Azara DVRS as a Specialized Registry for Modified Stage 2 Meaningful Use Public Health Objective in Year 2018

If you have more than 10 providers please email Shannon at sdrakebuhr@wphca.org

Question Title

* 1. Health Center Information

Health Center Name

Health Center Contact Person

Contact Email Address

Preferred Phone Numer

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* 2. Eligible Providers Audit Letter Request
Please provider each providers first and last name, NPI and the start date of their MU reporting period for 2018.
Example: Florence Nightingale, 1234567, Oct 1, 2018

Provider 1

Provider 2

Provider 3

Provider 4

Provider 5

Provider 6

Provider 7

Provider 8

Provider 9

Provider 10

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* 3. If you have a question please enter it here.