economic disciplines will support this multi-site clinical trial. We will continue our leadership in data-cleaning and in the analyses of 6 and 12 month post-return outcomes data.