MDS/OASIS Email Registration
Exit this survey

Florida Provider Email Alert Registration

1. Individual Name:

Individual Name:

2. Facility Name:

Facility Name:

3. Facility ID:

Facility ID:

4. Provider ID (CMS Certification Number):

Provider ID (CMS Certification Number):

5. User Type:

User Type: Individual/Facility

Corporate/Facility

Third Party/Consultant

Vendor

Other (please specify)

6. Phone Number:

Phone Number:

7. Fax Number:

Fax Number:

8. Email Address:

Email Address:

9. Provider Type

Provider Type MDS

OASIS

Swing Bed

10. Action:

Action: Opt-In

Opt-Out