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895897

OSDH Registration for Meaningful Use Immunization Messaging


Registration Form for Prioritization to Submit an Immunization Meaningful Use Message.

* Indicates Required Field


Organization Information










(no dashes e.g. 555554444)














(no dashes e.g. 5554443333)



Vendor Information








(no dashes e.g. 5554443333)

Attestation Time 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





Email Notification (Required for Documentation)





 
    
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