Meaningful Use Registration of Intent
Florida Meaningful Use Public Health Reporting Info
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Registration of Intent
Please select the provider type of the registering facility
Provider Type:
Eligible Hospital
Eligible Professional - Urgent Care
Eligible Professional - Not Urgent Care
The Florida Department of Health is not accepting syndromic surveillance and reportable lab results data from non-urgent care EP s. As such, non urgent care EP s may be eligible for a Meaningful Use exclusion for the syndromic surveillance and reportable lab results objectives. For more information please send inquiries to
DLFDOHReportableLabResultsInquiry@flhealth.gov
or
DLFDOHSyndromicSurveillanceInquiry@flhealth.gov
Please select the MU public Health objective(s) that the registering facility is interested in
participating in
MU Objective:
Reportable Lab Results
Syndromic Surveillance
Immunizations
Cancer
For more information on Immunizations Registry send inquiries here:
FLSHOTSMU@flhealth.gov
For more information on the Cancer Registry send inquiries here:
MU2FLCancerReporting@med.miami.edu
Please enter the name of the individual facility that is registering
Facility Name:
Please enter the street address of the registering facility
Facility Street Address:
Please enter the city that the registering facility is located in
Facility City:
Please enter the county that the registering facility is located in
Facility County:
Please enter the state that the registering facility is located in
Facility State:
Please enter the zip code of the facility that is registering
Facility Zip Code:
Please enter the name of the person coordinating Meaningful Use within the facility or organization. This will be the person responsible for receiving and responding to the Florida Department of Health's requests for action
Organization Primary Contact Name:
Please enter the 10 digit phone number for the organization's primary contact
Phones
Phone Type:
Primary
Alternate
Phone Number:
Please enter the email for the organization's primary contact
Emails
Email Type:
Primary
Alternate
Email:
Please type in the registering facility's 10 digit National Provider Identification number
Facility NPI:
Please enter any Health Information Exchanges that the organization may participate in
HIE Affiliation:
Please enter the name of the person developing the HL7 message for testing and onboarding
Contacts
Primary Technical Contact Name:
Please enter the 10 digit phone number for the technical contact
Contact Phones
Please select Contact name created in previous step
Contact Phone Type:
Primary
Alternate
Contact Phone:
Please enter the email for the technical contact
Contact Emails
Please select Contact Name created in previous step
Contact Email Type:
Primary
Alternate
Contact Email:
Please select the stage and year of MU that the facility is registering for
MU Stage:
Stage 1
Stage 2
Year 1
Year 2
Please enter the beginning and end dates of the registering facility's EHR reporting period
MU Reporting Period:
From:
(mm/dd/yyyy)
Through:
(mm/dd/yyyy)
Please select the appropriate incentive program that the registering facility is participating in
Incentive Program:
Medicaid
Medicare
Please enter the name of the EHR vendor that the registering facility has partnered with for MU
EHR Vendor:
Please enter the EHR product and version that the registering facility will use to achieve the MU public health objectives
EHR Product & Version:
Please select the HL7 version that the registering facility will use to meet the MU public health objectives
HL7 Version:
2.3.1
2.5.1
Other
Other:
Please select the laboratory tests that the registering facility conducts and the estimated volumes
Lab Tests & Volume:
STD
HIV
General Communicable Disease
Volume:
Version : e2.48