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13701371

OSDH Registration for Meaningful Use Messaging of Immunizations


Registration Form for Prioritization to Submit a Meaningful Use Message of Immunizations.

* Indicates Required Field


*Type of Meaningful Use Provider

 
 
 





Organization Information










(no dashes e.g. 555554444)












(no dashes e.g. 5554443333)



EHR Vendor Information








(no dashes e.g. 5554443333)

Meaningful Use Reporting Period




(Format: mm/dd/yyyy)
Click Here to Pick up the date,opens in a new window


(Format: mm/dd/yyyy)
Click Here to Pick up the date,opens in a new window

Message Information





Health Information Exchange (HIE)

*Are you a participant of an HIE?

   

If yes, what is the name of the HIE?

 
 
 
 

Email Notification (Required for Documentation) 





 
    
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