MDS/OASIS Email Registration Florida Provider Email Alert Registration Question Title * 1. Individual Name: (Required.) Question Title * 2. Facility Name: Question Title * 3. Facility ID: Question Title * 4. Provider ID (CMS Certification Number): Question Title * 5. User Type: Individual/Facility Corporate/Facility Third Party/Consultant Vendor Other (please specify) Question Title * 6. Phone Number: Question Title * 7. Fax Number: Question Title * 8. Email Address: (Required.) Question Title * 9. Provider Type (Required.) ePOC MDS OASIS Swing Bed Question Title * 10. Action: (Required.) Opt-In Opt-Out Done