Name, Degree

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* 1. Name, Degree

HNE 5-Digit Provider ID#

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* 2. HNE 5-Digit Provider ID#

Email address

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* 3. Email address

Website address

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* 4. Website address

Complete office hours detail

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* 5. Complete office hours detail

Extended office hours

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* 6. Extended office hours

Office handicapped accessible?

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* 7. Office handicapped accessible?

Do you E-Prescribe, if applicable?

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* 8. Do you E-Prescribe, if applicable?

Do you have Electronic Medical Records (EMRs)?

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* 9. Do you have Electronic Medical Records (EMRs)?

Do you treat the Hearing Impaired / offer Sign Language?

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* 10. Do you treat the Hearing Impaired / offer Sign Language?

Languages spoken by provider in addition to English

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* 11. Languages spoken by provider in addition to English

Are you accepting new patients?

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* 12. Are you accepting new patients?

What ages do you treat?

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* 13. What ages do you treat?

Services provided - Check all that apply

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* 14. Services provided - Check all that apply

Please visit the Provider Search on HNE.com to view your current listing and notify us of any additional changes. (http://www.healthnewengland.com/Provider_Lookup_Direct/Default.aspx)

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